Treatment Options for a Herniated Disc
A disc is the tissue that serves as “padding” between two vertebrae in the spine (regardless of whether it is the cervical, thoracic, or lumbar spine). A herniated disc refers to a condition in which the outer layer of a disc ruptures and the soft-gel-like material on the inside extrudes into the surrounding tissue. This often results in the irritation of nearby nerves as the material comes into contact with them. The irritation can cause pain and other symptoms all along the nerve route beginning where the contact first happens.
Fortunately, there are ways of treating herniated discs. For example, one commonly used method is chiropractic care, available in Anchorage at multiple providers. Here is a list and discussion of the most prevalent techniques for dealing with herniated discs:
I. Non-Surgical Treatment Options
A. Chiropractic Care
Chiropractic is one of the most effective means of treating and preventing herniated discs in Anchorage patients. It most often involves the use of a technique known as “spinal manipulation.” This is a technique by which a chiropractor, using his hands, massages and manipulates the bones of the spine to gradually and gently restore proper posture and spinal alignment.
Poor posture is one of the most common underlying causes of spinal misalignment which, in turn, leads to herniated discs. If a chiropractor can realign the spine into a more natural posture, the problem disc may cease to extrude further material, heal, and repair itself. The already extruded material is then, over the course of some time, reabsorbed into the body.
A study on Science Direct found that chiropractic care (i.e. spinal manipulation plus education) was effective in treating a patient with post-surgical disc herniation.
Spinal manipulation (if appropriate)
Risks and benefits
Of course, as with any other medical technique, there are risks to chiropractic care. Typically, the most likely risk is simply a case of a sore back and other muscles. In rare cases, there may be nerve damage or other serious issues, but these are typically very rare, and usually the result of an unskilled chiropractor.
Where should you get chiropractic care?
B. Physical Therapy
- Guided exercises to strengthen back and core muscles
Physical therapy is another form of non-surgical treatment for a herniated disc. It, too, seeks to restore proper alignment in the spine, although in a subtly different manner than chiropractic care. It uses specific guided exercises to strengthen the muscles around the problem disc. These are usually the back and core muscles. Essentially, by strengthening these muscles, the muscles become more capable of keeping the spine in appropriate alignment while at the same time discouraging any developing poor posture.
- Stretching to relieve pressure on the disc
In addition to exercise, another tactic of physical therapy is stretching. These are usually specific stretches designed to open up the space between the vertebrae that surround the disc. Typical stretches include the cat/cow (from Yoga), knees-to-chest, and the piriformis stretch.
Where can you get physical therapy?
- Better Health Alaska
- The Physical Therapy Place, LLC
- Alaska Physical Therapy Specialists
- Advanced Physical Therapy – Anchorage
C. Medications
- NSAIDs (e.g., ibuprofen, naproxen)
Medications are also useful when dealing with a herniated disc. In particular, NSAIDs (Non-steroidal anti-inflammatory drugs) are often used to manage pain and reduce inflammation. This will allow the area around the disc to heal and absorb nutrients more effectively. It basically serves to prepare the area so that other treatments (like chiropractic care and physical therapy) are more effective.
- Muscle relaxants
Muscle relaxants are another medication used to, as the name suggests, relax the muscles. This reduces tightness, lessens pain, and allows for the flow of nutrient-laden blood to reach the problem area.
- Neuropathic pain relievers (e.g., gabapentin)
Neuropathic pain relievers (such as gabapentin, among others) serve to interrupt the nerve signal that carries the sensation of pain to the brain. They are designed to reduce pain – and they are fairly powerful. They are typically used when less-potent drugs are not doing the job. Note, though, that they work by blocking the nerve signal. As a result, they are not treating the condition. Rather, they are making the condition more bearable to live with.
D. Acupuncture
- Evidence on pain relief
Acupuncture is a practice that developed in the East. It involves inserting special needles into nerve points along the body. This, in turn, serves to block or alter the transmission of certain nerve signals. It has been used in the East for thousands of years.
A case study on PubMed in which a 52-year-old man underwent 23 days of acupuncture found that the acupuncture safely, and effectively treated a lumbar disc herniation.
- How it complements other therapies
Because it can be used to reduce pain, it can complement other therapies by making the pain more manageable. This, in turn, gives other treatments (like chiropractic care and physical therapy) more time to produce results. It is somewhat analogous to using some types of medications.
Where can you get acupuncture?
- Independence Park Medical Services Inc.
- Snow Blossom Acupuncture LLC – Wellness and Float Center
- Relaxupuncture
II. Minimally Invasive Treatments
A. Epidural Steroid Injections
- How they work
Epidural Steroid Injections are injected at the site of the damaged disc. They fill the area around the nerves being irritated by the disc. This, in turn, reduces inflammation and lessens the irritation. That means less pain, again giving other treatments more time for the healing process.
A study on PubMed (https://pubmed.ncbi.nlm.nih.gov/9791328/) found that 61% of patients in the study group who received Epidural Steroid Injections experienced a significant reduction in pain.
