Herniated disk guide
Welcome to Herniated disk guide
A herniated disk can affect how you're able to perform everyday tasks and can cause severe pain that influences almost everything you do. You and your doctor will make decisions about how to best treat your herniated disk (herniated disc), sometimes also called herniated disc, ruptured disk or slipped disk.
No single treatment choice is best for everyone. Your decisions will be based on a number of factors, including:
- The nature of your condition
- The degree to which it's affecting your lifestyle
- The level of pain you're experiencing
Think of yourself and your doctor as partners in making decisions about how to treat your herniated disk. You'll want to carefully consider all your options and the risks and benefits of each in relation to your lifestyle and what's important to you. The information here is intended to help you understand the various treatment options and decide which treatment may be best for you. This guide also frames key questions to help you in this important decision-making process.
This guide is designed for you if you're diagnosed with a herniated lumbar disk, but not a herniated cervical disk. Lumbar disk herniation occurs in the lower (lumbar) region of the spine and occurs more frequently than does neck (cervical) herniation.
Herniated disk treatment options
The pain of herniated disks can be severe. However, the most severe pain usually eases within a week or two allowing you to be more physically active. In about four to six weeks, most people no longer feel the need to seek medical care. So, only about one in 10 people go on to surgery.
The portion of the disk that herniates tends to shrink over time, and you may experience partial or complete shrinkage after six months. And over the long term, you typically get similar results regardless of whether you opt for surgical or nonsurgical treatment. Because of this, your doctor usually suggests that you try nonsurgical treatments first, as long as you don't have significant or progressive muscle weakness or loss of bowel or bladder control.
When will the pain subside?
Most people with a herniated lumbar disk — estimates range from 80 percent to more than 90 percent — improve and return to normal activities without aggressive treatment. Improvement generally occurs within a month or two. However, with various treatments, you may find that the pain is controlled to the point that you can resume many of your usual activities while you wait for resolution of symptoms.
Conventional treatment options for herniated disk range from nonsurgical methods to surgical methods.
Nonsurgical options for herniated disk
- Pain medications
- Cold therapy, heat therapy or both
- Electrical stimulation
- Bracing
- Hydrotherapy
- Traction
- Stretching
- Dynamic lumbar stabilization exercises
- Aerobic exercise using pain-free activities
Surgical options for herniated disk
- Minimally invasive procedures
- Decompression procedures
Nonsurgical treatments for herniated disk
Most herniated disk problems improve with nonsurgical treatment. The goal of such conservative treatment is to reduce the irritation of the nerve. You want to improve your physical condition so that your spine is protected and its function is enhanced. After evaluating your particular case, your doctor may recommend one or more of the following common treatment options, typically occurring in two basic steps.
Step 1: Pain control
The goal of these treatments is to control your pain so that your body is given time to heal itself:
Decreased activity. One or two days of rest in bed on a firm surface or mattress may ease severe pain caused by your disk problems. You may be most comfortable lying with your back on the floor, with hips and knees bent and legs elevated. But because you need to move regularly to maintain muscle tone, avoid long periods of strict bed rest — more than a day or two may even slow recovery. When not in bed, limit activities that aggravate your symptoms, such as prolonged sitting, bending and lifting.
Pain medications. Medication may be used to relieve your discomfort until the inflammation goes away and your body heals itself.
- Acetaminophen. Acetaminophen (Tylenol, others) may help control your discomfort.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as aspirin and ibuprofen (Advil, Motrin, others) can relieve pain and reduce inflammation of the disk or nerve roots. Some NSAIDs, such as naproxen sodium (Aleve), may increase your risk of heart attack and stroke. It's wise to discuss your individual risk profile with your doctor to determine whether the potential benefits of taking an NSAID outweigh the risks for you.
- Neuropathic pain medications. This is a newer class of medications that appears to work well for painful nerve conditions. The medications include gabapentin (Neurontin), pregabalin (Lyrica), duloxetine (Cymbalta) and tramadol (Ultram) and may be used with either acetaminophen or NSAIDs or as an alternative to them.
- Tricyclic antidepressants. Low doses of medications such as nortriptyline (Pamelor) also may relieve pain.
- Muscle relaxants. Your doctor might prescribe muscle relaxants, such as methocarbamol (Robaxin), carisoprodol (Soma) and cyclobenzaprine (Flexeril), if you have persistent back spasms.
