Slipped disc: Non-surgical treatment options – InformedHealth.org

Last Update: April 9, 2020; Next update: 2023.

Most people with a slipped disc in the lumbar region of their spine (lower back) are offered “conservative” treatment, meaning that the treatment does not involve surgery. This mainly involves exercise, relaxation and positioning, painkillers or local anesthetics, and manual and physical therapy.

Some slipped discs don’t cause any symptoms, whereas others lead to severe back pain. A slipped disc in the lumbar region of the spine (the lower back) can press on the sciatic nerve and cause pain that often radiates down one leg and into the foot. Most people recover from a slipped disc within six weeks without treatment. Until then there are a number of treatment options that aim to help relieve the pain and improve mobility.

Exercise, relaxation and positioning

In the past, people who had a slipped disc were typically advised to stay in bed for one to two weeks. Nowadays the opposite approach is taken: people are advised to stay active instead. This is because remaining in a lying position for a long time can make muscles and bones weaker, which can end up causing other problems.

Studies have shown that physical activity can improve mobility. However, whether people keep up with exercise or rest instead wasn’t found to influence the back pain itself. So it is a good idea to try to carry out your normal daily activities as much as the pain allows. Exercise has also been proven to effectively prevent back pain from returning.

Relaxation exercises may also be worth a try to help relieve back pain. How you perceive pain and how well you cope with it can be influenced by your mind.

If the pain is very severe, though, there is sometimes simply no other way to deal with it than to lie down and find a position that puts as little strain on your back as possible. Many people find the “psoas” position comfortable: While lying on your back, you put your lower legs on a raised platform high enough so that your knees are bent at a 90-degree angle. But it is important not to stay inactive for too long.

Psoas position

Medication for the pain

There are a number of different medications for the relief of sciatic nerve pain (sciatica) caused by a slipped disc. Most of these are painkillers, but you can also use muscle relaxants and anti-inflammatory drugs. The following medications are the most commonly used. They are all available without a prescription when taken at a low dose:

• Non-steroidal anti-inflammatory drugs (NSAIDs): These painkillers belong to the same group of drugs as acetylsalicylic acid (ASA, the drug in medicines like “Aspirin”). NSAIDs that may be an option for the treatment of sciatica include diclofenac, ibuprofen and naproxen. They have a pain-relieving and anti-inflammatory effect.Because NSAIDs prevent blood from clotting to an extent, they can cause bleeding. The bleeding may be mild, such as a nosebleed or bleeding gums, but more serious bleeding can sometimes also occur, for example in the stomach or bowels. In some cases NSAIDs cause stomach ulcers, too. NSAIDs may also impair the function of the kidneys. If you have asthma, a cardiovascular disease, or a stomach ulcer, you should ask your doctor for advice before taking NSAIDs. NSAIDs can also be injected into muscle tissue, although that is generally not done anymore nowadays. NSAID injections probably don’t have any advantages over tablets or suppositories, but they may cause nerve damage, bleeding or inflammation at the site of injection.

• Acetaminophen (paracetamol): Acetaminophen (paracetamol) is also a painkiller, but it is not an NSAID. It is well tolerated and can be used as an alternative to NSAIDs – especially for people who do not tolerate NSAID painkillers because of things like stomach problems or asthma. But higher doses of acetaminophen can cause liver and kidney damage. For this reason, adults should follow the information on the package insert and make sure they do not take more than 4 grams (4,000 milligrams) of acetaminophen per day. This is the amount in, for example, 8 tablets containing 500 milligrams each. It is not only important to take the right dose, but also to wait long enough between doses.

Some of the medication options have to be prescribed by a doctor. These include:

• Opioids: Strong painkillers that may only be used under medical supervision. Opioids are available in many different strengths, and some are available in the form of a patch. Morphine, for example, is a very strong drug, while tramadol is a weaker opioid. These drugs may have a number of different side effects, some of which are serious. They range from nausea, vomiting and constipation to dizziness, breathing problems and blood pressure fluctuation. Taking these drugs for a longer time can lead to habitual use and physical dependence.

