Understanding Spinal Disk Problems -- Diagnosis & Treatment
What Are the Treatments for Spinal Disk Problems? continued...
Physical therapy and exercises to strengthen the back and abdominal muscles may be helpful in the long term.
Transcutaneous Electrical Nerve Stimulation (TENS)
One treatment option for temporary pain relief of a disk problem is transcutaneous electrical nerve stimulation (TENS), in which a device applies a small electrical current to critical points along the path of a nerve. TENS is not painful and also may be effective therapy for diabetic neuropathy. However, TENS for chronic low back pain is not effective and cannot be recommended, according to the American Academy of Neurology (AAN).
Another nonsurgical treatment option is acupuncture. It's not clear how acupuncture works, but some patients get significant relief. Some spine surgeons and pain management specialists consider the use of acupuncture controversial.
Epidurals Steroid Injections (ESI) involve putting steroids and a local anesthetic into the space outside the sac of fluid around the spinal cord. The local anesthetic provides short-term relief and the steroid reduces the inflammation that occurs because of the disk herniation. This treatment option is recommended when pain persists despite pain medications, modified activity, and physical therapy.
Surgery for Spinal Disk Problems
When a herniated disk causes weakness or paralysis of the nerves that control muscles of the back and limbs, or if you lose control of your bladder or bowels because of the damaged disk, your doctor will recommend surgery.
Surgery may also be recommended for those who have persistent symptoms despite conservative treatment. The decision for surgery for pain alone (absent any neurological findings) must be carefully considered, because although pain may improve in the short term, clinical studies do not support a long-term benefit.
A surgeon may use a hollow needle to remove some of the soft core of a swollen disk so that it no longer puts pressure on a nerve. Other microsurgical procedures can remove fragments of core disk material that have broken through the fibrous outer wall.
Diskectomy is the surgical removal of part of a herniated disk that is done to relieve pressure on the nerve. In this procedure, the core of the disk is removed, leaving the tough outer casing in place between the vertebrae.
Fusion (surgically fusing vertebrae together to immobilize them) can also be done for back instability. It sometimes brings long-term relief, but there is no guarantee of permanent recovery.
Another surgical option is a procedure called a laminotomy, in which a small amount of vertebral bone is removed to relieve pressure on the nearby nerve.
Any invasive therapy near the spinal cord has the potential for serious side effects and long-term complications; surgery should be undertaken when the potential benefit is greater than the risks -- when the herniated disk is causing weakness or paralysis of nerves going to muscles or serving basic body functions, such as bowel or bladder function.