Treatment of disc herniation
Contrary to what you might think, only a minority of patients need surgery for their herniated discs. In fact, all patients except for emergency cases undergo medical therapy first before resorting to surgery. Medical therapy includes:
- Rest: This cannot be stressed enough. Rest following disc herniation can be enough for the body to heal the problem. Most of the disc herniation and the pain it causes is the result of swelling, and the swelling cannot subside if you keep putting stress on the disc.
- Pain killers: Pain killers especially non-steroidal anti-inflammatory drugs are the cornerstone of medical therapy. They are given until the patient feels better, commonly for 1-2 weeks. Anti-inflammatory drugs are not only pain killers, but they also reduce the inflammation and swelling of the disc, which contributes greatly to symptoms. Anti-inflammatory drugs include Aspirin, Diclofenac, and Naproxen.
- Steroids: Steroids are the strongest anti-inflammatory drugs available, and they can be used in more severe cases to reduce swelling more quickly and when other anti-inflammatory drugs fail. They have to be given under medical supervision and should be withdrawn gradually to avoid side effects.
- Muscle relaxants: Muscle relaxants are given to relieve muscle spasms that overlie the herniated disc. Muscle spasm contributes to the pain and its relief greatly improves symptoms.
Medical therapy is continued for at least 2 weeks before deeming it as unsuccessful. Afterward, surgery is considered. There are a few cases where surgery is considered first before medical therapy including:
- Cauda equina syndrome: Cauda equina syndrome is an absolute indication for surgery before medical therapy. Any delay can cause neurological damage.
- In case of muscle weakness accompanying the pain or numbness.