• Steroids: Inflammation-reducing drugs that can be used to treat various diseases systemically. It is called a systemic treatment if the medication spreads throughout the entire body. This happens when it is taken as a tablet, injected into a muscle or given through a drip (infusion).Systemic steroids can soothe inflammation and relieve pain. They can also increase the risk of certain medical problems, including stomach ulcers, osteoporosis, infections, skin problems, glaucoma and glucose metabolism disorders.

• Muscle relaxants: Sedatives that also relax the muscles. Like other psychotropic medications, they can cause fatigue and drowsiness, and affect your ability to drive. Muscle relaxants can also affect the functioning of your liver and cause gastrointestinal (stomach and bowel) complications. Benzodiazepines such as tetrazepam may lead to dependency if they are taken for longer than two weeks.

• Anticonvulsants: These medications are typically used to treat epilepsy, but some are approved for treating nerve pain (neuralgia). Their side effects include drowsiness and fatigue. This can affect your ability to drive.

• Antidepressants: These drugs are usually used for treating depression. Some of them are also approved for the treatment of pain. Possible side effects include nausea, dry mouth, low blood pressure, irregular heartbeat and fatigue.

Anticonvulsants and antidepressants are typically not used unless the symptoms last for a longer period of time or the painkillers don’t provide enough relief.

Manual therapy and treatments based on physical stimuli

The treatment options for sciatica following a slipped disc also include manual therapy and treatments based on physical stimuli. Manual treatment may include massages and special techniques for relaxing tense muscles or locked joints. Treatments based on physical stimuli use warming and cooling methods to relieve pain. These treatments are also called passive therapies because patients don’t have to actively participate. Common treatments include:

• Massages: Various massage techniques are used to relax muscles and ease tension.

• Heating and cooling: This includes the use of hot packs and heating patches, a hot bath, going to the sauna or using an infrared lamp. Heat can also help relax tense muscles. Cold packs, like cold wraps or gel packs, are also used to help soothe irritated nerves.

• Ultrasound therapy: Here the lower back is treated with sound waves. The small vibrations that are produced generate heat and relax the body tissue.

There is no overall proof that passive treatments speed up recovery from a slipped disc or relieve the pain especially well. But many people find that heat or massages are pleasant and relaxing.

Traditional Asian medicine

Treatment approaches based on traditional Asian medicine include:

• Acupuncture: In ´´acupuncture the therapist inserts fine needles into certain points on the body. This is thought to relieve the pain..

• Reiki: Reiki is a Japanese treatment which aims to relieve pain by using specific hand placements.

• Moxibustion: This method is used to heat specific points on the body by placing heated needles or glowing sticks made of mugwort (“Moxa”) close to those points.

There are very few good-quality studies on these treatments, and there is no proof that they help to relieve pain. Acupuncture is the only approach for which there is weak evidence that it might relieve pain – although this relief has been shown to be unrelated to where the needles are placed on the body.

Injections near the spine

Injection therapy mainly uses local anesthetics and/or inflammation-reducing medications like steroids. These drugs are injected into the area immediately surrounding the affected nerve root. There are different ways of doing this:

• In lumbar spinal nerve analgesia, the medication is injected directly at the point where the nerve root leaves the spinal canal. This has a numbing effect on the nerve root.

• In lumbar epidural analgesia, the medication is injected into what is known as the epidural space (“epidural injection”). The epidural space surrounds the spinal cord and the spinal fluid in the spinal canal. This is also where the nerve roots are located. During this treatment the spine is monitored using computer tomography or x-rays to make sure that the injection is placed at exactly the right spot.

Injections close to the spine can have side effects such as bleeding, infection and nerve damage. A treatment involving injections over a longer period of time may also lead to muscle weakness and is associated with radiation exposure due to the use of x-rays. For this reason, only a limited number of injections may be given. It is important to carefully weigh the pros and cons of having multiple injections.

Studies on treatments with injections have shown that they are able to relieve sciatica for several weeks. People were able to move more easily while going about their day-to-day activities as a result. Steroid injections seem to be somewhat more effective than other types of injections.

Treating pain and staying active

Acute low back pain usually has no clear cause and goes away on its own after a few days. And even if a slipped disc is causing it, your body will probably be able to make the problem go away on its own within six weeks. Most treatments hardly affect the speed of recovery. Hot packs or massages might help you feel better. If you have severe pain, short-term relief can be provided by getting into a position that reduces the strain on your back and by using anti-inflammatory drugs or local anesthetics. But most of the work is usually done by the body itself.

