Treatments

Non-Surgical Treatment Methods for Lumbar Disc Herniation

Posted on by Prof. Dr. Özgür KILIÇKESMEZ

Lumbar herniated disc is a condition that arises from structural deterioration of the intervertebral discs and reduces quality of life. Non‑surgical treatment methods are preferred to make the patient’s daily life more comfortable. Among the interventional methods developed for herniated discs are epidural steroid injections, percutaneous discectomy, intradiscal electrothermal therapy (IDET), and endoscopic discectomy. These methods aim, using minimally invasive techniques, to reduce inflammation, alleviate pain, and improve function. Generally applied as alternatives to open surgery, these treatments target symptom relief in patients.

What Are Non‑Surgical Treatment Methods for Lumbar Herniated Disc?

Non‑surgical treatment methods for lumbar herniated disc include various minimally invasive techniques to improve patients’ quality of life and relieve pain symptoms. These options include epidural steroid injections administered directly into the epidural space to reduce inflammation and pain, providing relief. Percutaneous discectomy aims to remove disc material via a small incision to relieve nerve compression. In addition, oxygen‑ozone injections use the biochemical properties of ozone gas to reduce disc pressure and inflammation. The FDA‑approved Barricaid annular closure device is an advanced solution used after discectomy to minimize the risk of re‑herniation. These methods offer patients a non‑surgical path to recovery.

When Are Non‑Surgical Treatment Methods Used in Lumbar Herniated Disc?

Non‑surgical treatment methods are generally used when conservative treatments are insufficient and symptoms significantly impair the patient’s daily quality of life. Such methods are chosen to reduce pain, control inflammation, and increase mobility without the need for surgery. The main non‑surgical treatment options for lumbar herniated disc include:

  • Epidural steroid injections
  • Percutaneous laser disc decompression (PLDD)
  • Ozone discectomy
  • Radiofrequency disc ablation

Epidural steroid injections are performed by injecting corticosteroids directly into the affected area to relieve radicular pain (sciatica) associated with herniated disc. This method is especially recommended for patients whose daily activities are severely limited but do not require surgical intervention.

Percutaneous laser and radiofrequency disc decompression generate heat via laser or radiofrequency energy to reduce excess intradiscal pressure. Preferred for radicular pain and mild disc herniations, these methods reduce disc material to relieve nerve root compression.

In ozone discectomy, ozone gas is injected into the disc to cause a shrinkage effect that reduces compression.

Selecting the appropriate method for herniated disc treatment depends on the patient’s anatomy, pain severity, and individual characteristics. Therefore, a detailed evaluation and imaging studies are required before intervention.

Who Is Not a Candidate for Non‑Surgical Treatment Methods in Lumbar Herniated Disc?

Non‑surgical treatment methods for lumbar herniated disc may not be suitable for some patients. Procedures such as epidural steroid injections, spinal cord stimulation, prolotherapy, anterior cervical discectomy and fusion, and percutaneous disc decompression techniques carry risks for individuals with certain health conditions and anatomical features. Contraindications affecting applicability include the patient’s overall health, presence of infection, bleeding risks, and certain psychological conditions. The following lists who is not suitable for these treatments:

Epidural Steroid Injections

  • Infection
  • Bleeding disorders or anticoagulant therapy
  • Allergy to corticosteroids or anesthetics

Spinal Cord Stimulation

  • Bleeding disorders
  • Infection
  • Pacemaker or defibrillator
  • Anatomical barriers
  • Psychological issues

Percutaneous Disc Decompression Techniques

  • Calcified discs
  • Uncontrolled disc herniation
  • Disc height loss over 50%

Patients should undergo a thorough evaluation before undergoing these treatments. Alternative options should be considered for individuals with systemic diseases, bleeding tendencies, or psychological problems.

How Are Non‑Surgical Treatment Methods Applied in Lumbar Herniated Disc?

These methods aim to reduce pressure and nerve irritation caused by herniated discs without surgery. While application details vary, all aim to perform the procedure with minimal tissue damage. Each method follows specific procedures to achieve its goals, including:

  • Epidural Steroid Injections (ESI): Injecting corticosteroids into the epidural space to reduce inflammation and relieve pain.
  • Percutaneous Disc Decompression: Removing part of the nucleus pulposus to reduce intradiscal pressure.
  • Nucleoplasty: Vaporizing disc tissue with radiofrequency energy.
  • Percutaneous Laser Disc Decompression (PLDD): Reducing disc volume with laser to alleviate nerve compression.
  • Radiofrequency Ablation (RFA): Targeting pain-transmitting nerves to interrupt signal transmission.
  • Intradiscal Electrothermal Therapy (IDET): Heating intradiscal tissue to coagulate nerve endings and reduce pain.
  • Chemical Nucleolysis: Injecting enzymes to shrink disc volume and relieve nerve compression.

Choice of procedure depends on the patient’s clinical condition, symptom severity, pain duration, and anatomy, as well as response to prior conservative treatments. These techniques were developed to preserve spinal health, shorten recovery time, and enable faster return to daily activities.

What Are the Side Effects of Non‑Surgical Treatment Methods in Lumbar Herniated Disc?

