When is Surgery Recommended for a Lumbar Herniated
(Slipped) Disc?
Discs are the flat cushions between the individual
bones in the spine. In some people, a piece of the disc
material can squeeze out of its normal position and
push on the nerves in the spine. In the lower back,
this may cause problems including low back pain and
leg pain.
The majority of patients with this problem initially
are treated conservatively or non-surgically. This is
because most will get better without surgery. Conservative
treatment usually begins with medications, such as a
nonsteroidal anti-inflammatory. Depending on the situation,
physical therapy and occupational therapy may be added.
Many patients improve with this regime alone. If the
pain continues, epidural steroid injections may be recommended.
This procedure involves injecting medication around
the nerves in the spine helping to reduce inflammation
and pain.
The goal of conservative treatment is not to put the
herniated fragment back into its normal position, but
to reduce the inflammation of the irritated and painful
nerve. Most patients are able to obtain relief with
these measures. Some patients continue to have pain
despite conservative therapy. In these patients a surgical
removal of the disc may be recommended. While most patients
enjoy a significant improvement after surgery, there
are small risks that must be considered in the decision
to proceed with surgery. However, in patients who suffer
severe debilitating pain and possible neurological deficits,
surgery may be the only way to obtain relief.
It should be noted that each patient is unique and
the above sequence of care must be tailored to the particular
patient depending on the situation. In rare circumstances
some patients present with loss of bowel and bladder
control. In this situation, surgery is recommended without
a trial of conservative care. This is because with a
delay in surgery, there is less chance of improvement
in bowel and bladder control.
The decision to undergo surgery for a herniated disc
must be considered very carefully. Both the benefits
and the risks must be weighed. Fortunately, however,
most patients will do well with the conservative approach.
For those patients where the pain continues despite
conservative treatment, surgery can provide an elimination
or marked reduction in pain.
The specialists at the CINN Institute for Spine Care
have significant expertise in treating herniated discs,
both with conservative and surgical techniques. If you
would like more information on the Institute for Spine
Care or would like to schedule an appointment with one
of our spine specialists, please call 1-800-446-1234.
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