If slipped disc symptoms persist for a longer time, surgery may be an option to try to relieve the pressure on the affected nerve. However, most experts believe that slipped disc surgery is done more often in Germany than is actually necessary. So it might make sense to get a second opinion if your doctor advises you to have surgery and you aren’t sure whether this is the right treatment.

It is particularly important to stay as physically active as possible despite the pain. Exercise will not only keep your body in shape, it generally also has a positive effect on your mood. Getting enough exercise and keeping up the strength of your torso (core muscles) is key in order to stop back pain from becoming chronic. Physical activity has been scientifically proven to have a preventive effect – and it is probably the most important thing you can do to help yourself.

Sources

• Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg 2016; 122(3): 857-870. [PubMed: 26891397]

• Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Nicht-spezifischer Kreuzschmerz. Langfassung. AWMF-Registernr.: nvl-007. 2017.

• Jordan J, Konstantinou K, O’Dowd J. Herniated lumbar disc. BMJ Clin Evid 2011: pii: 1118.

• Lee JH, Kim DH, Kim DH, Shin KH, Park SJ, Lee GJ et al. Comparison of Clinical Efficacy of Epidural Injection With or Without Steroid in Lumbosacral Disc Herniation: A Systematic Review and Meta-analysis. Pain Physician 2018; 21(5): 449-468. [PubMed: 30282390]

• Lewis R, Williams N, Matar HE, Din N, Fitzsimmons D, Phillips C et al. The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 2011; 15(39): 1-578. [PMC free article: PMC4781007] [PubMed: 22078311]

• Li X, Han Y, Cui J, Yuan P, Di Z, Li L. Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation: A Meta-Analysis. J Evid Based Complementary Altern Med 2016; 21(4): 311-319. [PubMed: 26378088]

• Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 2012; 344: e497. [PMC free article: PMC3278391] [PubMed: 22331277]

• Qin Z, Liu X, Wu J, Zhai Y, Liu Z. Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2015: Article ID 425108. [PMC free article: PMC4631886] [PubMed: 26576192]

• Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW et al. Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review. Spine 2017; 42(8): 586-594. [PubMed: 28399072]

• Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev 2016; (10): CD012382. [PMC free article: PMC6461200] [PubMed: 27743405]

• Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364: l689. [PMC free article: PMC6396088] [PubMed: 30867144]

• Tang S, Mo Z, Zhang R. Acupuncture for lumbar disc herniation: a systematic review and meta-analysis. Acupunct Med 2018; 36(2): 62-70. [PubMed: 29496679]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Slipped disc: Non-surgical treatment options – InformedHealth.org

Last Update: April 9, 2020; Next update: 2023.

Most people with a slipped disc in the lumbar region of their spine (lower back) are offered “conservative” treatment, meaning that the treatment does not involve surgery. This mainly involves exercise, relaxation and positioning, painkillers or local anesthetics, and manual and physical therapy.

Some slipped discs don’t cause any symptoms, whereas others lead to severe back pain. A slipped disc in the lumbar region of the spine (the lower back) can press on the sciatic nerve and cause pain that often radiates down one leg and into the foot. Most people recover from a slipped disc within six weeks without treatment. Until then there are a number of treatment options that aim to help relieve the pain and improve mobility.

Exercise, relaxation and positioning

In the past, people who had a slipped disc were typically advised to stay in bed for one to two weeks. Nowadays the opposite approach is taken: people are advised to stay active instead. This is because remaining in a lying position for a long time can make muscles and bones weaker, which can end up causing other problems.

Studies have shown that physical activity can improve mobility. However, whether people keep up with exercise or rest instead wasn’t found to influence the back pain itself. So it is a good idea to try to carry out your normal daily activities as much as the pain allows. Exercise has also been proven to effectively prevent back pain from returning.

Relaxation exercises may also be worth a try to help relieve back pain. How you perceive pain and how well you cope with it can be influenced by your mind.

