It is very concerning when you find out you have a lumbar herniated disc and are experiencing sciatica (a shooting pain that radiates down the leg), foot drop, and other painful symptoms. Fortunately, there are several nonsurgical, or “conservative,” and surgical treatment options available to help relieve your pain and get your life back—but how do you know which approach is best for you?
Here’s an overview of both nonsurgical and surgical treatment options for a lumbar herniated disc.
Nonsurgical Lumbar Herniated Disc Treatments
The most encouraging news is over 85% of patients with painful herniated discs resolve without surgical treatment. There are several nonsurgical treatment options that are highly effective for relieving pain from a lumbar herniated disc.
Exercise and stretching
Regular exercise and stretching are a great way to relieve lumbar herniated disc symptoms without surgery. Plus, weight loss resulting from exercise is an added benefit that can also help reduce herniated disc pain, because being overweight puts added stress on your lumbar discs.
Certain yoga poses1, such as knees-to-chest, bird-dog, reclining hand-to-big-toe , and cobra, can help to stretch out tense muscles in the core and lower back. Other forms of exercise like walking, swimming, and biking can all relieve lumbar herniated disc symptoms and aid in your recovery.
When exercising, it’s important to maintain good form and perform activities in a slow, controlled manner to reduce the risk of exacerbating symptoms or reinjury. Always remember to hold your back straight (neutral spine position) and bend your knees when lifting heavy objects. Also, you should avoid high impact activities2 that can make pain worse such as jogging, aerobics, and martial arts. You should also avoid activities and/or body positions which cause an increase in pain that involve excessive twisting and bending, because they can put more pressure on the spine.
Pain medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) and other over-the-counter pain medications can help reduce swelling and relieve moderate pain from a lumbar herniated disc. Prescription pain relievers and injection therapy with trigger point injections may also help you manage painful symptoms and stay active while you’re recovering. This is important because active patients are much more likely3 to experience lasting pain relief than those with a more sedentary lifestyle.
Relaxation techniques
Meditation and massage can relax stiff muscles and ease tension, ultimately reducing pain from a lumbar herniated disc. While staying active is also an important part of recovery, relaxation techniques can also relieve pain. Many people find the “psoas” position comfortable, which involves lying on your back with your lower legs on a raised platform and knees bent at a 90-degree angle. A Zero Gravity chair can help create this position and take pressure off your spine.
Heat and cold therapies
Hot and cold packs can help you manage painful symptoms caused by nerves that are irritated due to lumbar disc herniation. Applying heat loosens tight muscles and increases blood flow, whereas cold packs can significantly reduce inflammation in affected areas.
Surgical Treatments for Lumbar Herniated Discs
Responsible surgeons will recommend you exhaust your conservative treatment options before moving forward with surgical intervention. However, if the nonsurgical options do not work, or if your physician recommends early surgery for specific reasons, there are a few surgical treatments available to lumbar herniated disc patients
Lumbar discectomy
Lumbar discectomy surgery is the most common surgical procedure for relieving painful symptoms due to a herniated disc in the spine. During lumbar discectomy surgery, a surgeon removes the fragmented disc material in the spine to decompress irritated nerve roots and reduce associated pain.
There are a few different types of discectomy surgery.
- Aggressive discectomy- Involves removing all free disc fragments as well as additional material from inside the disc.
- Limited discectomy- A more conservative approach, involves removing any free disc material without probing the inner core of the disc. Depending on the extent of your herniation and your likelihood of reherniation, your spine surgeon may remove more or less material from inside your disc.
- Lumbar discectomy with Annular Closure- An option if you’re at high risk for reherniation due to having a large hole in your disc that won't heal. Research shows that implantation of a bone-anchored annular closure device significantly lowers the risk of reherniation and the return of symptoms. The tiny device allows your spine surgeon to perform a less aggressive discectomy, preserving as much of your disc as possible while reducing the reherniation risk. It is important to understand that although reherniation only occurs in a relatively small percentage of patients, when a reherniation does occur it leads to further disability and pain and frequently requires a fusion surgery to fix.
Research shows that almost 80 percent4 of discectomy patients achieve good or excellent results. With that said, no surgery is completely without risks. Lumbar discectomy patients must take the necessary precautions during recovery to reduce the risk of reherniation and increase the odds of a positive outcome.
Spinal fusion
Spinal fusion is another surgical treatment option for relieving pain from a herniated lumbar disc. The procedure involves permanently fusing two vertebrae together using implants and bone. While a spinal fusion can stabilize the spine and reduce pain from a herniated disc, lumbar discectomy is typically the preferred surgical approach because it’s less invasive than a fusion, preserves movement, has a shorter recovery period, and typically presents fewer complications.
Key Considerations When Weighing Your Options
While only a doctor can make the final recommendation, there are certain factors you can consider when deciding whether surgical or nonsurgical lumbar herniated disc treatment is the best option for you.
Extent of herniation
How advanced is your lumbar disc herniation? The degree of herniation (and whether or not sequestration, or disc fragments that break off, has occurred) can be a major determining factor for those evaluating surgical options in comparison to nonsurgical treatment.
Severity of symptoms
The severity of your lumbar herniated disc symptoms also comes into play. If you’re suffering from severe leg pain (sciatica), foot drop, and/or you are unable to control your bladder and bowel functions, then surgical intervention may be necessary, rarely but possibly urgently or emergently, to successfully address your symptoms.
Previous treatments
Conservative treatments like those we outlined above can prove highly effective when it comes to relieving leg pain caused by a herniated disc in the lumbar spine. However, if you’ve already tried nonsurgical treatment options for at least six weeks without any success, then you may be a good candidate for lumbar herniated disc surgery.
Surgical risk factors
If you’re considered at high risk of surgical complications due to your weight, tobacco use, serious illness, or another risk factor, it may be advisable to avoid surgery unless it’s absolutely necessary. A spine surgeon can weigh in on whether you’re a likely surgical candidate or if a conservative approach is best.
Moving Forward with Lumbar Herniated Disc Treatment
Lumbar herniated discs can be painful and disabling; fortunately, there are a myriad of effective treatment options ranging from conservative to surgical. Consulting with a specialist in spinal conditions is still the best way to determine which option is right for you—and to move forward with treatment so you can relieve your pain and return to an active lifestyle. And remember, you are the patient and you are in charge! If you do not feel good about your doctor’s recommendations then it is your right to get a second opinion, which hopefully your surgeon will not only be open to, but also be able to help with the process.
While this blog is meant to provide you with information you need to make an informed decision about your treatment options, it is not intended to replace professional medical care or provide medical advice. If you have any questions about the Barricaid, please call or see your doctor, who is the only one qualified to diagnose and treat your spinal condition. As with any surgical procedure, you should select a doctor who is experienced in performing the specific surgery that you are considering.
If you have any questions about the Barricaid, you may ask your doctor. For additional information, please visit www.barricaid.com. For complete risk-benefit information: www.barricaid.com/instructions-for-use.
References:
1 Darren Riccio, “Best Yoga Poses for Sciatica Relief,” Spine Health, Veritas Health, May 2020, https://www.spine-health.com/blog/best-yoga-poses-sciatica-relief.
2 Amanda Barrell, “Safe exercises for a herniated disk,” Medical News Today, Healthline Media UK, January 2019, https://www.medicalnewstoday.com/articles/324311.
3 “Slipped disc: Non-surgical treatment options.” Informed Health, IQWiG, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758163.
4 George J. Dohrmann and Nassir Mansour, “Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of Over 39,000 Patients,” Med Princ Pract 24, no.3 (2015): 285-290, doi: 10.1159/000375499.
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