Our Summary

Lumbar disc herniation (LDH) is a condition where the central part of the spinal disc pushes out of its normal space, causing pressure on the spinal nerves. This can lead to symptoms such as leg and lower back pain, and uses up significant healthcare resources for treatment. The paper reviews current treatments, identifies areas where more treatment options are needed, and discusses upcoming therapies.

For patients whose symptoms do not improve with non-invasive treatments, epidural steroid injections (ESIs) are commonly used. These can provide short-term relief, but there is limited evidence that they provide long-term benefits. They also carry some rare but serious risks, such as infection and neurological injury, and potential long-term effects from the steroids. They are not approved by the US Food and Drug Administration (FDA) for this use.

If non-surgical treatments do not work, a surgery called lumbar discectomy can be performed to provide quick relief. However, this also has risks, such as complications during surgery and potential long-term issues like recurring pain or herniation, needing more surgery, loss of disc height, and changes in the spine.

New treatments currently being developed include a long-lasting ESI formulation and a new substance for chemonucleolysis, a non-surgical treatment that reduces the volume of the displaced disc. These minimally invasive therapies that address the root cause of the disease could potentially provide a middle ground between symptom management and surgery.

The paper points out that the limited long-term benefits of ESIs and the risks associated with surgery highlight the need for new, minimally invasive treatments that can address the nerve root compression caused by LDH.

FAQs

  1. What is lumbar disc herniation (LDH) and how is it currently treated?
  2. What are some potential risks associated with existing treatments for LDH, such as epidural steroid injections and lumbar discectomy?
  3. What new treatments are currently being developed for lumbar disc herniation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about microdiscectomy is to carefully follow post-operative instructions provided by the surgeon, including restrictions on activities, proper wound care, and physical therapy recommendations. It is important to give the body time to heal and to gradually resume normal activities to prevent complications and optimize recovery. Additionally, maintaining a healthy lifestyle with regular exercise, proper nutrition, and weight management can help support long-term back health and prevent future issues.

Suitable For

Patients who are typically recommended for microdiscectomy are those who have not experienced improvement in their symptoms with non-invasive treatments such as physical therapy, medication, or epidural steroid injections. These patients may have severe leg pain, weakness, or numbness due to nerve compression caused by lumbar disc herniation. Additionally, patients who have significant functional limitations or quality of life issues due to their symptoms may also be considered for microdiscectomy. It is important for patients to discuss their treatment options with a healthcare provider to determine the best course of action for their specific situation.

Timeline

  • Before microdiscectomy:
  1. Patient experiences symptoms of lumbar disc herniation such as leg and lower back pain.
  2. Patient may undergo non-invasive treatments such as physical therapy or medication.
  3. If non-invasive treatments do not work, patient may receive epidural steroid injections for short-term relief.
  4. If symptoms persist, patient may be recommended for microdiscectomy surgery.
  • After microdiscectomy:
  1. Patient undergoes microdiscectomy surgery to relieve pressure on spinal nerves.
  2. Patient may experience immediate relief from leg and lower back pain.
  3. Patient may have a short recovery period before returning to normal activities.
  4. Risks of surgery such as complications during surgery, recurring pain, or need for additional surgery are monitored.
  5. Patient may require physical therapy or rehabilitation to fully recover.
  6. Patient may experience improved quality of life and reduced symptoms of lumbar disc herniation.

What to Ask Your Doctor

Some questions a patient should ask their doctor about microdiscectomy include:

  1. What are the potential risks and complications associated with microdiscectomy surgery?
  2. What is the success rate of microdiscectomy in relieving symptoms of lumbar disc herniation?
  3. What is the recovery process like after microdiscectomy surgery?
  4. Are there any alternative treatments or therapies I should consider before opting for surgery?
  5. What are the potential long-term effects of microdiscectomy surgery?
  6. How likely is it that I will need additional surgery in the future after undergoing microdiscectomy?
  7. Are there any specific lifestyle changes or precautions I should take after microdiscectomy surgery?
  8. What is the expected outcome in terms of pain relief and improvement in mobility after microdiscectomy?
  9. Are there any specific rehabilitation exercises or physical therapy programs I should follow post-surgery?
  10. Are there any new or upcoming treatments for lumbar disc herniation that I should be aware of before making a decision about surgery?

Reference

Authors: Beall DP, Kim KD, Macadaeg K, Donboli K, Chauhan K, Sowlay M, Guo A, Vaccaro A. Journal: Pain Physician. 2024 Sep;27(7):401-413. PMID: 39353108