Treatment for a lumbar disc herniation will largely depend on the length of time the patient has had his or her symptoms and the severity of the pain. For most patients, symptoms from a lumbar disc herniation will go away over time. While there are no hard and fast rules, this article reviews some general guidelines for non-surgical and surgical treatment options.

Generally, patients will start with 6 to 12 weeks of conservative (meaning non-surgical) treatment, unless their condition is an emergency situation (e.g., loss of bowel/bladder control or progressive weakness in the legs). Patients may need to try more than one type of treatment to discover what works well. Surgery may be considered if a course of conservative treatment does not provide pain relief, or if the pain is severe and the patient is having difficulty functioning.

Conservative (non-surgical) treatments
There are a wide variety of conservative treatment options for patients to try. The primary goals of treatment are to provide pain relief and to allow the patient to return to a normal level of activity.  If the symptoms start to abate within the six-week period, continued conservative treatment is warranted.  Depending on the patient’s clinical situation and physician’s recommendations, one or several of the following non-surgical treatments may be considered:

• Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root

• Ice and heat therapy for pain relief

• Manipulation (such as by a chiropractor, osteopath, or appropriately trained physical therapist)

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or other pain relief

• Narcotic pain medications for pain relief

• Oral steroids or epidural steroid injections to decrease inflammation for pain relief

• Treatment options for a lumbar herniated disk • Treatment options for a herniated disc • Rehabilitation and exercise for a healthy back

It may be necessary for a patient to try more than one or a combination of the above treatments. The recommended length of conservative treatment for patients needs to be individualized. For those patients who are not in severe pain and can function well, a longer period of conservative treatment is reasonable. The vast majorities of people with a lumbar disc herniation do not need surgery and will recover and return to their normal lifestyle within several weeks or months of conservative treatment.

Surgical treatments
The goal of surgery is to help alleviate the pain faster. If a patient has severe pain and is unable to function at a satisfactory level, surgery may be a reasonable option even before six weeks of symptoms. In recent years, the morbidity (or unwanted side effects, such as post-operative pain) of surgery for a lumbar herniated disc has decreased and the results have improved, so surgery is generally considered a reasonable option for relieving pain and other neurological symptoms more quickly.

The most common surgery to treat a lumbar herniated disc is a microdiscectomy (microdecompression). This is a minimally-invasive procedure (since the incision is small and muscles are moved rather than cut) to remove the herniated portion of the disc under the nerve root. By giving the nerve root more space, pressure is relieved and the nerve root can begin to heal. The microdiscectomy procedure is usually highly successful for relieving the leg pain (sciatica) caused by a herniated disc. Although the nerve root takes several weeks or months to fully heal, patients often feel immediate relief of their leg pain and usually have a minimal amount of discomfort following the surgery. Depending on the patient’s clinical situation and surgeon’s preference, a lumbar laminectomy (open decompression), arthroscopic lumbar discectomy (endoscopic percutaneous discectomy), or microendoscopic surgery may also be considered.

Any patient who has progressive neurological deficits or develops the sudden onset of bowel or bladder dysfunction should have an immediate surgical evaluation, as these conditions may represent a surgical emergency. Fortunately, these conditions are rare.

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