Lumbar Disc Herniation

Lumbar disc herniation occurs when a portion of the intervertebral disc, soft cartilaginous cushion between the vertebral bodies or bones in the spine, protrudes out of the disc space. When this protrusion occurs within the spinal canal, it can cause compression of the nerves. This is often extraordinarily painful. Symptoms often include back pain with radiating pain down the leg. There may be associated numbness weakness or abnormal sensations which we call paresthesias. This pain can vary anywhere from intermittent and mild to debilitating to the point that patients cannot walk or even get out of bed.

Treatment of disc herniation is actually very well studied. A large prospective surgical trial was done called the sport study. This trial compared conservative care versus surgical treatment for disc herniation. While the data produced from the study is complex and difficult to completely interpret, the general conclusion was that after a couple of years, people who underwent surgery and people who avoided surgery and instead waited, had about the same outcome. For this reason surgical intervention is no longer considered mandatory for disc herniation. A closer look at the numbers from the sport study demonstrated that patients who underwent surgical treatment pending have more rapid recovery of their symptoms. They also showed that patients who felt strongly that they needed surgery tended to do better with surgery and patients who had the feeling that they could recover without surgery did better without surgery. This has lead us to feel that patients are actually a good judge of their own symptoms and given the right information, are capable of making the decision of whether to have surgery or not.

General reasons to more strongly consider surgery would include significant neurologic deficits such as numbness and weakness or pain that is uncontrollable with oral pain medications. Another reason for surgery would be symptoms that fail to improve with time. Also patients who are suffering significant disability from her symptoms which may compromise the likelihood her ability to care for others may want to consider surgery sooner.

Nonoperative treatment options include a variety of noninvasive or minimally invasive procedures.  Noninvasive treatment includes physical therapy medical management chiropractic care or other alternative care such as acupuncture.  The true mainstay of noninvasive therapy however is time.  Invasive nonsurgical treatment includes epidural steroid injection which may provide significant relief of pain.  Often times patients with moderate pain will undergo an epidural injection which will provide significant pain relief, allow them to do physical therapy, and by them the time that it takes for the body to heal the disc herniation naturally.

Surgical treatment for disc herniation is generally a microdiscectomy. This can be done under the microscope or endoscopically. Both techniques provide resolution of the disc herniation in a time trusted fashion. They’re generally performed as outpatient surgeries with a short time for recovery and rapid return to normal function. This is likely the most common surgery performed on the spine and is considered routine for most spine surgeons.