If the pain is very severe, though, there is sometimes simply no other way to deal with it than to lie down and find a position that puts as little strain on your back as possible. Many people find the “psoas” position comfortable: While lying on your back, you put your lower legs on a raised platform high enough so that your knees are bent at a 90-degree angle. But it is important not to stay inactive for too long.

Psoas position

Medication for the pain

There are a number of different medications for the relief of sciatic nerve pain (sciatica) caused by a slipped disc. Most of these are painkillers, but you can also use muscle relaxants and anti-inflammatory drugs. The following medications are the most commonly used. They are all available without a prescription when taken at a low dose:

• Non-steroidal anti-inflammatory drugs (NSAIDs): These painkillers belong to the same group of drugs as acetylsalicylic acid (ASA, the drug in medicines like “Aspirin”). NSAIDs that may be an option for the treatment of sciatica include diclofenac, ibuprofen and naproxen. They have a pain-relieving and anti-inflammatory effect.Because NSAIDs prevent blood from clotting to an extent, they can cause bleeding. The bleeding may be mild, such as a nosebleed or bleeding gums, but more serious bleeding can sometimes also occur, for example in the stomach or bowels. In some cases NSAIDs cause stomach ulcers, too. NSAIDs may also impair the function of the kidneys. If you have asthma, a cardiovascular disease, or a stomach ulcer, you should ask your doctor for advice before taking NSAIDs. NSAIDs can also be injected into muscle tissue, although that is generally not done anymore nowadays. NSAID injections probably don’t have any advantages over tablets or suppositories, but they may cause nerve damage, bleeding or inflammation at the site of injection.

• Acetaminophen (paracetamol): Acetaminophen (paracetamol) is also a painkiller, but it is not an NSAID. It is well tolerated and can be used as an alternative to NSAIDs – especially for people who do not tolerate NSAID painkillers because of things like stomach problems or asthma. But higher doses of acetaminophen can cause liver and kidney damage. For this reason, adults should follow the information on the package insert and make sure they do not take more than 4 grams (4,000 milligrams) of acetaminophen per day. This is the amount in, for example, 8 tablets containing 500 milligrams each. It is not only important to take the right dose, but also to wait long enough between doses.

Some of the medication options have to be prescribed by a doctor. These include:

• Opioids: Strong painkillers that may only be used under medical supervision. Opioids are available in many different strengths, and some are available in the form of a patch. Morphine, for example, is a very strong drug, while tramadol is a weaker opioid. These drugs may have a number of different side effects, some of which are serious. They range from nausea, vomiting and constipation to dizziness, breathing problems and blood pressure fluctuation. Taking these drugs for a longer time can lead to habitual use and physical dependence.

• Steroids: Inflammation-reducing drugs that can be used to treat various diseases systemically. It is called a systemic treatment if the medication spreads throughout the entire body. This happens when it is taken as a tablet, injected into a muscle or given through a drip (infusion).Systemic steroids can soothe inflammation and relieve pain. They can also increase the risk of certain medical problems, including stomach ulcers, osteoporosis, infections, skin problems, glaucoma and glucose metabolism disorders.

• Muscle relaxants: Sedatives that also relax the muscles. Like other psychotropic medications, they can cause fatigue and drowsiness, and affect your ability to drive. Muscle relaxants can also affect the functioning of your liver and cause gastrointestinal (stomach and bowel) complications. Benzodiazepines such as tetrazepam may lead to dependency if they are taken for longer than two weeks.

• Anticonvulsants: These medications are typically used to treat epilepsy, but some are approved for treating nerve pain (neuralgia). Their side effects include drowsiness and fatigue. This can affect your ability to drive.

• Antidepressants: These drugs are usually used for treating depression. Some of them are also approved for the treatment of pain. Possible side effects include nausea, dry mouth, low blood pressure, irregular heartbeat and fatigue.

Anticonvulsants and antidepressants are typically not used unless the symptoms last for a longer period of time or the painkillers don’t provide enough relief.

Manual therapy and treatments based on physical stimuli

The treatment options for sciatica following a slipped disc also include manual therapy and treatments based on physical stimuli. Manual treatment may include massages and special techniques for relaxing tense muscles or locked joints. Treatments based on physical stimuli use warming and cooling methods to relieve pain. These treatments are also called passive therapies because patients don’t have to actively participate. Common treatments include:

• Massages: Various massage techniques are used to relax muscles and ease tension.

