Most cases of lumbar disc herniation do not require surgery. Research evidence suggests that pain associated with a herniated disc often diminishes without surgical treatment within 4-6 months. Thus, patients are usually prescribed non-surgical treatments initially to help relieve symptoms.

Non-Operative Treatment

• Pain medications: anti-inflammatories, muscle relaxers and on rare occasions narcotic painkillers
• Alternating heat/cold therapy during the first 24-48 hours
• Physical therapy exercises to include: stretching, massage strengthening
• Epidural steroid injections are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from.

Surgical Treatment

If pain still persists and patient is intolerant to the pain after non-surgical treatment and there is evidence by CT Scan, MRI or X-ray or neurological deficit, then surgical intervention is usually recommended.

The following surgical options can treat herniated disc with 90% success:

• Microdiscectomy: Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loops that helps magnify the anatomy. Recovery can be long and painful. Most of the pain post-operative is from the approach the surgeon made through major muscle support in your back. Anesthesia is necessary.
• Laminectomy: During the microdiscectomy surgeons often have to resect the bone called the lamina in order to see the affected nerve and herniated disc. Recovery from microdiscectomy can be long and with bone resection adds to possible scarring in the area the surgeon is working. Anesthesia is necessary.
• Endoscopic Discectomy (transforaminal or interlaminer): With an incision less than a ½ inch. The surgeon can avoid all lamina bone resection and enter the spinal canal without disturbing or cutting muscle. The surgeon directly observes the herniated disc in a water (arthroscopy) environment with a surgical working channel endoscope coupled with a HD camera. Recovery is superior to microdiscectomy with most patients returning to work within a week. Conscious sedation is used with the patient awake, comfortable and aware during the procedure.

Spinal Fusion

Spine fusion should always be a last resort scenario for patients with discogenic back pain and a herniated disc. Our endoscopic discectomy techniques allow our physicians to pinpoint the herniated disc and with patients under conscious sedations instead of general anesthesia making the smallest incision in spine surgery. Endoscopic discectomy uses a ¼ inch incision, placing a 7mm working cannula from the patient’s side directly through the foramen avoiding all major muscle and tissue destruction and the use for a laminectomy. With a working channel endoscope and an HD camera the physician is able to better visualize and decompress the herniated disc and the affected nerve.

Recovery

At our practice, most patients can begin getting out of bed one hour after surgery and go home shortly afterwards. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, we want you to be as comfortable possible and will provide you adequate pain medications.

At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. We will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.