Herniated disc alternative treatment



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




There are many treatments for herniated disc. These may be divided into non invasive and invasive categories.

Non-invasive:

Exercises

Stretching exercises can improve flexibility of the trunk muscles. Flexion exercises may help to open the intervertebral foramen. These are small canals through which the nerve roots exit the spinal cord. The intervertebral foramen are located on the left and right sides of the spinal column.

Extension exercises, such as the McKenzie method, focuses on the muscles and ligaments. These exercises help maintain the spine’s natural lordotic curve.

Aerobic exercise (no/low impact) help with muscle endurance, coordination, strength, strong abdominal muscles, and weight loss. Strong abdominal muscles work to support the lumbar spine. Walking, bicycling, and swimming are forms of aerobic exercise.



Acupuncture

Acupuncture, a type of alternative medicine, has been shown to control pain. Acupuncture stimulates the production of endorphins, acetylcholine, and serotonin. However, acupuncture should be combined with an exercise program.



Drug Therapy

During the acute phase of low back pain, drugs may be prescribed. Some of these may include narcotics, acetaminophen, anti-inflammatory agents, muscle relaxants, and anti-depressants.

Massage therapists may also provide short-term relief from a herniated disk.



Manipulation

Manipulation is believed to be effective because of its effect on spinal mobility. Acute low back pain, chronic low back pain, and degenerative disc disease without nerve compression may respond to manipulation.


Minimally Invasive

Prolotherapy

A ligament is a band of fibrous tissue that holds bone together and can become "over-stretched." The resulting laxity can cause severe pain because muscles are overworked as they tighten in an attempt to stabilize the bones. Prolotherapy is a treatment where a proliferant solution is injected directly into the site where the weakened ligament attaches to the bone. These injections trigger an immune response to grow new, healthy tissue that properly stabilizes the bones and joints, relieving musculoskeletal pain and stiffness.

As with many treatments, prolotherapy is not without risks or side effects. Since the intent of the technique is to create a specifically localized inflammation, pain, swelling, redness, soreness, temporary stiffness, and bruising at the injection site are normal. In trained hands, prolotherapy is a safe, effective, and highly successful technique.

Other invasive techniques include:

Radiowave

New Radio Wave Treatment to Correct Back Disorders Offers Alternative to Drugs, Open-Spine Surgery

Boston--May 2002, Harvard Medical School affiliate Beth Israel Deaconess Medical Center--If you are one of the estimated 1.5 million Americans who will be diagnosed this year with a contained herniated disc--also known as a 'thrown-out back' or 'pinched nerve' of the upper leg--the answer may be as familiar as your radio. Doctors at Beth Israel Deaconess Medical Center are using radio waves the same energy that sends signals to your car radio--to gently dissolve small amounts of unwanted disc tissue and relieve the pressure often associated with lower back and upper leg pain.

For patients whose body motion is restricted by a spine disc attack and who can't stand the prospect of a sometimes lengthy and painful convalescence, radio wave injection may be just the answer, says Joshua A. Hirsch, M.D., an interventional neuroradiologist and associate professor of radiology at Harvard Medical School. Virtually bloodless and exceptionally precise, Nucleoplasty radio wave injection is more like getting a vaccination or epidural steroid injection than traditional open-spine surgery.

"Nucleoplasty fills a serious technology gap that has existed for millions of spine disc sufferers," says Hirsch. "Since approximately 80 percent of back and leg pain sufferers are not appropriate candidates for disc surgery, the focus until now has been on trying to manage the problem with drugs, epidural injections and physical therapy. Nucleoplasty radio waves provide patients with the possibility of a permanent solution that drugs and therapy can't provide, but without the stress of traditional open-spine techniques."

Nucleoplasty radio wave injection is an offshoot of a technology used to treat over one million patients since 1995 for a variety of common medical problems, ranging from knee injuries to sleep apnea. A version of the technology for decompressing spine discs was approved for physicians' use by the FDA last summer.