• Heating and cooling: This includes the use of hot packs and heating patches, a hot bath, going to the sauna or using an infrared lamp. Heat can also help relax tense muscles. Cold packs, like cold wraps or gel packs, are also used to help soothe irritated nerves.

• Ultrasound therapy: Here the lower back is treated with sound waves. The small vibrations that are produced generate heat and relax the body tissue.

There is no overall proof that passive treatments speed up recovery from a slipped disc or relieve the pain especially well. But many people find that heat or massages are pleasant and relaxing.

Traditional Asian medicine

Treatment approaches based on traditional Asian medicine include:

• Acupuncture: In ´´acupuncture the therapist inserts fine needles into certain points on the body. This is thought to relieve the pain..

• Reiki: Reiki is a Japanese treatment which aims to relieve pain by using specific hand placements.

• Moxibustion: This method is used to heat specific points on the body by placing heated needles or glowing sticks made of mugwort (“Moxa”) close to those points.

There are very few good-quality studies on these treatments, and there is no proof that they help to relieve pain. Acupuncture is the only approach for which there is weak evidence that it might relieve pain – although this relief has been shown to be unrelated to where the needles are placed on the body.

Injections near the spine

Injection therapy mainly uses local anesthetics and/or inflammation-reducing medications like steroids. These drugs are injected into the area immediately surrounding the affected nerve root. There are different ways of doing this:

• In lumbar spinal nerve analgesia, the medication is injected directly at the point where the nerve root leaves the spinal canal. This has a numbing effect on the nerve root.

• In lumbar epidural analgesia, the medication is injected into what is known as the epidural space (“epidural injection”). The epidural space surrounds the spinal cord and the spinal fluid in the spinal canal. This is also where the nerve roots are located. During this treatment the spine is monitored using computer tomography or x-rays to make sure that the injection is placed at exactly the right spot.

Injections close to the spine can have side effects such as bleeding, infection and nerve damage. A treatment involving injections over a longer period of time may also lead to muscle weakness and is associated with radiation exposure due to the use of x-rays. For this reason, only a limited number of injections may be given. It is important to carefully weigh the pros and cons of having multiple injections.

Studies on treatments with injections have shown that they are able to relieve sciatica for several weeks. People were able to move more easily while going about their day-to-day activities as a result. Steroid injections seem to be somewhat more effective than other types of injections.

Treating pain and staying active

Acute low back pain usually has no clear cause and goes away on its own after a few days. And even if a slipped disc is causing it, your body will probably be able to make the problem go away on its own within six weeks. Most treatments hardly affect the speed of recovery. Hot packs or massages might help you feel better. If you have severe pain, short-term relief can be provided by getting into a position that reduces the strain on your back and by using anti-inflammatory drugs or local anesthetics. But most of the work is usually done by the body itself.

If slipped disc symptoms persist for a longer time, surgery may be an option to try to relieve the pressure on the affected nerve. However, most experts believe that slipped disc surgery is done more often in Germany than is actually necessary. So it might make sense to get a second opinion if your doctor advises you to have surgery and you aren’t sure whether this is the right treatment.

It is particularly important to stay as physically active as possible despite the pain. Exercise will not only keep your body in shape, it generally also has a positive effect on your mood. Getting enough exercise and keeping up the strength of your torso (core muscles) is key in order to stop back pain from becoming chronic. Physical activity has been scientifically proven to have a preventive effect – and it is probably the most important thing you can do to help yourself.

Sources

• Bhatia A, Flamer D, Shah PS, Cohen SP. Transforaminal Epidural Steroid Injections for Treating Lumbosacral Radicular Pain from Herniated Intervertebral Discs: A Systematic Review and Meta-Analysis. Anesth Analg 2016; 122(3): 857-870. [PubMed: 26891397]

• Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Nicht-spezifischer Kreuzschmerz. Langfassung. AWMF-Registernr.: nvl-007. 2017.

• Jordan J, Konstantinou K, O’Dowd J. Herniated lumbar disc. BMJ Clin Evid 2011: pii: 1118.

