How to Treat lumbar disc herniation with Nerve Compression Effectively? “Targeted, Safe, and Permanent Recovery”

Back pain, radiating pain down the legs, numbness, or weakness in the legs are common symptoms of lumbar disc herniation with nerve compression. This condition is frequently seen in working-age individuals, and if left untreated, severe cases can affect urinary and bowel functions.

Currently, most patients with lumbar disc herniation start with non-surgical treatments, including pain medications, anti-inflammatory drugs, or neuropathic pain medications, as well as physical therapy. However, some patients may not respond well to these treatments, resulting in worsening symptoms that hinder daily activities. As a result, surgery may be required to permanently resolve the issue and reduce the risk of recurrence.

This article will explore the surgical treatment options compared to other methods, providing patients with useful information to help them make informed decisions on the most appropriate treatment for their condition. Each treatment method has its benefits, precautions, and suitability depending on the patient.

Assoc. Prof. Koopong Siribumrungwong, M.D., an expert in spine surgery at Kossook? Orthopedic Hospital, will explain three treatment options for lumbar disc herniation with nerve compression: epidural steroid injections, laser surgery, and minimally invasive spine surgery.

Table of Contents

(Epidural Steroid Injection) Epidural Steroid Injection

Epidural Steroid injections
(commonly known as anti-inflammatory steroids) are administered into the epidural space around the compressed spinal nerves to reduce inflammation and alleviate pain and numbness caused by nerve compression.

Ideal Candidates for Epidural Steroid Injection:

Patients with pain only, without muscle weakness or urinary/bowel issues.
Patients seeking to avoid surgery.
Patients with multiple health conditions that make surgery risky.

Procedure for Epidural Steroid Injection:

An X-ray is used to pinpoint the needle’s location during the injection.
Patients rest for 30 minutes post-injection to monitor any adverse reactions. If no issues arise, they can go home.
The radiating pain in the legs gradually decreases 3-5 days after the injection.

Benefits of Epidural Steroid Injections:

Helps diagnose the source of symptoms, especially when multiple disc herniations are present but only one level is causing the pain.
Provides effective short-term pain relief, allowing patients to resume daily activities.
Safe for patients with multiple chronic health conditions who are not good candidates for surgery.

Precautions for Epidural Steroid Injections:

Not suitable for patients with muscle weakness or urinary/bowel dysfunction.
Effects are short-lived, typically lasting 2-3 months.

Laser Spine Surgery

Laser (Laser)

stands for Light Amplification by Stimulated Emission of Radiation. It is a type of light that, when emitted, interacts with the body’s tissues in various ways, giving it a range of properties and applications.

Laser technology is increasingly used in medical treatments and is a popular method among patients both in Thailand and abroad. This is especially true for new treatment methods such as Laser Spine Surgery, Minimally Invasive Spine Surgery, and Artificial Disc Replacement.

In particular, “Laser Spine Surgery” has gained significant attention from patients. However, many patients may not fully understand the treatment process, which comes with its own set of advantages, disadvantages, and potential complications associated with laser treatment.

Ideal Candidates for Laser Spine Surgery:

Mostly used for treating bulging or herniated discs that are minimally compressing the nerve.

Procedure for Laser Spine Surgery:

A microscope is used to guide the laser to the disc, where it applies heat to shrink the herniated disc and relieve pressure on the nerve.

Benefits of Laser Spine Surgery:

Ideal for patients with mild disc herniation that is compressing the nerve.
Less invasive compared to traditional open surgery, with a faster recovery time.

Precautions for Laser Spine Surgery:

- Higher recurrence rates compared to traditional surgery.
- Limited research and evidence on long-term effectiveness, with studies showing traditional surgery is more effective in reducing pain and recurrence.
- Not suitable for patients with large disc herniations.

Laser spine surgery is not considered the standard treatment and is generally reserved for specific cases where the herniation is minimal.
Patients should thoroughly discuss this option with a spine specialist before opting for it.

Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery (MIS)

is a modern surgical approach that reduces tissue damage compared to traditional open surgery. This technique uses advanced technology to access the spine with small incisions, reducing recovery time and minimizing risks.

There are two primary types of minimally invasive spine surgery:

Non-Fusion Surgery (Non-Fusion)
Fusion Surgery (Fusion)

Non-Fusion Surgery:

Non-fusion surgery involves removing the herniated disc without the need for spinal fusion by endoscopy. This approach is suitable for patients with disc herniation or spinal stenosis but no instability of the spine. Endoscopic discectomy or endoscopic decompression now is more popularity and become the standard for treatment of lumbar disc hernation and spinal stenosis without instability. These precedures is very reliable and safe for all patients with speedy recovery.

Ideal Candidates for Non-Fusion Surgery:

Patients with leg pain due to disc herniation or spinal stenosis.
Patients without spinal instability.

Current clinical research shows consistent findings that treatments and surgeries in this category are more effective in reducing back pain and radiating leg pain compared to traditional open surgery. Specifically, the minimally invasive procedures involve shorter surgery times, less blood loss, and shorter hospital stays. In the long term, however, these minimally invasive techniques offer similar treatment outcomes as open surgery.

Spinal Fusion Surgery

This procedure involves a minimally invasive technique for spinal surgery in the lower back (Minimally Invasive Surgery: MIS TLIF, Endoscopic TLIF). It involves making a small incision in the back to insert a device into the spine to stabilize it. The procedure typically replaces a damaged intervertebral disc after it has been removed, in order to relieve pressure on the nerves. The spine is then fused with the help of the inserted device to provide stability and prevent movement that could cause further complications.

Ideal Candidates for Fusion Surgery:

Patients with unstable spinal segments.
Patients with severe spinal stenosis and advanced joint degeneration

Benefits of Minimally Invasive Spine Surgery:

Smaller incisions
Reduced tissue damage and post-operative pain.
Reduced blood loss.
Reduced infection rates.
Shorter hospital stays and quicker recovery times.

Precautions for Minimally Invasive Spine Surgery:

Not suitable for every patient; careful evaluation is necessary to determine suitability.

Minimally invasive surgery (with small incisions and minimal tissue damage) is another treatment method that is suitable for patients who aim for a full recovery and want to reduce the chances of recurrence. It allows for quicker recovery. For the best treatment outcome, patients should consult with a specialist to determine the most effective approach.

Article by: Assoc. Prof. Koopong Siribumrungwong, M.D., Specialist in Spine Surgoen