Noninvasive Treatment
Typically, the first line of treatment for a bulging or herniated disc is noninvasive, meaning it does not involve breaking the skin. For mild to moderate back pain, rest is usually recommended to decrease inflammation of the spinal nerves. Patients may be told to stay in bed or, at the very least, maintain a level of activity that does not cause pain. Depending on the severity of the pain, this rest period may last for a few days or for two or three weeks. Physical therapy may also be recommended to strengthen the back muscles, which will help provide more support and stability to the spine. A common physical therapy regimen involves stretching exercises, pelvic traction (bracing that gives extra support to the lower back), massage, electrical muscle stimulation of the back muscles and regular application of ice along with use of muscle relaxants.
Anti-Inflammatory Treatment
If rest and physical therapy do not provide sufficient relief from back pain and stiffness, the next option is to use medications to attempt to reduce the inflammation. Although over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) may help, patients may also require anti-inflammatory injections. Corticosteroids, powerful anti-inflammatory drugs, are injected into the affected area. The needle is guided by X-rays to ensure the medication is delivered as close as possible to the herniated disc and inflamed tissue.
Surgery
Surgery is typically a last resort because of the risk of complications as well as the chance that it will not be effective in reducing the pain and inflammation. Patients may be considered for surgery if their pain is debilitating or if they have symptoms of progressive nerve damage (such as tingling or weakness of the legs or other muscles). One kind of surgery involves replacing the herniated disc with an artificial disc. Other options include removal of part of the herniated disc. In some cases, portions of a vertebra may be removed to relieve pressure on the spinal nerves. Often this procedure is accompanied by bone grafting between two vertebrae in a spinal fusion operation, which will give the affected part of the spine additional support.