• Lee JH, Kim DH, Kim DH, Shin KH, Park SJ, Lee GJ et al. Comparison of Clinical Efficacy of Epidural Injection With or Without Steroid in Lumbosacral Disc Herniation: A Systematic Review and Meta-analysis. Pain Physician 2018; 21(5): 449-468. [PubMed: 30282390]

• Lewis R, Williams N, Matar HE, Din N, Fitzsimmons D, Phillips C et al. The clinical effectiveness and cost-effectiveness of management strategies for sciatica: systematic review and economic model. Health Technol Assess 2011; 15(39): 1-578. [PMC free article: PMC4781007] [PubMed: 22078311]

• Li X, Han Y, Cui J, Yuan P, Di Z, Li L. Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation: A Meta-Analysis. J Evid Based Complementary Altern Med 2016; 21(4): 311-319. [PubMed: 26378088]

• Pinto RZ, Maher CG, Ferreira ML, Ferreira PH, Hancock M, Oliveira VC et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ 2012; 344: e497. [PMC free article: PMC3278391] [PubMed: 22331277]

• Qin Z, Liu X, Wu J, Zhai Y, Liu Z. Effectiveness of Acupuncture for Treating Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med 2015: Article ID 425108. [PMC free article: PMC4631886] [PubMed: 26576192]

• Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW et al. Nonsteroidal Anti-inflammatory Drugs for Sciatica: An Updated Cochrane Review. Spine 2017; 42(8): 586-594. [PubMed: 28399072]

• Rasmussen-Barr E, Held U, Grooten WJ, Roelofs PD, Koes BW, van Tulder MW et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev 2016; (10): CD012382. [PMC free article: PMC6461200] [PubMed: 27743405]

• Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364: l689. [PMC free article: PMC6396088] [PubMed: 30867144]

• Tang S, Mo Z, Zhang R. Acupuncture for lumbar disc herniation: a systematic review and meta-analysis. Acupunct Med 2018; 36(2): 62-70. [PubMed: 29496679]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Herniated disc

Hospital departments

Home » Departments of the hospital » Department of Neurosurgery named after G.S. Pakhomenko » Herniated disc

Intervertebral hernia (herniated disc) is a displacement of the nucleus pulposus of the intervertebral disc with a rupture of the fibrous ring. The most common hernias of the intervertebral discs of the lumbosacral spine, hernias are less common in the cervical spine, the most rare – in the thoracic region.

Clinical manifestations

Clinical manifestations of degenerative changes in the intervertebral disc in the lumbosacral spine:

• local pain in the projection area of ​​the affected disc — in the lumbosacral region (lumbalgia), aggravated by exercise;
• pain radiating to the buttock, along the back, posterior surface of the thigh and lower leg on the side of the lesion (ischalgia),
• numbness and tingling in the area of ​​innervation of the affected roots, weakness in the lower limb;
• weakness and sensory disturbance in both legs;
• violation of the functions of the pelvic organs – urination, defecation and potency, numbness in the perianogenital area.

Clinical manifestations of degenerative changes in the cervical spine:

• pain radiating to the shoulder or arm
• dizziness
• rises in blood pressure
• combination of headaches with rises in blood pressure and dizziness
• numbness of fingers

Clinical manifestations of degenerative changes in the thoracic spine:

• persistent pain in the thoracic region when working in a forced position
• combination of pain in the thoracic spine with scoliosis or kyphoscoliosis

Species

• Sequestered spinal hernia
• Schmorl’s hernia

Examination

Magnetic resonance imaging (MRI) is currently the method of choice for diagnosing herniated discs. If necessary, non-invasive MR myelography or invasive CT myelography is performed.

Treatment

In most cases, herniated disc symptoms subside within six weeks of onset, remission occurs, and surgery is not required.

Surgical repair of a herniated disc should be considered after unsuccessful attempts at conservative management that have failed to control pain.

The main method of conservative treatment of herniated discs is systemic anti-inflammatory therapy using non-steroidal anti-inflammatory drugs (NSAIDs). In some cases, topical corticosteroids have been effective.

In addition to the main treatment, physiotherapy exercises are also used.

