The big question is: At what point does conservative treatment for a herniated disc switch over to decompression treatment?
A herniated disc can be treated with conservative means or with a technique called percutaneous disc decompression.
A herniation is when part of the disc, the sponge-like shock absorber between vertebral bones, protrudes or bulges outside the space that it’s supposed to be confined to.
The protruding portion then presses on nerves coming out of the spine, namely the sciatic nerve.
Conservative treatment is typically physical therapy, epidural steroid injections, muscle relaxants and anti-inflammatory drugs.
In disc decompression, the disc is deflated. This gives the nerve root space, mitigating nerve root irritation, alleviating the patient of pain.
The disc is deflated by first puncturing it with a needle and then removing some of it, or using energy to dissolve some of the tissue.
Disc decompression is an outpatient procedure utilizing local anesthesia. Patients usually can resume normal activities within 30 days.
Conservative Treatment of a Herniated Disc vs. Decompression
“In general, surgery carries risks associated with it including death, so conservative treatment is always better initially if possible,” says Melissa Franckowiak, MD, an anesthesiologist in Lockport, NY.
“This includes rest, ice and analgesics. Conservative treatment is also unlikely to improve many work-related injuries or automobile related injuries, with some studies showing only one-third of patients improving, one-third with no change in symptoms and one-third getting worse in these populations.
“Many times, however, once the swelling and inflammation of the acute injury settles, surgical decompression becomes unnecessary.
“However, if a disc herniation is large enough, and the disc contents are extruding through the posterior spinal structures, even rest and anti-inflammatories are unlikely to completely relieve the pain.
“Surgical decompression can improve the symptoms dramatically when they are severe and acute.
“Additionally, if there is neuropathy, chronic, longstanding muscle weakness from nerve compression, or acute compression causing bowel or bladder dysfunction, surgical decompression may be required emergently.”
- Always try a good course of multiple conservative approaches first for your disc herniation before considering any kind of surgical technique.
- Be faithful to your therapy exercises; don’t skip any or else you’ll never know what the outcome may have been.
- Get a second, even third opinion if the situation becomes vexing.