Herniated Disk Treatment Options: What Are Your Choices?

Back problems are incredibly common. People who haven't experienced back pain directly probably know somebody who has. Although there are multiple causes of back pain, a herniated disk is the usual suspect, and many people have questions about herniated disk treatment options.

To understand the options, first understand the problem. The back is a stacked set of small bones (vertebrae) that house the spinal cord. A disk cushions the joint between each vertebrae. A jelly donut is often used to describe a vertebral disk because the disk has a strong, tough exterior encasing a soft, pulpy interior. A disk herniates when the outer shell weakens, allowing some of the soft, inner material to push out.

There aren't always symptoms when a disk herniates; some people never know they have a bad disk. Symptoms occur when the extruded material presses on a spinal nerve. Back pain is typical, and often pain, numbness or weakness radiates into a limb. If it's an upper back herniation then the arm can be affected; if the lower back is involved then the symptoms radiate to the buttocks and down the leg.

Usually, symptoms resolve over time as the body resorbs the protruding material and the inflammation subsides. That said, this can take several months.

Because 90% of herniations do resolve, initial treatment is usually conservative and focuses on relieving the pain while the body heals itself.

- Bed Rest: For the first several days, the patient may want to just stay in bed. Bed rest is all right, but it should only last a few days. It is best to periodically get up and walk or do light, tolerable activities. Pain is a good guide; patients should find rest positions that relieve the pain and light activities that don't aggravate it.

- Ice and Heat: Ice is recommended for the first couple of days, followed by heat. Ice helps decrease inflammation, and heat helps relax the surrounding muscles. Heating pads, warm showers and heat wraps are all good options.

- Medication: Many people use over-the-counter (OTC) anti-inflammatory drugs such as Motrin and Aleve. Stronger pharmaceuticals require a prescription. Muscle relaxants (Valium, Flexeril), drugs that target nerve pain (Lyrica, Ultram, Neurontin) or codeine based pain relievers are possibilities. Additionally, the doctor may try a direct steroid injection, guided by spinal imaging.

- Physical Therapy: Manual manipulation by a therapist can help relax muscles. The therapist may also recommend ultrasound, heat or ice therapy, electrical stimulation or even support braces.

If conservative treatment fails, or if initial symptoms rapidly worsen, surgery may be recommended.

- Diskectomy: The surgeon removes only the extruding disk material. This surgery is successful in 85% to 90% of patients.

- Microdiskectomy and Endoscopic Diskectomy: These newer procedures are minimally invasive, requiring smaller incisions and specialized instruments with remote visualization. Although less invasive, they are appropriate only in certain situations.

- Fusion: This surgery removes the entire damaged disk and fuses the involved vertebrae. Sometimes metal hardware is also inserted to better stabilize the joint.

- Artificial Disk: Implantation of an artificial disk is an alternative to spinal fusion. This is a relatively new procedure.

The best herniated disk treatment, however, is prevention. Take care of the back with good posture, proper lifts, a healthy weight and exercise. Although these are old recommendations, they remain good ones.

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