- Corticosteroids. If your pain isn't improved through the use of these medications, corticosteroids given orally or by way of injections may help. Corticosteroids in doses that exceed your naturally occurring levels suppress inflammation. Epidural injection — injecting corticosteroids into the area around the spinal nerves — provides a strong localized anti-inflammatory effect. Some people get significant benefit with the first injection. Additional injections may be given to maximize your pain relief. Usually no more than three injections are given.
- Narcotics. Your doctor may have you take narcotics, such as codeine or hydrocodone, for a short time if other options don't relieve your pain. Some medications may cause unwanted reactions if taken together, so check with your doctor if you're taking medications for other health problems.
Cold or heat therapy. Cold packs can be used initially to relieve pain. Wrap an ice pack or a bag of frozen vegetables in a piece of cloth. Hold it on the sore area for about 15 minutes, typically several times a day. To avoid frostbite, never place ice directly on your skin. Alternatively, use a warm bath, warm packs, a heating pad or a heat lamp for pain relief. Be careful not to burn your skin. If, for instance, you find that cold provides more relief than heat does, continue using cold packs, or try a combination of the two methods. Check with your doctor before using heat therapy within the first 48 hours of pain, because heat increases blood flow to the affected area and may increase inflammation and swelling (edema).
Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it's thought that it might relieve pain by stimulating the release of pain-inhibiting molecules (endorphins) or blocking pain fibers that carry pain impulses. Scientific literature doesn't provide strong evidence that TENS is effective at reducing low back pain when used as the only treatment. However, your doctor may use TENS in conjunction with other treatments.
Bracing. Your doctor may have you wear a back brace or corset for a short time to increase your comfort and help you to regain mobility. A brace can help you to maintain good posture and alignment during everyday activities. Wearing a brace also reduces spinal motion, decreases pressure within the affected disk and helps to keep the soft tissues of your back warm. Don't use a brace long term as it can weaken your abdominal and back muscles. Instead, strengthen these muscles through exercise in order to provide internal support to the spine.
Hydrotherapy. Hydrotherapy involves either sitting in an ordinary whirlpool bath or performing a variety of exercises — such as walking, stretching or joint range-of-motion exercises — while in water. Your doctor may suggest hydrotherapy to help relieve your pain and enhance muscle relaxation. Hydrotherapy may be helpful early on in your course of nonsurgical treatment by allowing you to stay mobile without aggravating your pain.
Traction. Traction stretches the lower back and improves pain by decreasing muscle spasms, and possibly by decreasing the pressure on the herniated disk. Treatment is typically provided using a traction machine either continuously for five to 15 minutes or intermittently, such as for two minutes followed by one minute of rest and repeated several times in one treatment session. It's typically performed under the guidance of a trained physical therapist. If the initial traction treatments provide improvement in pain, home traction devices can be used.
Step 2: Restore function
Once your pain improves, you can begin the process of strengthening and stabilizing your back.
Exercise and physical therapy. Physical activity plays a vital role in your recovery, allowing you to both control your pain and prevent future injury.
- Stretching exercises may help control initial pain symptoms. Once acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help decrease the risk of recurrent injuries. Specific stretches called McKenzie maneuvers may decrease or eliminate leg and back pain for minutes to hours. These maneuvers are first tested during a screening examination by a spine physical therapist. If helpful, your therapist may then teach you how to do the maneuvers at home.
- Dynamic lumbar stabilization exercises. Rehabilitation may include exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Many exercises focus on a program termed dynamic lumbar stabilization. This program includes exercises that involve coordinated use of both the abdominal and back muscles in a balanced-spine posture. Your doctor will have you start physical therapy, exercise or both as early as possible. Exercise and physical therapy are an important part of your treatment program and should become part of your permanent routine at home.
- Aerobic exercises. You may be able to participate in activities such as walking, biking, swimming or elliptical machine workouts to help control pain. Which exercises help your back pain will be specific to you. Start with a small amount of activity, such as five to 10 minutes and add minutes in the days that follow. Your goal is to comfortably work up to 30 to 40 minutes of vigorous physical activity five days each week.
Know when urgent medical care is needed
No single treatment option works best for everyone. Your doctor may have you try a range of nonsurgical treatments over time, changing from one to another based on results. With time, you and your doctor will discover which treatments are the most effective at relieving your pain and restoring function to your back.
Even if you decide to begin with nonsurgical treatment, contact your doctor immediately or go to an emergency room if any of these situations occur:
- Significant or progressive weakness of your muscles. For instance, if you had been able to lift up your foot or stand on your toes initially after your injury but now you can't, injury to your nerve may be worsening. This development may warrant surgery.
