Symptom Finder - Treatment of Herniated Lumbar Disc
HERNIATED LUMBAR DISC
1. Patients with no clinical evidence of radiculopathy or a neurogenic bladder may be treated conservatively.
2. Patients with evidence of a neurogenic bladder or cauda equine syndrome should be referred to a neurosurgeon without delay.
3. Patients with clinical evidence of radiculopathy and weakness or atrophy of one or both lower extremities need neurosurgical or orthopedic Consult.
4. Patients with clinical evidence of radiculopathy without muscle atrophy of the lower extremities may be treated conservatively, but should be given the option of an orthopedic or neurosurgical consult.
5. Conservative treatment includes one or more of the following:
a. Naproxen (Naprosyn): 500 mg bid–tid or other NSAIDs:
b. Cyclobenzaprine (Flexeril): 5–10 mg tid or another muscle
relaxant
c. Gabapentin (Neurontin) or other medications for neuropathic pain
d. Lumbosacral support.
e. Firm mattress or bed board (3×5 plywood) inserted between mattress and box springs.
f. Exercise to strengthen the anterior spinal muscles including pelvic tilts and sit-ups. If the clinician is unable to demonstrate these to the patients, consult a physiotherapist.
g. Consult a physiotherapist for evaluation and recommendations for treatment.
h. Facet or trigger point injections with 2–3 cc of 1% lidocaine (Xylocaine) with or without 20–40 mg of methylprednisolone acetate (Depo-Medrol).
i. Epidural steroid injection by anesthesiologist or neurosurgical specialist.
j. Trial of prednisone 10–20 mg for first 4 days of each week × 6 weeks.
k. Psychiatric consult for evaluation and psychometric testing.
l. Except in acute low back pain and radiculopathy, narcotic analgesic should be used as last resort and then only until more definitive treatment can be initiated.
1. Patients with no clinical evidence of radiculopathy or a neurogenic bladder may be treated conservatively.
2. Patients with evidence of a neurogenic bladder or cauda equine syndrome should be referred to a neurosurgeon without delay.
3. Patients with clinical evidence of radiculopathy and weakness or atrophy of one or both lower extremities need neurosurgical or orthopedic Consult.
4. Patients with clinical evidence of radiculopathy without muscle atrophy of the lower extremities may be treated conservatively, but should be given the option of an orthopedic or neurosurgical consult.
5. Conservative treatment includes one or more of the following:
a. Naproxen (Naprosyn): 500 mg bid–tid or other NSAIDs:
b. Cyclobenzaprine (Flexeril): 5–10 mg tid or another muscle
relaxant
c. Gabapentin (Neurontin) or other medications for neuropathic pain
d. Lumbosacral support.
e. Firm mattress or bed board (3×5 plywood) inserted between mattress and box springs.
f. Exercise to strengthen the anterior spinal muscles including pelvic tilts and sit-ups. If the clinician is unable to demonstrate these to the patients, consult a physiotherapist.
g. Consult a physiotherapist for evaluation and recommendations for treatment.
h. Facet or trigger point injections with 2–3 cc of 1% lidocaine (Xylocaine) with or without 20–40 mg of methylprednisolone acetate (Depo-Medrol).
i. Epidural steroid injection by anesthesiologist or neurosurgical specialist.
j. Trial of prednisone 10–20 mg for first 4 days of each week × 6 weeks.
k. Psychiatric consult for evaluation and psychometric testing.
l. Except in acute low back pain and radiculopathy, narcotic analgesic should be used as last resort and then only until more definitive treatment can be initiated.
