THE #1 Neurosurgeon Recommended Treatment For A Herniated Disc
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What is the best treatment
What is the best treatment for a herniated disc?
Most people with a herniated disc will get better on their own without the need for further treatment over days to weeks. Pat had a history with the clinic, so he came to see us. But for most people the best treatment for pain from a herniated disc depends on how long you have had it.
First Six Weeks
We advised Pat to try rest, moist heat, and anti-inflammatory drugs. Rest means light activity. Tylenol is the safest anti-inflammatory drug. If Tylenol is not enough, you can try ibuprofen (2 tablets every 8 hours with food) or Alleve (one tablet every 12 hours) and Prilosec (one tablet a day). Prilosec is to prevent an ulcer caused by acid due to Alleve or ibuprofen. You can consider acupuncture or chiropractic treatment. Braces and exercise do not work well in this phase. Narcotics and muscle relaxants should be avoided.
Pat did not have any red flags. If he did, he would need to see a surgeon on an emergency basis, the same day.
Although not severe, Pat’s leg pain was associated with numbness or weakness, so he got an MRI right away; most of the time an MRI is not needed in the first six weeks. Pat’s MRI showed a giant herniated disc. For herniated discs causing severe pain without numbness or weakness epidural injection is an option. Epidural injection relieves pain temporarily, buying you time for the body to heal. In Pat’s case, he skipped the epidural injection because he had so much hip weakness that if he was left in that position his gait would be permanently altered.
After 6 Weeks
Pat was referred to surgery because he had a giant disc herniation and motor weakness. Physical therapy may be considered in this phase. If 12 weeks (about 3 months) have gone by and someone still has the pain is something structural. Hang in there.
Many patients with herniated discs will choose epidural injection in this phase of recovery. Your doctor will get an x-ray of your back and refer you to physical therapy if appropriate. If you fail to improve over three weeks and there is a lot of leg pain, then your doctor will send you for an MRI of your lower back. If the MRI shows a herniated disc as the cause of your pain, then they may refer you to a pain management doctor for epidural steroid injection.
During the injection, a needle is placed under x-ray guidance outside your spine and a cocktail of steroid and numbing medicine administered.
Learn more about Epidural Injection - Phoenix Spine & Joint (phoenixspineandjoint.com)
No matter what, if you are not improved after 12 weeks (about 3 months), then your doctor will refer you to an orthopedic spine or neurosurgeon as appropriate.
After 12 weeks (about 3 months)
If you are still having trouble 12 weeks (about 3 months) after the pain started, then it is time to have an MRI if one was not done already and see a surgeon. They will advise you on any structural problem that may be treated in your back to relieve your pain. The use of microdiscectomy surgery was established by the surgeon experience, case series, and eventually a randomized controlled trial – the NIH sponsored SPORT (Spine Patient Outcomes Research Trial). Microdiscectomy surgery is considered the standard of care by professional societies and is covered by Medicare as well as all commercial health insurance for the treatment of MRI-confirmed lumbar disc herniation with motor or sensory deficit as well as uncontrolled pain after the failure of appropriate conservative care.
Most people with a herniated disc will get better on their own without the need for further treatment over days to weeks. Pat had a history with the clinic, so he came to see us. But for most people the best treatment for pain from a herniated disc depends on how long you have had it.
First Six Weeks
We advised Pat to try rest, moist heat, and anti-inflammatory drugs. Rest means light activity. Tylenol is the safest anti-inflammatory drug. If Tylenol is not enough, you can try ibuprofen (2 tablets every 8 hours with food) or Alleve (one tablet every 12 hours) and Prilosec (one tablet a day). Prilosec is to prevent an ulcer caused by acid due to Alleve or ibuprofen. You can consider acupuncture or chiropractic treatment. Braces and exercise do not work well in this phase. Narcotics and muscle relaxants should be avoided.
Pat did not have any red flags. If he did, he would need to see a surgeon on an emergency basis, the same day.
Although not severe, Pat’s leg pain was associated with numbness or weakness, so he got an MRI right away; most of the time an MRI is not needed in the first six weeks. Pat’s MRI showed a giant herniated disc. For herniated discs causing severe pain without numbness or weakness epidural injection is an option. Epidural injection relieves pain temporarily, buying you time for the body to heal. In Pat’s case, he skipped the epidural injection because he had so much hip weakness that if he was left in that position his gait would be permanently altered.
After 6 Weeks
Pat was referred to surgery because he had a giant disc herniation and motor weakness. Physical therapy may be considered in this phase. If 12 weeks (about 3 months) have gone by and someone still has the pain is something structural. Hang in there.
Many patients with herniated discs will choose epidural injection in this phase of recovery. Your doctor will get an x-ray of your back and refer you to physical therapy if appropriate. If you fail to improve over three weeks and there is a lot of leg pain, then your doctor will send you for an MRI of your lower back. If the MRI shows a herniated disc as the cause of your pain, then they may refer you to a pain management doctor for epidural steroid injection.
During the injection, a needle is placed under x-ray guidance outside your spine and a cocktail of steroid and numbing medicine administered.
Learn more about Epidural Injection - Phoenix Spine & Joint (phoenixspineandjoint.com)
No matter what, if you are not improved after 12 weeks (about 3 months), then your doctor will refer you to an orthopedic spine or neurosurgeon as appropriate.
After 12 weeks (about 3 months)
If you are still having trouble 12 weeks (about 3 months) after the pain started, then it is time to have an MRI if one was not done already and see a surgeon. They will advise you on any structural problem that may be treated in your back to relieve your pain. The use of microdiscectomy surgery was established by the surgeon experience, case series, and eventually a randomized controlled trial – the NIH sponsored SPORT (Spine Patient Outcomes Research Trial). Microdiscectomy surgery is considered the standard of care by professional societies and is covered by Medicare as well as all commercial health insurance for the treatment of MRI-confirmed lumbar disc herniation with motor or sensory deficit as well as uncontrolled pain after the failure of appropriate conservative care.
2 سال پیش
در تاریخ 1400/11/07 منتشر شده
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