A letter from Dr. Hanson
I am an orthopedic spine surgeon in Minnesota that specializes in endoscopic spine surgery to treat disc herniations. I personally have had three disc herniations and surgery to treat one of them. Most of the time, non-surgical management results in an 80-90 percent resolution in symptoms. That said, dealing with the pain and neurological symptoms can be very persuasive to get some help. Here is what I’d suggest:
1. Start with short-term use of over-the-counter medications that you can tolerate, such as acetaminophen and ibuprofen. It is generally okay to combine the two medications unless you have a medical condition preventing the use of these medications. Make sure to not take more than 4000mg per day of acetaminophen.
2. Look online for exercises to treat a lumbar or cervical disk herniation. We have some of these on my website. Download a copy of my resource, Stretches & Tips For Your Spine Wellbeing.
3. Consider a telemedicine or primary care visit. This is a great first step in initiating treatment and provides the opportunity to obtain prescription medication and document the onset of treatment for your insurance company. For insurance purposes, make sure the provider recommends over-the-counter medication and provides a home exercise plan. This will help you meet insurance requirements to obtain an MRI scan. We provide these through my clinic and have been a great way to help people, especially during the COVID-19 pandemic.
4. Consider starting oral steroids, such as a Medrol dose pack. This isn’t such a good idea if you are an insulin-dependent diabetic, but for other people, this medication might significantly reduce your pain. This can be prescribed during your consultation or appointment.
5. A referral to a physical therapist or chiropractor.
6. Depending on the severity of symptoms and whether you’ve already completed the steps listed above, an MRI scan may be necessary.
7. An epidural steroid injection has been shown to be effective in up to 70% of people to avoid surgery.
8. Surgery- this may involve some research on your part to identify how you want the surgery performed.
- I am partial to an endoscopic microdiscectomy because it is the least invasive method to remove the disc herniation. It can be performed through the foramen along the side of the spine or from the back (posterior) side. Typically the surgery is done with a 7mm diameter tube through a small (8mm) incision. This means there is less injury to the muscle and minimal scar tissue forms around the nerves afterward. The transforaminal approach avoids the type of injury to the multifidus muscles that occurs during an MIS or open approach.
- “MIS” or minimally invasive microdiscectomy. This is done using a posterior approach and is performed through an 18 or 22mm tube. Between the lamina or Interlaminar window and the bottom of the access tube, some muscle and bone are usually removed to access the disc herniation. Bone removal refers to a laminotomy or hemilaminectomy that is usually performed. Generally, a longer period of time is required to heal the muscles and skin. The incision is usually between 20-30mm. Scar tissue typically forms along the nerves after this type of surgery.
- Open microdiscectomy. This is done using a posterior approach and involves cutting the muscle off the spine and placing a retractor so that the interlaminar window and lamina are seen. A laminotomy or hemilaminectomy with the removal of bone is usually performed except at L5-S1. This approach may take the muscles and skin the longest to heal depending on the incision size and retractor used. Scar tissue typically forms along the nerves after this type of surgery. The incision size can vary- I’ve seen 25mm (1 inch) to 152mm (6 inches) incisions to treat one level disc herniations.
If the symptoms are getting in the way of daily life, don’t wait to start conservative treatment. If constant numbness, weakness, and severe pain are present, get evaluated right away. If loss of bowel or bladder control occurs or significant weakness develops then this becomes an emergency and needs evaluation immediately.
Hope this information is helpful,
Daniel W. Hanson MD
Minnesota Spine Institute