Indications for surgical treatment of herniated discs

Surgical treatment of herniated discs is performed mainly in the development of neurological disorders and pain syndrome resistant to conservative therapy. If compression of the cauda equina occurs (severe pain in the back of the thigh and lower leg, severe pain in the lower abdomen, aggravated by coughing, urinary and fecal incontinence, impaired potency), emergency surgical intervention is necessary.

Types of surgical treatment

Until recently, the removal of a herniated disc by laminectomy of the appropriate level was used. With the advent of the surgical microscope, it became possible to reduce the trauma of the surgical approach and remove the disc herniation through a smaller trepanation window, so the method of intralaminar microsurgical removal of the disc herniation appeared, which is still used today, being the “gold standard” of surgical treatment of herniated intervertebral discs. Further development of methods goes along the path of reducing surgical trauma, and this development is inextricably linked with the development of medical equipment and optics. Currently, microsurgical removal is widely used and many options for endoscopic removal of hernial protrusion have appeared.

Microsurgical removal of a herniated disc

Microsurgical removal of a herniated disc ( microdiscectomy ) is an operation that is an effective method of surgical treatment. This method is performed under high magnification using an operating head loupe or using an operating microscope. The main advantage of this method is the ability to remove a herniated disc of any density and any location. The risk of postoperative complications is minimal. Modern neurosurgery involves early activation of the patient, already on the next day. The average length of stay in the hospital is 5-7 days. The patient can start non-physical labor after 7-14 days, and physical labor after 4-6 weeks. It is usually recommended to limit sitting positions for a month. To maintain posture and minimize possible complications, it is recommended to wear a semi-rigid lumbar corset for 1-2 months.

Endoscopic hernia removal

Endoscopic method of surgical treatment of herniated discs is a fairly new direction and, as such, is subject to a lot of criticism and comparisons. To date, there is an extensive arsenal of endoscopic methods for the treatment of herniated intervertebral discs. The use of an endoscope can significantly reduce surgical trauma, but has more limited conditions for use (size? location of a herniated disc). The size of the incision and the entire access are reduced to 1-2. 5 cm, the risk of postoperative complications is less. The patient can walk the next day, is discharged from the hospital 3-4 days after the operation. This type of intervention provides faster rehabilitation and the resumption of the previous work activity.

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Intervertebral disc herniation. Treatment of spinal hernia, symptoms, causes, diagnosis

Video

Title

• Manifestation
• Methods of treatment

Herniated discs are the most common and most severe manifestation of spinal osteochondrosis. At the same time, a pain radicular syndrome develops, which may be accompanied by paresis or paralysis of the muscles of the lower extremities, a sensitivity disorder, and a dysfunction of the pelvic organs. 19% of patients with herniated discs need surgical treatment.

Dystrophic changes in the lumbosacral spine are most pronounced at the age of 20 to 50 years and are one of the most common causes of temporary disability and often – disability of the patient. Up to 50% of all surgical interventions in neurosurgical hospitals are performed for the pathology of discs at the lumbosacral level.

The disease occurs as a result of rupture of the intervertebral disc . The resulting hernia of the spine , protruding back and to the side, presses on the nerve root at the point of its exit from the spinal canal and causes inflammation, accompanied by edema. This explains why pain and loss of sensation appear only a day after the onset of the disease. The pinched nerve root sends pain impulses to the brain, which are perceived by the patient as if they were coming from the leg. The part of the nerve that is outside the area of ​​pressure hernia almost ceases to function, which leads to a sharp decrease in sensitivity and the appearance of weakness in the leg.

Manifestation

In almost all patients, the main complaint is pain. As a rule, pain occurs in adolescence after moderate physical exertion, an uncomfortable position at the workplace or in bed. As well as with “lumbago”, the disease often occurs when tilting with a simultaneous turn to the side, often in combination with heavy lifting. Sudden, not particularly severe pain in the lumbar region is also characteristic. Then, during the day, pain and weakness appear in one of the legs, sometimes with loss of sensation on the inside of the foot and lower leg or on the outside of the foot and the inside of the leg. When moving, coughing, sneezing or straining, the pain in the back and leg intensifies and often becomes so intense that the patient needs bed rest. Some relief can be achieved by lying down, raising your legs or placing them on a pillow.

