CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Lumbar Disc Herniation
< Back


Injuries and Conditions: Lumbar Disc Herniation : Lumbar Disc Herniation : Treatment Options
 

Overview

Treatment options:

Lumbar Disc Herniation Overview

  • To alleviate the compression of the nerve root by removal of the herniated disc material.

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • Post-operative pain will be controlled through the administration of painkillers.
  • Patients are up and walking the same night or the next morning following surgery.

    Surgical Procedure

  • The patient is brought to the operating room and carefully positioned on the operating table. The type of anesthesia administered will be dependent on the physical condition of the patient and the location of the surgery.
  • An incision, approximately 1-2inches in length, will be made directly over the level of the herniated disc.
  • The muscle is moved away from the lamina of the vertebrae.
  • A small portion of the lamina is removed to gain access to the damaged disc.
  • The herniated disc material is then visually identified and removed. The actual disc space may also need to be entered and additional disc material removed.
  • The incision is sutured closed and a sterile dressing is applied.

    Long Term Expectations for Recovery

  • Patients who are in good physical condition are likely to recover within 1-3 months and should be able to perform all or most of their pre-injury activities.
  • Removal of the herniated disc does not guarantee that future back pain will not occur.
  • A patient's goals and lifestyle may need to be altered, with modification of future activity levels.
  • The overall condition of the spine at the level of the disc may result in the recommendation for a fusion procedure.

    Possible Complications and Risks

  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
  • Nerve root injury that could result in paralysis, loss of feeling, or loss of bowel and bladder control A tear in the covering of the spinal cord (dura) with leaking of spinal fluid and the need to repair the tear and stop the leak.
  • Injury to blood vessels.

    Conservative Treatment of Lumbar Disc Herniation Overview

  • Initial rest that may include bed rest for 2-10 days
  • The administration of anti-inflammatory medication (NSAID's), analgesics (pain medicine), and muscle relaxants to decrease the inflammation around the nerve root and reduce the level of pain.
  • Initial physical therapy that may include hot and cold packs, massage, ultrasound and traction.
  • Ongoing physical therapy will incorporate stretching and back strengthening exercises. The type and duration of exercise will be dependent on the severity of the herniation and the severity and duration of symptoms.
  • Activities that place stress on the spine or cause pain (for example lifting heavy objects, bending, or straining) should be avoided until symptoms are minimal and a gradual increase in activity can begin.
  • Sleep on a firm supportive mattress and adjust sleeping posture; sleeping on your back reduces the amount of stress placed on the spine.
  • Maintain proper posture while standing, lifting and sitting.
  • An epidural steroid injection may be ordered to provide pain relief and a reduction in inflammation.

    Medication and Medical Products
    Lumbar: Supports A bad back can often be the result of poor posture and positioning. A lumbosacral back support, when properly fitted and positioned, will help to maintain a proper, stable posture when sitting at a chair or driving in the car. Poor posture while sitting forces the spine out of its proper position and puts a significant strain on the muscles, tendons and ligaments that support the spine. Lumbar supports can be found in a wide range of sizes and styles.


    NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Hot/Cold Pack The use of hot and cold packs to relieve pain and inflammation is a common method of treatment for many conditions. When the soft tissue groups become strained or irritated the rotating application of hot and cold can be beneficial. Cold therapy numbs the nerves to reduce pain and combats swelling by constricting blood vessels and by slowing blood flow to the site of injury. The application of heat to an injury after a few days of cold therapy and after swelling and redness has been reduced promotes the healing process. Heat therapy speeds up healing by increasing the flow of blood to the site of injury. Heat will also restore flexibility, relieve muscle cramping, and arthritic symptoms.


    Long-Term Expectations for Recovery
    Patient's who follow a treatment plan and rehabilitation schedule should expect a significant reduction in their symptoms.

  • Patient's tend to recover from an injury at different rates, each individual's recovery time is dependent upon the severity of the herniation, degrees of nerve root compression, and general physical condition of the patient.
  • The prognosis for recovery is good for both non-surgical and surgical.
  • The length of time to recover from a surgical procedure may be shorter than for non-surgical therapies.

    Possible Complications and Risks

  • Permanent damage to the nerve root may occur.
  • Non-surgical therapies fail to provide relief or symptoms become increasingly worse during therapy.
  • Returning to a pre-injury activity level may increase the severity of the disc herniation requiring immediate surgical attention.