Herniated Discs | Treatment Options

A herniated disc, sometimes called a slipped or ruptured disc, is a common cause of back and leg pain. The discs between the vertebrae in your spine act as cushions or shock absorbers and can develop tears or leaks over time. When the inner gel-like substance pushes out through these tears, it can press on spinal nerves, leading to symptoms like sciatica or numbness. Fortunately, there are both conservative and surgical options for managing herniated discs depending on the severity. Treatment options for a herniated disc typically starts small but may progress if pain becomes debilitating.

Causes and Risk Factors

Several factors can contribute to a herniated disc over time:

• Aging – As we age, the outer layer of discs weakens and becomes more prone to cracking or tearing. Discs degenerate naturally as part of the aging process.
• Excess weight – Carrying extra pounds puts more strain on the spine and increases pressure on the discs.
• Improper lifting or twisting – Bending and twisting while lifting aggressively can lead to tears or ruptures. Always lift with the legs, not the back.
• Repetitive strain – Certain sports or occupations require repetitive spine motions. Over time, these can damage discs.
• Genetics – Some people may have a hereditary predisposition for disc issues. If disc problems run in your family, you are at greater risk.

Paying attention to spine health and avoiding disc strain when possible can help lower risks. But ultimately herniated discs can happen spontaneously in some cases.

Symptoms

Symptoms of a herniated disc depend largely on the location of the damaged disc along the spine:

• Back pain – Most herniated discs lead to localized back soreness or achiness, sometimes with muscle tightness or spasms.
• Leg/arm pain and numbness – A ruptured disc pressing on specific spinal nerves can cause sharp, shooting nerve pain into the legs (sciatica) or arms. Numbness and tingling may also occur.
• Muscle weakness – Nerve compression can make muscles fatigue more quickly and feel weak or difficult to control.
• Loss of bowel/bladder control – This emergency symptom (cauda equina syndrome) requires immediate medical care to prevent permanent damage.

If pain persists for more than a week or two and is impacting your regular function, see a spine specialist for an exam.

Diagnosis

During a physical exam, the doctor will check for tenderness along the spine, test reflexes, sensation, coordination and muscle strength. If a herniated disc is suspected, the following imaging exams help confirm:

• X-ray – Helps visualize the vertebrae and discs to check for abnormalities or rule out other causes of pain.
• CT scan – Cross-sectional CT images can reveal if discs are protruding and pressing on spinal nerves.
• MRI – Considered the most accurate imaging test for herniated discs. MRIs use magnets rather than radiation to produce 3D images of spine anatomy.
• Myelogram – A CT scan done after injecting contrast dye around the spinal cord and nerves to highlight nerve compression.
• Nerve Tests – Electromyography (EMG) and nerve conduction studies check for nerve inflammation or damage.

Once a herniated disc is diagnosed, treatment options can be explored.

Conservative Treatments

For mild to moderate herniated discs without severe neurological symptoms, conservative treatment is typically the first line of care before considering invasive options like surgery. The goal is to relieve inflammation and pain in order to heal the damaged disc over time.

Medications

Anti-inflammatory medications can help reduce swelling around the irritated nerve root. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen work well for this purpose. Muscle relaxants may also be prescribed to release muscle tightness and spasms near the affected disc area. For short-term pain relief, opioids can be utilized when other options have failed, but they carry risks of dependency.

Steroid Injections

Under x-ray guidance, an epidural steroid injection can deliver a corticosteroid medication directly towards the spine region with the herniated disc. This concentrated anti-inflammatory effect helps calm inflammation irritating the nerve root. Proper imaging ensures the medication reaches the correct target area.

Cold/Heat Therapy

Alternating cold packs and heat pads may relieve local discomfort and muscle tension. Typically icing for 15-20 minutes followed by warming for 15-20 minutes works best. The cold temporarily numbs pain receptors while the warmth boosts blood flow to aid healing.

Activity Modification

While brief rest periods help reduce nerve inflammation initially, lengthy inactivity can increase stiffness and deconditioning. Light walking and gentle range-of-motion exercises are recommended to retain flexibility and strength. Prolonged sitting should also be avoided.

Physical Therapy

A physical therapist can design a customized exercise program to improve core muscle strength, spine alignment, and disc pressure. Stretches, aerobic activity, and techniques like traction or massage address specific needs like relieving nerve compression. PT stabilizes structures around damaged discs so they can heal.

Surgery

If conservative treatments fail to alleviate pain after 6-12 weeks, surgery may be warranted, especially if limb weakness or numbness persists. Surgical options include:

Discectomy

The protruding portion of the disc pushing on the nerve is removed through a small incision to decompress the nerve. This preserves motion and stability.

Laminectomy

Part of the bony arch (lamina) is removed to create more space for nerves. This type of treatment if often combined with discectomy.

Spinal Fusion

Two vertebrae are fused together for stability using bone grafts, plates/screws or cages. Limits mobility but can relieve nerve compression.

Artificial Disc Replacement

Damaged disc is removed and replaced with a flexible artificial one. Avoids fusion-related stiffness but has strict candidacy requirements.

Surgeries like discectomy and laminectomy often successfully reduce leg and back pain caused by herniated discs. Fusion may be incorporated as well in some cases depending on the specifics of nerve involvement.

When to Consider Surgery

Consult with your doctor if:

• Pain worsens or persists after 6 weeks of nonsurgical care.
• There is progression of neurological deficits like leg weakness.
• Bowel or bladder dysfunction develops.
• Standing, walking or normal activity remains severely impaired.

Surgery risks should always be balanced with quality of life considerations for each individual patient.

Recovery and Prevention

After surgery, activity restrictions protect healing tissues while pain medications help manage postoperative discomfort. Physical therapy then helps safely rebuild flexibility and strength. Some tips for avoiding reinjury:

• Maintain proper lifting form (bend knees, keep back straight).
• Strengthen core muscles to better support the spine.
• Engage in low-impact exercise like swimming or walking.
• Lose excess weight to minimize disc pressure.
• Stop smoking to optimize disc health.

Small daily efforts to care for your back add up and may prevent future disc trouble.

Conclusion

Herniated discs are complex injuries but can improve greatly when properly diagnosed and cared for using customized treatment plans. Patience through the healing and rehabilitative process is critical, as is communicating with your healthcare providers about your symptoms. While recovery varies, a combination of rest, medication, therapy approaches and sometimes surgery help most patients regain strength and mobility. Committing to spine-healthy habits may then help prevent reinjury.