Herniated Disc: Treatment Options

Herniated Disc: Treatment Options

This video will review treatment options for herniated discs. Treatment decisions are based on the disc herniation, location, type, and severity of a patient's symptoms. In rare cases where a patient has severe neurological symptoms, surgery is an immediate priority. For most patients, however, treatment begins with nonsurgical care, which is often successful in decreasing stress to the discs and reducing symptoms.

Nonsurgical treatment may include: rest and activity modification by limiting heavy lifting and improving posture; pain management with anti-inflammatory medication and epidural injections; and physical therapy to increase strength, stability, and range of motion. If symptoms continue despite conservative treatment for several weeks, surgery may be recommended.

The surgeon will review the location and nature of the herniation before selecting what type of surgery is needed, which can be performed through open, minimally invasive or endoscopic approaches. A discectomy is one of the most common surgeries performed for a herniated disc, and can be performed through any approach. Here it is shown through an endoscopic approach. This involves using a small camera and instruments to remove the portion of the disc that has herniated.

To access the disc material, some portions of bone or ligament are also often removed. If a lot of disc material needs to be removed or if there are multiple disc herniations, other types of surgeries are needed to stabilize the vertebrae. This commonly involves spinal fusion, where an entire disc is removed and replaced with a spacer that allows the vertebra above and below it to fuse together. Plates and screws may be used to maintain alignment during healing.

In some cases, artificial disc replacement may be performed instead, which involves removing the entire disc and replacing it with an implant designed to move like a normal disc. All surgical procedures require some period of limited mobility and lifting. Endoscopic approaches, however, often allow patients to begin strengthening and return to normal activities sooner than traditional open procedures.

In summary, nonsurgical care such as activity modification, medications, injections, exercise and physical therapy may be successful in the treatment of herniated discs in those with significant symptoms. Surgical procedures, such as a discectomy or spinal fusion may be selected. Technology is advancing these surgeries to be less invasive so that patients can return to activities sooner.