Treatment of lateral disc protrusion

The treatment of lateral disc protrusion can be divided into initial conservative measures and later operative intervention.

Conservative measures may be sufficient in 90% of cases:

• bed rest - for 6 weeks on an orthopaedic mattress, or with a hard board under the mattress
• pain relief - NSAID and diazepam

Surgical review and possible operative treatment is indicated by:

• severe and persistent pain despite conservative measures
• recurrent attacks causing for example, time off from work
• neurological deficit

Operative intervention may involve removal of the extruded disc material (discectomy), aided by use of an operation microscope. The method has a 90% short-term success rate. The patient is advised to avoid heavy lifting.

Note that NICE (1) have suggested that prosthetic intervertebral disc replacement is an alternative to the established operations of discectomy and spinal fusion in patients with:

• herniated lumbar intervertebral disc
• degenerative disc disease in lumbar spine
• post-laminectomy syndrome in the lumbar spine
• lower back pain refractory to conservative treatment for more than 6 months

Reference:

1. NICE (June 2005).prosthetic intervertebral disc replacement