What are the medical treatments for lumbar disc disease?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Almost all patients with sciatica and disc herniations deserve a trial of medical therapy. The one obvious exception is a patient presenting with cauda equina syndrome or profound motor deficits.

Most practitioners are well versed in the initial management of cases of sciatica. Counseling and education about the disease help the patient commit to a successful trial of nonoperative management. Encourage bedrest and prescribe anti-inflammatory agents (steroidal and/or nonsteroidal) with analgesics that are sufficiently strong enough to relieve pain. Muscle relaxants aid in relieving associated muscle spasm. After 7-14 days, slow mobilization is started. [18]

Once the patient has recovered from the worst radicular pain, physical therapy can be instituted. Return to work (either limited or full) is important at this point. Stop steroidal medications. Reevaluate patients about a month after the onset of sciatica. At this time, studies can be ordered or a more intense back rehabilitation program can be designed, so appropriate referrals can be made.

The success of conservative management of lumbar disc herniations may depend on the type of herniation. A review of over 600 patients concluded that noncontained herniations may respond more successfully to nonsurgical treatment. [19]

Epidural steroid injections can be used at almost any time; however, the utility of this has been questioned. [20]


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