- Loss of bowel or bladder control. If you have lost the ability to maintain control of your urine, stool or both (incontinence), or have numbness in the saddle (perianal) area, it may mean that the nerves that control your bladder or bowel have been damaged and need to be surgically decompressed.
- Loss of sensation in the areas that would touch a saddle when sitting (saddle anesthesia).
- Loss of movement.
Additional signs and symptoms to be aware of include:
- Progressive increase in pain
- Fever lasting longer than 48 hours
- Pain that's worse at night or at rest
These signs and symptoms may indicate cauda equina syndrome — a very rare disorder of the nerves at the lower end of your spinal cord that can lead to permanent loss of function. Immediate medical attention and possible surgery are necessary to relieve the pressure on these nerves.
When nonsurgical treatments fail
If you try nonsurgical treatments but don't experience improvement after a period of time, you may need to consider surgery more seriously. Experts don't agree on a specific time frame for considering surgery, but many suggest waiting four to six weeks after the onset of pain, unless you have the signs or symptoms listed above. Where you fall within this range may depend on several factors, including how much the pain interferes with your daily activities, sleep, work and recreation.
Nonsurgical treatments for herniated disk: Pros and cons
In most cases it's best to begin with nonsurgical treatment. However, the decision is a personal one and is influenced by your home and work priorities, concerns and physical condition. When it's time to decide between staying with nonsurgical options or moving on to surgical options, keep these points in mind:
| Pros | Cons |
|---|---|
| It's less invasive than surgery. | It may take longer to improve, and you can't put an exact date on when the pain will stop |
| You can try it for a while and still opt for surgery. | It'll probably require a lifestyle change. |
| It's able to reduce irritation of disk and nerve in most cases. | Pain medications may have unwanted side effects. |
| You avoid the known risks of surgery. | Waiting too long before deciding on surgery may make the operation less successful. You may also develop signs of deconditioning syndrome, such as loss of strength and mobility in your spine. |
| It allows your body's own natural healing process to work. |
Surgery for herniated disk
When surgery is your last remaining option, the goals are twofold:
- To keep the herniated disk from pressing on and irritating nerves
- To relieve pain
Though progressive weakness of your muscles and loss of bowel and bladder control suggest that surgery may be needed immediately, you may be advised to wait four to six weeks before deciding on surgery since most people see improvement by then. After that time has passed, the severity of your pain and its effect on your function often helps determine if you're a good candidate for surgery. If your discomfort isn't improving with nonsurgical treatments or the pain is getting progressively worse, then surgery may be a good option for you.
Minimally invasive procedures to treat herniated disk
In an effort to avoid surgery and possible surgical complications and to limit recovery time, some surgeons use minimally invasive techniques:
Chemonucleolysis
In chemonucleolysis, an enzyme (chymopapain) derived from the tropical papaya tree is injected into the disk. Chymopapain dissolves the protruding disk, which can reduce pressure on the nearby nerve and, in some cases, eliminate pain. Other enzymes besides chymopapain also can be used for this procedure.
Chemonucleolysis generally isn't used in the United States — due to the risk of neurological complications and allergic reactions to the enzyme. However, these complications may be avoided if your doctor takes a thorough medical history, conducts sensitivity testing and uses proper surgical techniques. Severe muscle spasms used to be common in people who received chemonucleolysis, possibly as a result of the enzyme spreading beyond the disk. Decreased dosages and the use of corticosteroids can reduce the chance of muscle spasms.
What to expect. Chemonucleolysis can be performed with general or local anesthesia, and you'll also receive corticosteroids through a vein in your arm (intravenously, called an IV). The surgeon inserts a large needle into your back and slowly injects chymopapain for a few minutes. You may notice immediate pain relief after the procedure and can usually be discharged within 24 hours. Your doctor may suggest that you take pain medications, such as ibuprofen (Advil, Motrin, others), as needed during the week or so after the procedure.
Healing may take six to 12 weeks, but you can resume activities as soon as you're able to tolerate them. Your doctor may recommend that you begin walking or swimming to aid your rehabilitation. You may be able to return to light or sedentary work within two to four weeks. Heavier work can be resumed in six to 12 weeks.
Interpreting results. Chemonucleolysis is usually less effective than surgery, with a success rate of 70 percent to 80 percent. Chemonucleolysis may offer some pain relief, and — in properly selected people — it may be an effective treatment for those who want to avoid surgery. Trying chemonucleolysis first won't affect subsequent surgical outcomes.
