Oh, My Aching Back! Treatment Options for Herniated Disks

Call it what you want -- ruptured disk, herniated disk, bulging disk, compressed disk, prolapsed disk or slipped disk – it all means one thing, pain. Pain when you sit down. Pain when you bend over. Sharp pain in your back or down one of your legs.

I caught up this week with Dr. Daniel Kitchens, board certified neurological surgeon on staff at Des Peres Hospital, who reviewed the wide range of treatment options for this condition, both non-surgical and surgical. 

"People in their 30s through 50s are at the greatest risk of suffering from a herniated disk," said Dr. Kitchens. "This condition occurs when disks, which act as soft cushions between the bones of the spine, begin to flatten and become less flexible as people grow older. If the outer part of the disk tears, or ruptures, the inner part pushes through to press on nearby nerves."

Diagnosing a herniated disk usually involves reviewing the patient’s medical history and a physical exam. An X-ray may be taken to show potential causes of pain or rule out other conditions, such as a tumor. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can be performed for a more detailed look at the spine. A myelogram, which involves injecting a contrast dye into the spinal canal, may be used to detect pressure on the spinal cord. An electrical nerve conduction test can be done to identify signs of nerve damage.

"Non-surgical treatment of herniated disks is effective in treating more than 90 percent of patients," said Dr. Kitchens.   He cautioned that one or two days of bed rest may help alleviate pain, but any more than that may slow down recovery.

He noted that pain medications, such as acetaminophen, may help relieve discomfort. Non-steroidal anti-inflammatory drugs, including aspirin and ibuprofen, can lessen pain and reduce inflammation. Muscle relaxants may be prescribed for constant back spasms. Up to three corticosteroid injections in the affected area may be given to relieve pain. Physical therapy, in conjunction with prescribed medications, also may help lessen discomfort.

"Most people feel better after about a month," said Dr. Kitchens. "But you should talk with your doctor if your symptoms persist after four to six weeks. You may be a candidate for surgery."

He said the most common surgery to treat a herniated disk of the lumbar (lower) spine is open diskectomy. This procedure involves removal or partial removal of a disk to relieve pressure on a nerve. A diskectomy may be performed in conjunction with a laminotomy, which involves making an opening in the lamina (the back part of the bone over the spinal canal) to reach the herniated disk. A laminectomy could be done to remove most of the lamina. Surgery is performed under general anesthesia. Patients can expect to stay in the hospital one night and return to work in two to six weeks.

You are not alone if you have ever suffered from back pain. As many as eight or nine in 10 people are affected by back pain at some point during their lives. Herniated disks are not always the reason, so it is important to talk to your doctor to find out what is causing your back problems.