There are two stages in the development of the disease. At the first stage, there is pain in the lumbar region, which indicates the beginning of the degenerative-dystrophic process. Under the influence of degenerative changes in the spinal motion segments, the rather complex structure of the fibrous ring changes, radial cracks form in it, which reduces its strength. The nucleus pulposus protrudes, the blood circulation of this zone is disturbed, there is swelling of local tissues, hypoxia of the spinal cord root, adhesions. Annulus fibrosus, posterior longitudinal ligament, dura mater, intervertebral joints are well innervated by branches of the sinuvertebral nerve. A pain syndrome occurs, which leads to myopically fixation of the pathological zone due to the tension of the back muscles and, as a result, compensatory curvature of the overlying sections of the spine occurs. Thus, a vicious circle is formed. Subsequently, prolonged pathological impulsation leads to degenerative changes in the articular-ligamentous apparatus.

And at the second stage, the nature of the pain syndrome changes. There is a compression radicular syndrome, which is caused by mechanical compression and tension of the root. In this case, swelling of the root occurs, its blood supply is disturbed. With direct contact herniated disc with root chemical irritation causes more intense pain. Often, when radicular pain occurs, pain in the lumbosacral region weakens or disappears. Apparently, this is due to a decrease in intradiscal pressure due to rupture of the annulus fibrosus. Vertebrogenic pain syndrome can be caused not only by compression of the root (radiculopathy) or spinal cord (myelopathy), but also by the vessel feeding the root – radiculomyeloishemia.

Distribution and localization of radicular pain generally corresponds to the zone of innervation of the compressed root. Pain is more often “lamp” in nature, may be constant or coming. The disks L4-L5 and L5-S1 are mainly affected. The L3-L4 level suffers only in 2-4% of cases. In addition to pain, sensitivity disorders, such as hypoesthesia and anesthesia, sometimes hyperesthesia, can be determined.

Vegetative disorders are observed in the form of hypothermia of the skin, their pastosity, sweating changes, dryness of the skin increases.

Quite often, patients are in a forced position. Compensatory postures that reduce the degree of compression and tension of the root are manifested by scoliosis, flattening of the lumbar lordosis, limitation of flexion and extension of the body, and tension of the long back muscles.

Sometimes patients cannot straighten their leg due to pain. Motor disturbances in the form of paresis or paralysis are rarely noted, they are more typical for advanced cases. There may be trophic disorders in the form of “weight loss” due to muscle atrophy. In the early stages of the disease, symptoms of irritation are more pronounced, in the later stages – symptoms of loss of functions.

Treatment of intervertebral disc herniation.

The human body has a powerful ability to self-heal, which also applies to damaged intervertebral discs . Usually this disease goes away in 2-3 months, subject to bed rest and rest – the best prerequisites for a quick recovery without complications. As with other diseases of the lumbar spine, it is recommended to lie on your back with your legs raised or placed on a pillow, changing body position and looking for a comfortable, painless posture. Painkillers and anti-inflammatory drugs can be taken to relieve severe pain, although they do not speed up recovery, they reduce suffering. After 3-4 weeks, the pain usually subsides significantly, but the damage itself disk is not yet healed, therefore, in order to avoid possible complications in the form of chronic back pain, rest for another whole month is necessary.

Surgical treatment is indicated in the presence of intractable pain syndrome (treatment period from 2 weeks to 3 months), an increase in neurological deficit, cauda equina syndrome (impaired function of the pelvic organs, decreased potency, numbness of the perineum).

Other herniated disc treatment in the acute stage – traction of the spine. This is a very old method, interest in which has recently been increasing. Traction creates a pressure drop in the intervertebral space , which makes it possible to “suck in” a hernia of the spine . In this case, it is necessary to find the correct direction of influence and select the appropriate force so as not to damage the spine even more. Sometimes the patient is recommended to carry out traction himself, in accordance with pain. With the right procedure, the pain should decrease, not increase.

So, treatment for hernia is as follows:

• If the pain is moderate or tolerable, the patient is recommended bed rest and pain medication until the condition is relieved or at least for 3-4 weeks.
• The spinal traction method can also be used to quickly relieve pain. If they are still unbearable despite bed rest and drug therapy, mechanical stretching may also be a way out.
• However, if the pain is unbearable despite repeated traction and complete rest, surgery is not excluded.