Endoscopic procedures
A mechanical device that fits into a large needle is inserted into your back to remove parts of your disk from between vertebrae. One type of endoscopic procedure is endoscopic diskectomy, also called percutaneous arthroscopic diskectomy.
What to expect. In this procedure your surgeon inserts a thin tube through a small incision in your back. This allows your surgeon to use small cameras and tools — such as a suction or laser probe or forceps — to remove damaged parts of the disk. Endoscopic procedures typically are performed on an outpatient basis. You may receive local or general anesthesia. Because the surgeon conducts the procedure using small cameras, bone doesn't need to be removed to see and treat the disk. A small bandage is used to close the incision.
The surgeon is unable to see the nerve root because the small incision provides a limited range of vision. That means your surgeon may not be able to tell if the correct part of the disk has been removed or be able to identify and remove disk fragments that have entered the spinal canal.
Interpreting results. Endoscopic procedures usually are less effective than standard diskectomy or microdiskectomy and are still in the developmental stage. Success rates are wide ranging. You'll need to weigh whether you're willing to chance a lower effectiveness rate in return for the minimal invasiveness of these procedures.
Open decompression for herniated disk
About one in 10 people with herniated disks eventually need surgery. If you've tried conservative treatments and they've failed, you and your doctor may talk about a number of surgical options to treat your herniated disk, including the following:
Diskectomy
A diskectomy involves the removal of part of a disk to relieve pressure on a nerve. If you have leg pain, rather than back pain, you may achieve better surgical results from diskectomy.
What to expect. You receive general anesthesia or spinal anesthesia for this procedure. An incision is made, and the herniated portion of the disk and any pieces that have broken loose are removed. Ideally, just the fragment of disk that is pinching the nerve is removed, leaving most of the disk intact. That's preferred, as it preserves your normal anatomy as much as possible. Often, a partial facetectomy also is performed during a diskectomy. This involves removing a small part of an area of the spine called the facet joint that may be compressing the nerve.
You may stay in the hospital for one to three days, though diskectomy can also be performed as an outpatient procedure. Your pain may not be relieved immediately after the surgery, and you may also feel pain at the incision site. Your doctor may prescribe pain medication for pain following the procedure.
Interpreting results. Overall, satisfactory results are achieved in most cases. You'll be able to return to light or sedentary work in two to four weeks, but you may need to wait six to eight weeks to return to physical work.
Microdiskectomy
A microdiskectomy is similar to a standard diskectomy except that the procedure is performed through a smaller incision while the surgeon looks through a microscope. Microdiskectomy is the most common surgery for herniated disk.
What to expect. Some doctors say that the smaller incision of a microdiskectomy isn't as effective at revealing decreased space (stenosis) or herniation that occurs at the sides of the disk. The smaller incision may also make it more difficult to remove large fragments of disk and make it more likely to operate at the wrong level or miss some fragments that need to be removed.
Microdiskectomy may be performed as an outpatient procedure, or you may stay in the hospital for one to three days.
Interpreting results. The success rate is about equal to standard diskectomy, approximately 80 percent to 90 percent. Microdiskectomy can result in reduced time spent in the hospital and a quicker return to work, when compared with diskectomy. The decision of whether to use a microscope when performing a diskectomy is based on the anatomy of the herniated disk, individual preference and training of your surgeon.
Spinal fusion
This procedure rarely is used to treat herniated disks. It may be used if you've had spinal instability or have had several recurrent disk herniations at the same level. If your doctor has recommended only this procedure for treatment of herniated disk, get a second opinion.
Rehabilitation after herniated disk surgery
Your rehabilitation regimen varies depending on your procedure and your doctor's preferences. Initially you'll probably walk for exercise, and after several weeks you'll start a back rehabilitation (lumbar stabilization) program.
Your back rehabilitation program may include:
- Exercises to strengthen your lower back and abdominal muscles
- Exercises to improve your posture
- Stretches to increase the flexibility of your spine and legs
- Exercises to maintain your cardiovascular conditioning while you recover
Prolonged bed rest can lead to a decrease in your overall physical condition. As a general rule, it's preferable to get up and get moving as soon as possible, but be sure to follow your doctor's recommendations regarding specific activities you should participate in.
