Features February 2013 Issue

Solve Disc Problems Without Surgery

Medications, exercise and other conservative treatments can ease pain and keep you off the operating table.

Russell DeMicco, DO, compares a spinal surgeon to the ace relief pitcher in baseball: You’d like to keep him in the bullpen and never need him.

Fortunately, most people need only their “starting pitchers” (e.g. non-surgical treatments) to find relief from herniated spinal discs. An array of non-operative treatments can hasten your return to a pain-free spine and keep you swinging for the fences.

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Exercise and weight loss can help reduce the strain on your spine.

“The natural history of people with herniated discs is very favorable toward non-surgical measures,” says Dr. DeMicco, with Cleveland Clinic’s Center for Spine Health. “Probably 90 to 95 percent of people get better in a period of under 12 weeks without an operation.”

Damaged Discs
The spinal discs are designed to cushion the vertebrae and allow for smooth movement of your spine.  Trouble is your spine is built to last only about 30 years, at which point it begins a gradual decline, Dr. DeMicco says.

The discs, which consist largely of water encased in a tough fibrous outer ring, lose some of their fluid content and thus their flexibility and capacity to absorb stress. A herniation occurs when the gel inside the disc penetrates the fibrous casing and applies pressure to the nearby spinal cord or other spinal nerves.

Although discs in the neck also degenerate, most herniations occur in the lumbar region of the lower back. There, the nerves affected by the damaged discs can produce pain in the low back and buttock, but especially in the leg. Many people with disc herniations feel better when they stand or walk and worse when they sit, bend or lift. In severe cases, progressive numbness and leg weakness may develop.

“Most people associate a herniated disc with some type of injury, but only about a third of the time is there a specific inciting event,” Dr. DeMicco says. “A lot of times, you think you tweaked it or slept on it wrong, and then over the course of several hours to days or weeks, you go from a stiff back to full-blown pain shooting down your leg.”

Avoid the knife
Decades ago, doctors would recommend strict bed rest for people suffering from herniated discs. Today, those patients rest for no more than 24–48 hours before resuming activities, as tolerated.

“You’re trying to avoid the decondi­tioning syndrome, where you can lose 1 to 2 percent of your strength a day the less active you are,” Dr. DeMicco explains. “The more you lie in bed, the more likely it will be difficult to get out of bed when you need to.”

Over-the-counter analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can help ease pain while you get back on your feet, he says, as can heat, ice, electrical stimulation, and acupuncture. Some doctors also prescribe the anticonvulsant drug gabapentin (Neurontin), which has been shown to relieve some back pain.

Dr. DeMicco also recommends working with a physical therapist to develop exercises necessary to improve spinal strength and flexibility and ease your symptoms without causing further pain. If the pain prohibits you from staying active or if your improvement stalls, an epidural injection may be warranted.

“Recognize what the problem is and try out anti-inflammatories and then activities as usual,” Dr. DeMicco says. “If it doesn’t help, work on directed exercise with a physical therapist or seek an evaluation by a physician for a prescription medication, injections, and the other things we can offer, which usually will work. Lastly is surgery, but the majority of surgeons would recommend at least 12 weeks of treatment, with a good course of physical therapy, first.”