Managing Disc Herniation: When to Consider Surgery or Alternative Treatments

Q: Managing Disc Herniation: When to Consider Surgery or Alternative Treatments

Hello： 1. <br>Your description seems to indicate a lumbar spine issue causing sciatica. <br>However, a detailed examination is still necessary, such as X-rays and MRI (Magnetic Resonance Imaging). <br>2. <br>If physical therapy focusing on core muscle training is ineffective, you

Herniated disc

Hello Dr.
Lai: My current symptoms include left lower back pain, weakness in my left leg, and weakness in my toes, which sometimes feel numb.
Since I am abroad, the doctors here have recommended physical therapy.
I have been undergoing physical therapy for three months, primarily focusing on core muscle training, unlike in Taiwan where there are also lumbar traction treatments.
My condition fluctuates, but overall it is worse than when it first started.
Initially, I could sit for about half an hour without much discomfort, but now I feel uncomfortable after sitting for more than five to ten minutes.
Sitting for just over ten minutes quickly leads to numbness in my left toes or sharp pain in my left groin, which is very uncomfortable.
Riding the bus causes significant discomfort due to the jostling.
Usually, lying down for an extended period helps a bit, but my back remains very tight.
I can hardly sit now; I can only lie down or stand.
My condition is even worse than when it first began.
Should I continue focusing on core muscle training, or should I try traction therapy? Or is surgery an option? I would appreciate your advice.

AK, 30~39 year old female. Ask Date: 2016/05/21

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
Your description seems to indicate a lumbar spine issue causing sciatica.
However, a detailed examination is still necessary, such as X-rays and MRI (Magnetic Resonance Imaging).
2.
If physical therapy focusing on core muscle training is ineffective, you may consider lumbar traction (but if there are fractures or dislocations, or if traction increases pain, it is not appropriate to proceed with traction).
3.
<>: A personal consultation is required.
A physician experienced in spinal surgery needs to evaluate your symptoms, X-rays, and MRI to provide you with an answer.
Additionally, there are several surgical options available; determining which one is suitable for you also requires a personal consultation.
Wishing you a speedy recovery.
// Dr.
Lai Chao-Kang, Chief of Spine Neurosurgery, Changhua Hospital.

Reply Date: 2016/05/21

More Info

Managing disc herniation can be a complex process, especially when symptoms persist despite conservative treatment. Based on your description, it seems that your condition has not improved significantly with physical therapy, and you are experiencing increasing discomfort and functional limitations. Here’s a comprehensive approach to understanding your situation and considering the next steps.

Understanding Your Symptoms
Your symptoms of left lower back pain, weakness in the left leg, and numbness in the toes suggest that there may be nerve involvement, likely due to a herniated disc compressing the spinal nerves. The fact that your symptoms worsen with prolonged sitting and improve when lying down is typical for disc herniation, as certain positions can relieve pressure on the affected nerves.

Conservative Treatment
Physical therapy is often the first line of treatment for disc herniation. The goal is to strengthen the core muscles, improve flexibility, and reduce pain. However, if you have been undergoing physical therapy for three months without significant improvement, it may be time to reassess the treatment plan.
1. Core Strengthening: While core strengthening is essential, it should be complemented with other modalities. If your current therapy focuses solely on core exercises, consider discussing with your therapist the inclusion of other techniques such as:
- Manual therapy: Techniques that involve hands-on manipulation of the spine and surrounding tissues.

- Flexibility exercises: Stretching can help alleviate tightness in the back and legs.

- Pain management modalities: Such as heat, ice, or electrical stimulation.

2. Traction Therapy: If your current physical therapy does not include spinal traction, it might be worth considering. Traction can help relieve pressure on the spinal discs and nerves, potentially alleviating pain and improving mobility.

When to Consider Surgery
Surgery for disc herniation is generally considered when conservative treatments fail, and the patient experiences significant pain, weakness, or loss of function. The following criteria can help determine if surgery is appropriate for you:
1. Persistent Symptoms: If your symptoms have not improved after 6-12 weeks of conservative treatment, surgical options may be warranted.

2. Severe Symptoms: If you experience severe weakness, loss of bowel or bladder control, or significant impairment in daily activities, these are indications for surgical intervention.

3. Quality of Life: If your pain significantly affects your quality of life and daily functioning, surgery may be a viable option.

Types of Surgical Options
If surgery is deemed necessary, the most common procedures include:
- Microdiscectomy: This minimally invasive procedure involves removing the portion of the herniated disc that is pressing on the nerve.

- Laminectomy: This involves removing a portion of the vertebra to relieve pressure on the spinal cord or nerves.

- Spinal Fusion: In cases where instability is present, fusion may be performed to stabilize the spine.

Next Steps
1. Consultation with a Specialist: If you have not already, consider consulting a spine specialist or neurosurgeon. They can provide a thorough evaluation, including imaging studies like MRI, to assess the extent of the herniation and nerve involvement.

2. Reassess Physical Therapy: Discuss your ongoing symptoms with your physical therapist. They may need to modify your treatment plan or refer you to a specialist who can provide additional interventions.

3. Consider a Pain Management Specialist: If pain is a significant issue, a pain management specialist can offer various treatments, including injections or medications that may provide relief.

Conclusion
In summary, while conservative treatment is essential, your worsening symptoms may necessitate further evaluation and possibly surgical intervention. It’s crucial to work closely with healthcare providers to determine the best course of action tailored to your specific condition. Remember, the goal is to alleviate pain, restore function, and improve your quality of life.

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