Surgery for herniated disk: Pros and cons
Surgery may dramatically reduce the pain of your herniated disk, but it isn't the best solution for everyone. Your preferences and concerns play a large role in determining the right choice for you. Before deciding whether to undergo surgery, consider the following points:
| Pros | Cons |
|---|---|
| It can relieve pressure on spinal nerves, alleviating pain and improving function. | Surgery isn't a sure cure. You still may have pain, especially back pain. Perhaps the disk wasn't the only cause of your problem, or it may be that the nerve was compressed for too long or too severely. |
| It has the potential to reduce pain faster than nonsurgical means. Your leg pain may be gone by the time you awaken from surgery. | Possible complications include a small risk of bleeding, risks associated with anesthesia, infection, injury to the nerves, leakage of spinal fluid and scarring. |
| It may offer a better chance for improvement of nerve irritation. | Surgery is more effective at relieving leg pain than back pain. |
| It's a relatively common procedure, and results usually are good. | You may need additional surgery in the future. With every subsequent operation the chances of a good result decrease. |
| Long-term outcomes are often similar to those of less invasive treatments. |
Emerging treatments for herniated disk
Open diskectomy and microdiskectomy are the gold standards in surgical treatment for herniated disk. Minimally invasive treatments exist, such as chemonucleolysis and percutaneous arthroscopic diskectomy, but their success rates don't equal those of the two types of diskectomy. Researchers are working on less invasive treatments that provide a viable option between conservative treatments and open decompression procedures. Emerging treatments include:
Nucleoplasty. This procedure uses heat-producing (bipolar radiofrequency) technology to create an energy field that decreases pressure within a disk's nucleus. Decreased pressure within a disk can provide pain relief. Because the energy field dissolves disk tissue without creating excessive heat, damage to nearby structures is minimized.
Oxygen-ozone therapy. This therapy involves injecting a gas mixture of oxygen and ozone into a herniated disk. The treatment can limit pain and inflammation by reducing the disk's volume. When used in conjunction with corticosteroid injections, oxygen-ozone therapy may enhance the effect of the corticosteroids. Oxygen-ozone therapy is performed on an outpatient basis and doesn't require anesthesia.
Disk and nucleus replacement. In this procedure, a diseased disk is replaced with a prosthetic functional alternative. Often made of metal and plastic, these replacement disks were developed to treat the pain associated with degenerative disk disease. This is a new procedure, however, and long-term results of this procedure are still uncertain. Disk replacement has been proposed as an alternative to spinal fusion. Disk nucleus replacement is also available and is proposed to relieve pain resulting from the nucleus. This also is a new procedure without a proven track record or known long-term results. Some researchers suggest that, in the future, nucleus replacement may be performed in conjunction with a diskectomy to maintain the structure and function of the spine.
Biological repair. These are techniques that seek to repair or regenerate a disk through the use of proteins that promote the growth of cells (growth factor) and tissue engineering. Injecting growth factor into a disk showing early signs of degeneration could trigger the disk's cells to repair themselves. More research is needed before these techniques can be tried in humans.
Alternative therapies for herniated disk
Complementary and alternative medicine (CAM) includes a number of therapies that aren't an integral part of conventional medicine. "Complementary" generally refers to treatments that you might choose in addition to conventional medical treatment. "Alternative" generally refers to treatment that you might choose in place of conventional treatment. In some cases, researchers haven't studied these treatments adequately using widely accepted scientific methods. Or there may be conflicting evidence as to whether a specific treatment provides relief from the symptoms of herniated disk. Even so, a growing body of evidence indicates that some complementary and alternative treatments may help manage the symptoms of herniated disk. When the science supporting the safety and efficacy of a particular treatment is strong, it's often incorporated into conventional medicine. Combining the best of both conventional medicine with the best of evidence-based CAM is referred to as integrative medicine. Here are some CAM therapies for herniated disk:
Acupuncture. Acupuncture isn't generally used to treat herniated disks. It may relieve back pain, though the scientific literature isn't conclusive about this. Pain relief may come from the release of endorphins, your body's natural painkillers, but how acupuncture works isn't known for sure. It may control pain via the gate control theory of pain, which proposes that pain is blocked in the central nervous system by the sensation of the needle in your skin. Acupuncture may also alter your brain's chemistry in a way that affects the parts of the central nervous system that relate to sensation and involuntary body functions.
Depending on your reasons for seeking acupuncture, you'll have one or several hair-thin needles inserted into your skin. Some go as deep as three inches (8 centimeters), depending on where they're placed in your body and what the treatment is for. The needles usually are left in for 15 to 30 minutes. Several sessions may be needed.