Non‑surgical treatment methods for lumbar herniated disc include various minimally invasive procedures to relieve patient symptoms. However, each method carries its own complications and risks that can affect overall health and treatment course. Potential complications include:

Percutaneous Laser Disc Decompression (PLDD)

  • Thermal injury
  • Infection
  • Re‑herniation
  • Dural tear
  • Nerve root injury

Chemical Nucleolysis

  • Allergic reactions
  • Chemical radiculitis
  • Infection

Despite being minimally invasive, these methods can lead to serious complications. Therefore, individualized treatment planning and experienced practitioners are essential.

How Successful Are Non‑Surgical Treatment Methods in Lumbar Herniated Disc?

Success rates vary by technique and individual patient health. Interventional treatments for herniated discs aim to alleviate pain and other symptoms while minimizing complications. These methods are considered alternatives to surgery. Key factors affecting success include:

  • Conservative management: physical therapy, medication, lifestyle changes
  • Chemical nucleolysis: enzyme injection
  • PLDD: laser energy to reduce nerve compression

Advances in technology have improved efficacy and reduced complications. Endoscopic and laser‑assisted techniques in particular shorten recovery and enable quicker return to daily life. New technologies and implant systems offer advantages in patient satisfaction and functional outcomes compared to traditional fusion surgeries.

How to Prepare for Non‑Surgical Treatment Methods in Lumbar Herniated Disc?

Preparation involves several steps to ensure patient safety and treatment success, including pre‑procedure planning, patient education, and medical optimization. First, a comprehensive evaluation of general health, neurological status, and imaging studies is performed. Informed consent is obtained through patient education on benefits, risks, and alternatives. Chronic disease management and medication adjustments, particularly for bleeding risk, are part of medical optimization.

Infection control includes antibiotic prophylaxis and aseptic techniques. Finally, postoperative planning covers discharge instructions, wound care, and follow‑up scheduling.

What Is Post‑Procedure Care After Non‑Surgical Treatment Methods in Lumbar Herniated Disc?

Post‑treatment care is crucial to accelerate healing, reduce pain, and minimize recurrence risk. Key steps include physical rehabilitation, pain management, activity modifications, and follow‑up. Care steps are:

  • Physical rehabilitation
  • Start with gentle movements
  • Participate in physical therapy
  • Aerobic stretching and strengthening exercises
  • Pain management: analgesics or NSAIDs
  • Alternative therapies: acupuncture
  • Activity modification: ergonomic adjustments
  • Avoid prolonged sitting or standing
  • Lifestyle changes: regular exercise, healthy weight, no smoking
  • Monitoring and follow‑up: regular doctor visits, imaging as needed
  • Patient education and self‑management: symptom tracking, seek help if worsened

Self‑management, where patients monitor and observe their symptoms, is critical for faster and more lasting recovery.

How Does Resistance to Non‑Surgical Treatment Methods Develop in Lumbar Herniated Disc?

Resistance mechanisms to non‑surgical treatments pose challenges in patient care. These resistances arise from various biological and structural factors and can reduce treatment efficacy. Contributing factors include:

  • Persistent inflammation and scar tissue formation
  • Recurrent or persistent disc herniation
  • Neovascularization and dysregulated immune response
  • Matrix degradation and imbalance in remodeling
  • Mechanical factors and structural imbalances
  • Effects of infection and microbial factors

These mechanisms can lead to chronic pain and dysfunction despite treatment. Understanding them requires considering individual risk factors and developing new strategies.

Frequently Asked Questions

Physical therapy can be effective in some cases of lumbar herniated disc; a portion of cases improves spontaneously within a few months. Supervised exercise programs have been shown to significantly reduce pain and disability. Interventions such as McKenzie exercises and manual therapy, applied twice weekly in a 10‑session program, yield marked improvements in pain and functional limitations. Physical therapy enhances flexibility, muscle strength, and posture, reducing spinal nerve pressure and alleviating symptoms. It offers a non‑surgical, effective treatment option.

Manual therapy methods for herniated disc include spinal manipulation, mobilization, and soft tissue therapy. Spinal manipulation involves high‑velocity, low‑amplitude thrusts to improve alignment and mobility. Mobilization uses gentler, controlled movements to enhance joint function. Soft tissue therapy targets muscle and fascial tension to increase flexibility. Studies show combining manual therapy with exercise significantly reduces pain and movement restrictions. However, techniques must be tailored by a specialist.

Exercise is a key component, reducing pain and improving function. Research indicates exercise significantly lowers pain levels and improves lumbar range of motion. Motor control exercises effectively improve function in symptomatic lumbar disc herniation. Suspension exercise training also shows marked improvements in pain and disability scores. Targeted exercise programs offer substantial benefits in symptom relief and quality of life.

Ozone therapy for lumbar disc herniation involves injecting an oxygen‑ozone mixture into the affected disc to reduce volume and relieve nerve pressure. Clinical studies demonstrate its efficacy: in one study of 34 patients, 85% experienced pain reduction and 82% reported satisfactory results. In another study of 600 patients, success rates were 70.3% with ozone alone and 78.3% when combined with corticosteroids and anesthetics. Meta‑analyses show significant pain reduction and functional improvement. In a study of 149 patients, pain and disability scores dropped significantly with no serious adverse events. Low complication rates and high success make ozone therapy an alternative for patients unresponsive to conservative methods.

Non‑surgical methods, especially ozone therapy, can yield significant symptom improvement. Studies show about 63% of patients experience herniation regression. Ozone studies report 70.3% of patients achieving excellent or good results with intradiscal and periganglionic injections. Another meta‑analysis confirms significant pain reduction and functional gains. However, full recovery depends on individual factors and some patients may still require surgery.

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