Lumbar disc herniation can cause severe pain in the back and even into the legs. It can also affect the nerves going to the hips and legs. In extreme cases it can cause partial paralysis and loss of bowel and bladder control.
There are two types of lumbar disc herniation. Contained discs are still held within a ligament sheath and have not squeezed out and contacted the outer tissues. Noncontained discs have pushed out of the ligament enclosure and have come in contact with outside tissue. These authors did two studies on the different kinds of lumbar disc herniations to see if the two kinds of lumbar disc herniations had different outcomes.
In the first study, the authors looked at the records of 156 patients with lumbar disc herniations. Of these patients, 108 had contained herniations, and 64 had noncontained herniations. Conservative treatments of rest, medications, and a sacral epidural block (a special kind of anesthesia) were tried in all cases. Surgery was done when patients began to have problems with their bowels and bladder, when muscle weakness became worse, or when the pain became intolerable. About 67% (104) of the patients eventually had surgery.
Notably, the authors found that most patients with noncontained herniations who had surgery did so in the first two months. Most significantly, almost none had surgery after four months. This led the authors to believe that noncontained herniations might go away on their own if patients could wait that long.
So, in the second study, the authors used conservative treatments for at least two months on 390 patients with noncontained herniations. Only patients with severe problems had surgery without this period of conservative treatment. This study lasted for one year. In that time, the number of disc surgeries in the authors’ hospital went down significantly. More importantly, only one of the patients treated conservatively had complications.
A guest commentator cautions that conservative treatment of a noncontained disc herniation isn’t right for every patient. And if the pain lasts for longer than three months, surgery is probably the best option. But many patients might be spared going under the knife, if they’re willing to bite the bullet and put up with the pain for a couple months.