Chiropractic treatment. Chiropractic treatment is based on the rationale that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Some types of spinal manipulation can relieve symptoms in people with a herniated disk. However, the practice remains controversial and many medical doctors don't recommend chiropractic care to treat herniated disk.
Your chiropractor may ask you questions about your pain and examine your spine. This helps her or him decide where your spine needs manipulation. To manipulate your spine, your chiropractor puts pressure on your back using her or his hands. You may feel a pinching sensation and hear a popping noise, which is normal.
Massage. Massage is widely used as treatment for low back pain. Massage may provide relief from chronic low back pain, but the effect may not be strong or long lasting. Your doctor may recommend that you receive massage therapy for the pain relief and relaxation it may provide. Massage may also help stretch soft tissues, restore your muscle length and allow you to resume various activities. Though it isn't a proven treatment for herniated disk, massage therapy generally is safe and doesn't have adverse side effects. However, it's not completely risk-free. Massage isn't advisable for some people.
Don't try massage if you have:
- Osteoporosis
- Deep vein thrombosis
- Skin infections or open wounds
- Arthritis in the area to be massaged
Massage involves the kneading, stroking and manipulation of soft tissues — your skin, muscles and tendons. Your massage will vary depending on the rhythm, rate, pressure and direction of these movements. A Swedish massage uses long, gliding strokes to promote relaxation and improve your circulation. A deep-tissue massage uses slow strokes, but more pressure than a Swedish massage, to reach deeper layers of your muscle. During most massages, you'll need to take off your clothes and lie down on a padded table, though some massages can be done in a chair with your clothes on. Most massages take 30 minutes to an hour. About 100 different varieties of massage exist, and your doctor or massage therapist can help you decide which is best for you.
Do your homework and tell your doctor
If you decide to use complementary or alternative treatments, make sure you learn as much as you can about them. Find out what they are and what benefits their practitioners claim to provide. And before choosing a treatment, evaluate the benefits and risks. Lastly, if you decide to use a complementary or alternative therapy, it's important that you tell your doctor. Some treatments may alter the effect of other therapies or medications.
Things to consider about herniated disk treatment
Regardless of which treatment you pick, in the long run your results may be about the same. In fact, many herniated disks eventually shrink and cause no problems, even without surgical intervention.
But it's understandable that if you're experiencing pain, it's harder to imagine dealing with your discomfort for an indefinite period of time. In order to control your pain and allow your body to heal, you need to work with your doctor to come up with the best solution for you. When deciding on a treatment option, here are some things to keep in mind:
What is your current level of pain? Are you experiencing unbearable amounts of pain, or is it something that you can endure? This is a personal decision. Two people can react differently to the same amount of pain. However, how much you can stand the pain may influence how you view risks and benefits and help you decide which option to pick. Nonsurgical treatments may relieve your pain but not as quickly as surgical techniques can. If you're losing sleep, struggling to get through the workday and experiencing a lot of pain, surgery may be the best option for you.
How will your lifestyle be affected? In terms of your lifestyle, which treatment option best fulfills your needs and desires? Is there a significant event coming up that you want to be better for? If so, you may need a treatment that may provide quicker results.
Will surgery help your symptoms? Surgery is not the answer for everyone. Surgery is most effective at relieving leg pain. If back pain is your main complaint, this may not be an effective option for you. Also, there's a good chance that either surgery or nonsurgical treatment won't always rapidly relieve sensory symptoms such as numbness and tingling.
Have you done all that you can with nonsurgical options before progressing to surgery? Before you've waited four to six weeks, surgery is usually not the first option considered. Surgery becomes a higher priority when you have significant, disabling pain that is unrelieved by nonsurgical treatment measures or when your symptoms indicate a neurological emergency, such as progressive or significant weakness, or loss of bowel or bladder control. But if neither of these conditions is present, start with nonsurgical options to manage the pain and provide your body the opportunity to heal itself. Estimates range from 80 percent to more than 90 percent, but most people with a herniated lumbar disk recover without aggressive treatment.
It takes time
Remember that whichever choice you make, you have to work for your recovery, and your back may never be as good as new. In fact, if you don't take care of the injured area and rebuild its strength, you may continue to have problems with it in the future.
Though it may seem that it was just an unlucky twist that caused your herniated disk, in many cases the problem developed over months and years and was just waiting for a small event to trigger the rupture. It's important that you make proper body mechanics and your back rehabilitation a priority to avoid going through this again.
In the meantime, you do have options for taking away much, if not all, of your current pain, and it's up to you and your doctor to make the best decisions for you.
