A herniated disc is linked to an intervertebral disc (shock absorber located between two vertebrae) coming out of its natural zone. It protrudes (hernias) and can put pressure on nerves, which is the source of the symptoms observed.

Treatment depends on the extent and consequences of the herniated disc. 

No treatment for a herniated disc?

Not all herniated discs cause symptoms. We know this because doctors sometimes discover with surprise herniated discs by doing scans or MRIs for other reasons. Some people therefore present with herniated discs without suffering from it. And inevitably, these people not complaining about anything, do not look after themselves either. Thus, one can not treat a hernia which is not bothersome. You just have to let the time pass.

On the other hand, we know that in 6 months to a year, 70% of herniated discs disappear on their own. Knowing how to wait while relieving pain if it exists is therefore the most often appropriate strategy.

Medical treatment for a herniated disc

When you suffer from a herniation, the first treatment is medical treatment and it can cure 80% of the pain associated with herniated discs.

Rest ? It is not obligatory. Instead, we recommend staying active, being careful not to trigger pain. Of course, if the pain is very strong, rest is allowed, but it should last as little as possible so as not to engender apprehension limiting moving afterwards.

The use of a lombostat? It protects the spine from movement without immobilizing it completely. It reduces pain without its effectiveness being proven by studies.

The basic treatment consists of analgesics (painkillers), anti-inflammatories and muscle relaxants (relaxes the muscles).

• Analgesics are used in three stages, from the lightest to the most powerful:
• Level 1 (paracetamol) is often insufficient.
• Level 2 analgesics are more often prescribed in the event of sciatica resulting from a herniated disc, such as: a combination of paracetamol and tramadol, a combination of paracetamol, opium powder and caffeine, a combination of paracetamol and codeine or tramadol alone.
• Level 3 are the most powerful analgesics based on morphine. They are only used in case of hyperalgesia (hyper-pain).

Nonsteroidal anti-inflammatory drugs (not composed of cortisone) or NSAIDs: Their effectiveness on pain is not greater than that of analgesics. They are generally combined with level 2 analgesics. The most widely used in practice are ketoprofen, diclofenac or naproxen, but they are all of comparable effectiveness.

Muscle relaxants are used if there are significant muscle contractures associated with the herniated disc. And muscle relaxants have an anti-anxiety effect because they are related to anxiety medications (with the same drawbacks as an addiction).

Systemic corticosteroids: these are the most powerful anti-inflammatory drugs known. They can be used if the painkiller combined with anti-inflammatory drugs (NSAIDs) is not effective. This treatment cannot be taken for more than 7 to 10 days.

The infiltrations: a doctor injects corticosteroids in the area of ​​the herniated disc. The injections are effective on the pain within 3 to 6 weeks, but in the long term, they do not bring additional benefit to the medical treatment. We generally practice 3 infiltrations spaced a few days apart.

Spinal manipulations are not recommended in the event of a herniated disc. Physiotherapy is not indicated during the acute phase, but subsequently for the prevention of recurrence.

Surgical treatment of a herniated disc.

This treatment is given if the medical treatment does not give results after 6 months or in cases where there is an emergency.

When is it urgent to operate on a herniated disc?

• In case of intolerable pain despite an effective analgesic treatment,
• In case of sudden or progressive muscle paralysis or weakness. Because it means that the neurons controlling the affected muscles are affected.
• In the event of the appearance of urinary or anal incontinence.
• If there is any sign of destruction of the neurons affected by the hernia.

The goal of the surgery is to remove the hernia so as to stop the pressure it exerts on the nerves or neurons. Hospitalization lasts between 2 and 5 days and the operated person comes out with postural advice as well as a prescription for painkillers and anti-inflammatory drugs.

 What about prevention? We urge you to read our very complete file to prevent recurrence of herniated disc.