Treatment for a Lumbar Herniated Disc

The primary goals of treatment for a lumbar (low back) herniated disc are to:

• Alleviate pain and other symptoms such as numbness and/or weakness
• Prevent the symptoms from worsening
• Provide a better healing environment for the herniated disc

Most treatment approaches include exercise-based therapies and lifestyle changes to improve healing and minimize the chance of recurrence.

In This Article:

• Lumbar Herniated Disc: What You Should Know
• Lumbar Herniated Disc Symptoms
• Lumbar Herniated Disc: Causes and Risk Factors
• Diagnosing a Lumbar Herniated Disc
• Treatment for a Lumbar Herniated Disc
• Lumbar Herniated Disc Video

Bed rest for severe pain is best limited to one or two days, as extended rest leads to stiffness and more pain.

After a short period of rest, light activity and frequent movement—with breaks as needed—are advised.

Pain-relieving medication(s) and physical therapy, are usually the first-line recommendations to relieve inflammation and pressure on the affected spinal nerve root.

Additional treatments may be recommended based on the individual’s specific symptoms and signs.

Pain-relieving injections are considered if pain and disability persist despite medication and physical therapy.

These injections may also be recommended to manage severe pain, enabling patients to engage in physical therapy.

Surgical treatment is a last resort if symptoms do not improve or progressively worsen. 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382

Non-Surgical Treatments for a Lumbar Disc Herniation

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Back pain relief from oral or topical medication.

Oral or topical medications may help reduce inflammation and pain, and provide a calming effect.

Treating pain from a lumbar herniated disc usually involves reducing the inflammation and swelling around the disc to take pressure off the affected spinal nerve root. Usually, a combination of the non-surgical strategies listed below is recommended.

• Medications.Pain-relieving medications are sometimes used to treat herniated disc pain and may include one or more of the following 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382 , 2 Zhang AS, Xu A, Ansari K, et al. Lumbar Disc Herniation: Diagnosis and Management. Am J Med. 2023;136(7):645-651. doi:10.1016/j.amjmed.2023.03.024 , 3 Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil): usually recommended for initial treatment and are available over the counter or by prescription (if a higher dosage is needed)
  • Topical creams and gels, such as Aspercreme: available over the counter and used for temporary pain relief after strenuous activities or in case of a pain flare-up
  • Oral corticosteroids, such as prednisone: available by prescription only and recommended for severe inflammation and/or pain
  • Opioids, such as tramadol: available by prescription only and recommended in rare cases of severe, debilitating pain
  • Epidural steroid injections and selective nerve root blocks, which may help reduce inflammation and pain 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382 , 3 Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945 , 4 Singh S, Kumar S, Chahal G, Verma R. Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma. 2016;8(2):142–147. doi:10.1016/j.jcot.2016.02.001
  • Plasma-rich platelet (PRP) therapy, which promotes healing in the injured disc 5 Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM&R. 2015;8(1):1-10. doi:https://doi.org/10.1016/j.pmrj.2015.08.010
  • Tumor necrosis factor-alpha inhibitor (TNFi) injections, which treat inflammation by blocking specific inflammatory proteins (TNF) 6 Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. doi:10.1007/s12178-017-9441-4
  • Glucosamine
  • Devil’s claw
  • Omega-3 fatty acids
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  Surgical Treatments for a Lumbar Disc Herniation

  Surgery for a herniated disc is performed to relieve pressure on a mechanically compressed nerve and to prevent the worsening of neurologic deficits.

  Indications for surgery

  In most cases, surgery for a lumbar herniated disc is elective, meaning that it is the patient's decision whether or not to have surgery. Surgical intervention is considered in the following scenarios 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382 :

  • Symptoms have continued for 3 to 6 months or worsened despite non-surgical treatment
  • Development of progressive neurologic dysfunction, including loss of motor function
  • Debilitating pain and functional disability interfering with daily activities, such as standing, sitting, or walking
  • Imaging findings confirm that a herniated disc is the source of pain and/or neurologic symptoms

  Herniated discs that cause medical emergencies, such as cauda equina syndrome, require urgent surgery. 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382

  Microdiscectomy

  The gold standard surgery for a herniated disc is microdiscectomy, also called microdecompression, which involves removing a small portion of the herniated spinal disc to relieve pressure on the nerve root while leaving the rest of the disc intact. 15 Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

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  Spinal fusion and artificial disc replacement

  In some cases of recurrent lumbar disc herniations with spinal instability, the entire spinal disc is removed, and a bone graft is inserted in the disc space. The bone graft restores the disc height, relieves nerve compression, and facilitates bone growth for the fusion of the entire motion segment. This procedure is called lumbar spinal fusion surgery.

  An alternative option is to replace the painful spinal disc with an artificial disc – a device designed to mimic the disc’s natural movement. This procedure is called lumbar artificial disc replacement.

  Pain relief and functional improvement after surgery are largely dependent on the quality of rehabilitation after surgery, the overall health of a patient, and the skill and experience of the surgeon.

  Patients should discuss the surgical risks, benefits, and full range of treatment options with the physician before considering surgery for a lumbar herniated disc.

  • 1 Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016;10(10):CD012382. Published 2016 Oct 15. doi:10.1002/14651858.CD012382
  • 2 Zhang AS, Xu A, Ansari K, et al. Lumbar Disc Herniation: Diagnosis and Management. Am J Med. 2023;136(7):645-651. doi:10.1016/j.amjmed.2023.03.024
  • 3 Capsicum. Natural Medicines. Therapeutic Research Center; 2023. Updated October 11, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=945
  • 4 Singh S, Kumar S, Chahal G, Verma R. Selective nerve root blocks vs. caudal epidural injection for single level prolapsed lumbar intervertebral disc - A prospective randomized study. J Clin Orthop Trauma. 2016;8(2):142–147. doi:10.1016/j.jcot.2016.02.001
  • 5 Tuakli-Wosornu YA, Terry A, Boachie-Adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM&R. 2015;8(1):1-10. doi:https://doi.org/10.1016/j.pmrj.2015.08.010
  • 6 Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. doi:10.1007/s12178-017-9441-4
  • 7 Koren Y, Kalichman L. Deep tissue massage: What are we talking about? Journal of Bodywork and Movement Therapies. 2018;22(2):247-251. doi:10.1016/j.jbmt.2017.05.006
  • 8 Erwin WM. Should you adjust that herniated disc? Thoughts from a chiropractor/molecular scientist. J Can Chiropr Assoc. 2023;67(1):7-18.
  • 9 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719
  • 10 Deng R, Huang Z, Li X, Pei X, Li C, Zhao J. The effectiveness and safety of acupuncture in the treatment of lumbar disc herniation: Protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(12):e18930. doi:10.1097/MD.0000000000018930
  • 11 Hanscom DA, Brox JI, Bunnage R. Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview. Global Spine J. 2015;5(6):496-504. doi:10.1055/s-0035-1567836
  • 12 Glucosamine. Natural Medicines. Therapeutic Research Center; 2023. Updated July 19, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=807#background
  • 13 Alpha-linoleic acid. Natural Medicines. Therapeutic Research Center; 2023. Updated October 13, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=1035
  • 14 Devil’s claw. Natural Medicines. Therapeutic Research Center; 2023. Updated June 12, 2023. Accessed October 23, 2023. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=984
  • 15 Dowling TJ, Munakomi S, Dowling TJ. Microdiscectomy. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555984/

  

  Dr. Roger Härtl is a neurosurgeon with more than 20 years of experience specializing in spine surgery and neurotrauma. He is the Director of the Weill Cornell Medicine Center for Comprehensive Spine Care in New York.

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