Discs in the spine become herniated when a part of the nucleus (the soft spot inside the disc) is pushed out into the spinal canal. Herniated discs can occur in the cervical spine (neck), thoracic spine (upper back), or lumbar spine (lower back). Often, herniated discs will resolve on their own, typically within one to two months. However, some people experience severe pain, numbness, and tingling, a result of a nerve being pressed. In these cases, treatment is individualized based on where the disc is herniated, severity of symptoms, and the impact on activities of daily life.
Evaluation
Diagnosis of a herniated disc is made through a complete history and physician examination. A physician will ask about the onset of pain (gradual or sudden), what you were doing at the time the pain began, and what symptoms you are experiencing. Pain associated with a herniated disc is typically described as stabbing, sharp, or burning, with or without associated numbness, which radiates down through the leg or arm, depending on the location of the herniated disc. Additionally, the physician will assess motor, sensory, and reflex function by asking you to perform specific movements or maneuvers. Magnetic resonance imaging may be necessary to further delineate the location of the herniated disc.
Nonsurgical treatment
In most cases, nonsurgical, conservative treatment is initiated for herniated discs. This consists of medication such as acetaminophen and nonsteroidal anti-inflammatory drugs, bed rest, and/or physical therapy.
Medications are recommended to help ease pain associated with herniated discs. While acetaminophen and nonsteroidal anti-inflammatory drugs may be given for mild to moderate pain, individuals who experience more intense pain might be given neuropathic pain medications (eg, gabapentin, pregabalin, duloxetine, tramadol), muscle relaxants (eg, methocarbamol, carisoprodol, cyclobenzaprine), or a corticosteroid injection.
Physicians will usually recommend one or more days of bed rest. Any activity should be slow and gradual to allow for inflammation to decrease.
Physical therapy may include massage, ice and heat application, traction, stretching, ultrasound, or electrical muscle stimulation. The physical therapist will work closely with a physician's recommendations to develop a treatment plan based on individual symptoms.
Surgical treatment
For more severe cases in which pain significantly affects activities of daily living, function begins to deteriorate (i.e., bowel and/or bladder function, neurologic function worsens), or if discs are degenerating, surgical intervention should be considered.
The decision regarding which type of surgical procedure to perform depends on individual patient symptoms and location of the herniated disc. Options include minimally invasive procedures (e.g., chemonucleolysis), endoscopic procedures, or open compression (e.g., discectomy, microdiscectomy, laminotomy, laminectomy, spinal fusion).
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