Herniated Disc Treatments

Before surgery, your doctor will confirm that a herniated disc is causing your symptoms by using an imaging study, such as magnetic resonance imaging (MRI) or computed tomography (CT scan). Once confirmed, there are a variety of treatments that could first be explored when trying to treat herniated disc pain, the final of which is herniated disc surgery. Technology has recently made gains in minimal access spine procedures such as microscopic, endoscopic, or percutaneous discectomy. The difference between these techniques and open discectomy is the newly refined use of microscopes or endoscopes and small surgical instruments that necessitate only a much smaller incision. Smaller incisions result in less patient morbidity and quicker recovery from surgery.

TREATMENT OPTIONS

Non Surgical
Based on your doctors recommendation, the first option will usually be a non-surgical action such as short periods of bed rest or medications that can reduce swelling and decrease pain. Physical therapy can also be turned to, as well as customized exercises or epidural steroid injection therapy. Patients experiencing pain should meet with a doctor to discuss their symptoms in full detail, to pinpoint the cause, and then explore these non-surgical options.

Percutaneous Treatments
If these conservative treatments don’t help, or if something less invasive than herniated disc surgery is desired, patients could turn to some new procedures that make use of small surgical instruments which are inserted into the middle of the disc in order to destroy or remove the disc material. These instruments include suction devices, cutting tools, and laser. The goal of all of these methods is to remove or destroy the central disc (nucleus) in the hope that the disc material that has been pushed outward will be drawn back into the disc. These procedures are not well researched and are considered experimental.

Surgical: Percutaneous Discectomy
This is the least invasive of the surgical procedures. Surgery is considered if non-surgical treatment does not relieve symptoms. To relieve nerve pressure and leg pain, Percutaneous Lumbar Endoscopic Discectomy can be used and is different from standard lumbar disc surgery because there is no muscle dissection or bone removal. There is only one tiny incision to accommodate the micro-instruments, inserted into the herniated disc. Most complications that occur with surgery are eliminated with percutaneous lumbar endoscopic discectomy. Generally, patients who do not obtain relief within three to six weeks may be considered for microsurgical disc removal, depending on the circumstances. The use of the percutaneous discectomy procedure usually does not limit or hinder the subsequent use of micro-surgical procedures to remove discs. You can expect to go home on the same day as a routine percutaneous discectomy.

Standard micro-surgical procedures or endoscopic surgery usually involves a partial disc removal or discectomy. In addition, the surgeon may need to access the herniated disc by removing a portion of the bone covering the nerve. Fortunately, these procedures can often be done utilizing minimally invasive techniques. Minimally invasive or endoscopic surgery does not require large incisions, but instead uses small cuts and tiny specialized instruments and devices such as a microscope and endoscope during the operation.

Open surgery for a complete discectomy may be performed in preparation for fusion or other total disc procedures that should be considered as a last resort.

Endoscopic Surgery Pros			Open Surgery Cons
•	small size (2.8.mm-5mm skin opening to be closed with a steri-strip and Band-Aid - No stitches)		•	the degree of exposure is a benefit, but the extensive surgical exposure and prolonged periods of retraction can seriously injure the major muscles of the back and, in turn, cause considerable post-surgical pain
•	precise control		•	not as precise
•	visualization while working		•	hands can block view
•	no access damage		•	muscles and nerves may need to be cut or stretched for access
•	local anesthesia		•	general anesthesia
•	costs less		•	longer hospital stay = more costs
•	lowest morbidity of all invasive treatment options		•	higher morbidity rate
•	shortened hospital stay and a faster recovery		•	longer hospital stay
•	more detailed view of the operative site for more precise work		•	microscope may not be able to access area
•	reduced wound complications associated with large scars		•	greater chance of wound complications associated with large scars
•	less need for post-surgical pain medication, faster return to normal activities		•	greater need for post-surgical pain medications

Degenerative Disc VS. Herniated Disc

Degenerative disc disease is a common cause of low back pain.  Another common condition affecting the disc is disc herniation.  A disc herniation in the low back can press on the nerves that supply the leg, causing pain, numbness or even weakness in the leg.  Herniated disc usually cause more leg pain than back pain, whereas degenerative discs usually cause more back pain than leg pain.

Many herniated discs heal without surgery, but if surgery is needed, it generally entails removing the part of the disc that is pressing on the nerve (Microscopic Discectomy).  This procedure can be performed through a small incision with the use of the operating microscope.

On the other hand, discectomy surgery is generally not effective for degenerative disc disease.  Fusion of the degenerative disc is usually more effective in resolving the pain of degenerative disc disease, in those patients who don’t get better with non-surgical care. Learn about disc fusion here.