Hirsch is the first doctor in New England to offer radio wave injection for treating disc problems associated with lower back and upper leg pain. He says his success rate so far is comparable to that of major surgeries but without the trauma, recovery time and cost.

Nucleoplasty (literally, removing part of the disc's nucleus) usually takes about 30 minutes and is typically performed while the patient is awake and under a local anesthetic and light sedation. Most patients walk out of the clinic in about an hour and are back at work in two to three days, Hirsch says. The only cutting required is for a one-millimeter opening (about the diameter of a lead of pencil) in the lower back where the injection device is inserted. In the past, most spine disc attacks were treated with weeks and possibly up to two months of bed rest, plus narcotics for pain, anti-inflammatory drugs and physical therapy for body motion, and a variety of alternative techniques ranging from acupuncture to massage.

In extreme cases, open-spine procedures may be required to remove some (microdiscectomy surgery) or most (fusion surgery) of the nucleus in problem discs. Nucleoplasty radio wave injection is intended for the vast middle of the market--people with mild-to-moderate cases who want quicker and potentially more permanent relief than drugs and bed rest can offer, but who are not severe enough for open-spine procedures.

Contained herniated disc begins when the soft, gel-like substance in the center, or nucleus of the disc comes into contact with a weakened area in the disc shell. If the shell is weak enough, the nucleus material can create an unnatural bulge in the shell. In other cases, the material seeps out of the shell. In both cases, the soft nucleus material that is supposed to function as a shock absorber for the spine actually becomes an irritant, creating pressure on the spine's sensitive nerve endings and bringing pain to the lower back and-or upper leg.

Radio wave injection is designed to gently dissolve the excess nucleus material that creates bulges in the disc and irritates nearby nerve endings in the spine.

Although radio waves have been used on a limited basis in medicine for years, recent technological advances have enabled radio wave devices to replace more conventional devices. Radio waves are considered a potentially optimal energy source for certain surgeries because these signals can be exceptionally precise and controllable in a doctor's hands, uniform in the way they heat and dissolve unwanted tissue, and, because they are cooler than some other energy sources, more gentle on the patient since damage to surrounding tissue is minimized.

"With Nucleoplasty radio wave technology, I believe we are on the threshold of a new generation of medical devices that will treat ordinary diseases with greater precision for the surgeon and greater gentleness for the patient," Hirsch says.





Surgery

The type of surgical procedure(s) is dependent on the patient, the diagnosis, and the goals of surgery.

Surgical removal of an inferior disc may involve a limited laminotomy and partial disc excision. The disc fragments are removed and the nerve is decompressed. Micro-discectomy is often a preferred procedure requiring smaller incisions resulting in reduced scarring and a more rapid recovery.

If the entire disc is removed, spinal column instability may warrant fusion. Patients who are obese, smoke, or who have psychological problems exhibit lower rates of success. Smoking in particular negatively impacts the process of fusion and healing in general. Spinal fusion may be combined with spinal instrumentation, the use of medically designed hardware (e.g. screws, cages).



Artificial disc

The Food and Drug Administration has approved an artificial spinal disc for use in treating pain associated with degenerative disc disease (DDD). The device is intended to replace a diseased or damaged intervertebral disc. The first of its kind, the device is called the Charité artificial disc and is manufactured by DePuy Spine, Inc. It has been approved for use in patients who have DDD at one level in the lumbar spine (from L4-S1) and who have had no relief from low back pain after at least six months of non-surgical treatment.

Laser is used in different fields of medicine with unique advantages. In treatment of lumbar disc disease, it is useful and advantageous. Laser discectomy is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is burned by the laser.

The aim of percutaneous laser disc decompression (PLDD) is to vaporize a small portion of the nucleus pulposus of an intervertebral disc, thereby reducing the volume of a diseased disc and the pressure within it.

Surgery of any kind should be avoided, if possible.






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