What's the Best Treatment for a Herniated Disc?
There's no cure for chronic low back pain (CLBP). There's not even a best treatment known for certain conditions. Take for example, a herniated disc. Studies have not been able to show that one treatment is better than another for mild disc protrusion. In this article, overall research results are reported using minimally invasive nuclear decompression for disc protrusion.
Decompression refers to taking pressure off the spinal cord or spinal nerve from the protruding disc material. The specific decompression technique used was the disc nucleoplasty. Nucleoplasty is the removal of just the inner core of the disc, leaving the outer covering intact.
A radiofrequency device vaporized the disc material. High-voltage bipolar radiofrequency energy heats up and destroys the inner nuclear portion of the disc. This thermal ablation technique seems to cause the disc to implode inwardly.
The result is a lower nuclear pressure thus reducing tension on the nerve tissue. In fact, reducing volume inside the disc by even just a small amount causes a large drop in intradiscal pressure. The effect is immediate. The advantage of this method over a spinal fusion is the low cost and minimally invasive approach.
It's not known yet how the decrease in nuclear pressure affects the outer portion of the disc. And it's not clear how much of the nuclear tissue must be destroyed to have the desired effect. It's possible that only a few, small channels need to be made into the disc center via thermal ablation. Studies so far support the idea that removing large amounts of disc material is linked with worse symptoms and delayed return to sports participation.
Studies report between 20 and 80 per cent effectiveness of nucleoplasty for disc herniation. Measures used to assess results included pain relief, patient satisfaction, and improvements in sitting and standing. This wide range of response may be due to the size of the study and the lack of complete follow-up data. None of the studies had a valid control (comparison) group.
The authors believe that surgical decompression is a good way to treat disc herniation. In the future, this technique will be improved. Minimal tissue will be destroyed. Restoring disc tissue to normal may even be possible. At the very least, disc height will be maintained. And if the disc collapses, it will do so slowly enough to allow the body to adjust.
For now, the nucleoplasty should be tried before the more invasive spinal fusion or removal of the entire disc. Nucleoplasty is not recommended for patients with back pain alone. The chances of pain relief are 50-50 (same as not having the surgery). The procedure is best done on patients with mild protrusions causing back and leg pain.
Richard Derby, MD, et al. Evidence-Informed Management of Chronic Low Back Pain with Minimally Invasive Nuclear Decompression. In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 150-159.