- Short-term vs. long-term effectiveness
Although they can help reduce for as much as three months at a time, they are not a long-term solution. Like other medications, they do not address the underlying problem – in this case, a herniated disc. That must be treated so that the extruding material is either reabsorbed by the body or removed.
Where can you get Epidural Steroid Injections?
- Alaska Center for Pain Relief, Inc.
- Algone Anchorage Interventional Pain Clinic
- Advanced Pain Centers of Alaska
B. Nerve Blocks
- Temporary relief for diagnostic or therapeutic purposes
Another method available to patients with a herniated disc is the injection of nerve blocks. These medications are used to block or shut off a specific nerve and the messages traveling along it. This can serve either of two purposes.
- It can be a means of diagnosis. That is, one can narrow down and determine which specific nerve is being irritated by the judicial use of and careful placement of nerve blocks.
- It can serve therapeutically like some of the other methods we’ve mentioned. Interrupting the signal to the brain can be used to relieve pain and make life more bearable while other methods are used to heal the problem.
Where can you get Nerve Blocks?
- Algone Interventional Pain Clinic
- Alpenglow Pain & Wellness
C. Percutaneous Discectomy
- Image-guided procedure to remove disc material
A minimally invasive surgery known as percutaneous discectomy can also be used to address a herniated disc. This is an image-guided procedure whereby the doctor uses a needle to remove the problematic disc material that is extruding from the disc.
- Faster recovery than open surgery
Because it is minimally-invasive, the healing time for a percutaneous discectomy is far less than for open surgery or other invasive surgical options. In fact, patients can often be sent home on the same day as the procedure, having to wait only a few hours.
Where can you get a Percutaneous Discectomy?
- Alaska Surgical Group
- Alaska Spine Center
- Algone Anchorage Interventional Pain Clinic
III. Surgical Options
A. Microdiscectomy
- Indications (e.g., severe sciatica, neurological deficit)
Microdiscectomy, a form of true surgery, can be used to treat a herniated disc. It is, however, usually only used in severe situations. Such situations include cases of severe sciatica, or other situations that involve a neurological deficit of some sort (i.e. numbness, tingling, weakness, difficulty walking, or other abnormal issue).
A study on PubMed (https://pubmed.ncbi.nlm.nih.gov/32081830/) found that Microdiscectomy is “an effective and safe treatment.”
- Procedure overview
The procedure requires the doctor to cut the patient open and remove whatever materials are necessary to free up the affected nerve. These materials may include bits of bone, ligaments, or other types of tissue from the surrounding areas.
- Recovery time
Recovery time for a microdiscectomy ranges from six to twelve weeks for most people. Of course, this number can be influenced by a number of factors, such as severity of the original condition, age and health of the patient, and other things.
Where can you get Microdiscectomy?
- Alaska Medical Center – Providence
- Anchorage Neurosurgical Associates
- Algone Anchorage Interventional Pain Clinic
B. Laminectomy or Laminotomy
- When it’s needed (e.g., spinal stenosis with disc herniation)
Laminectomy and laminotomy are two similar procedure that are sometimes needed when a disc herniation occurs in conjunction with another condition called spinal stenosis (a narrowing of the spinal canal – the space through which the spinal nerve passes. When these conditions occur together, the spinal nerve is compressed by a combination of both material from the herniated disc and a lessening space in the spinal canal.
These two procedures are used to remove a material known as lamina which forms part of vertebrae that make up the spine. A laminotomy is a partial removal of this material, and laminectomy is a full removal of this material.
- Risks and outcomes
Typical risks of these procedures include: pain, a several-week recovery time, and even laminectomy-syndrome. That last refers to enduring pain in the back, legs, or even both. A short list of places to go:
- Providence Alaska Medical Center
- Anchorage Neurological Associates
C. Spinal Fusion (in select cases)
- Stabilization following disc removal
Sometimes, in the most extreme situations, a spinal fusion may be called for. This procedure involves the fusion of two vertebrae (or more). It is done to provide stability to the spine and improve or help retain mobility for the patient.
- Pros and cons
Pros include: a reduction in pain (after full recovery), the retention of the ability to move, stabilization of the spine, and correction of certain spinal abnormalities. Cons include: the risk of nerve damage from the surgery, reduced range of motion, and the fact that sometimes the fusion doesn’t take or hold. Lastly, recovery time for a spinal fusion can take as long as two years.
Where should you go?
- Providence Alaska Medical Center
- Alaska Spine Center
- Anchorage Neurological Associates
Conclusion:
As noted in the beginning of this post, there are a variety of options available to a patient with a herniated disc. A rule of thumb in medicine is to seek out and exhaust non-invasive, conservative methods first. The list above is roughly in the order of increasing invasiveness.
Basically, when possible, it’s best to start with the conservative methods like chiropractic care and physical therapy and then work your way down the list. Of course, every individual is unique, and some situations may require the use of different therapies. In some cases, surgery may be the first and only option necessary. Ultimately, the very first thing you should always do is consult a medical professional.
Here, at Better Health Alaska, we’ve been serving the Anchorage area for over 25 years. We have chiropractors, physical therapists, and more at our disposal – and, of course, a wealth of medical knowledge to get you pointed in the right direction.
