What's the Latest in Treatment for Lumbar Disc Herniation?
Low back pain from disc herniation is still a common problem patients and doctors face everyday. With all the improvements in drugs, treatment, and technology patients may wonder, "Is there anything new in the treatment of lumbar disc herniation? Is it still the old standby: antiinflammatory drugs, physical therapy, and maybe surgery?"

Researchers from the New York University Hospital for Joint Diseases took the time to review articles published on this topic. Results were compared for traditional, alternative, and surgical treatment.

The authors found no advantage of one treatment over another. Some patients still seem to get better on their own with time and nature's healing. Others only get better after surgery. Some don't get better at all.

A flow chart or algorithm is given for making treatment decisions. The first six to eight weeks is devoted to nonoperative care. Research does not support the use of acupuncture, massage, lumbar supports, or spinal manipulation during this acute phase. Physical therapy and exercise are often a good way to reduce pain. The number of days missed at work is also limited. Surgery right away is advised for patients with severe neurologic problems with or without pain.

Patients should see the doctor again after eight weeks. Decisions about care and management depend on progress made so far. The physician and patient must decide what to do. Should the nonoperative care be continued? Should some other form of treatment be tried?

Surgery isn't advised for the patient who is slowly getting better. More testing may be needed for the patient who just isn't getting better. The same is true for the patient who has made very little progress. MRI is the best choice for diagnosing disc problems.

The authors say the best approach is one that looks at each patient one at a time. The anatomy and spinal pathology must be evaluated. The patient's social and economic factors should be considered. Treatment is also evaluated one stage at a time. There doesn’t seem to be a “one-size fits all” treatment for lumbar disc patients.
John N. Awad, MD, and Ronald Moskovich, MD, FRCS. Lumbar Disc Herniations. Surgical Versus Nonsurgical Treatment. In Clinical Orthopaedics and Related Research. February 2006. No. 443. Pp. 183-197.