DEAR DOCTOR K:

I have a herniated disk in my lower back. What does this mean? And what are my treatment options?

DEAR READER:

Your spine is made up of a stack of bones called vertebrae. In between each of the vertebrae are intervertebral disks that cushion these bones. Each disk is made of a soft gel core surrounded by a tough, fibrous outer shell. A disk's outer shell can tear. If the gel in the middle of the disk bulges out through the tear in the shell, the condition is called a herniated disk.

Herniated disks often press on nerves, causing pain, numbness and muscle weakness. This pain usually begins in the lower back, then spreads down into the buttocks and down the back of one thigh and leg.

In most cases, symptoms from a herniated disk will get better without surgery. Treatments include limited bed rest, warm baths, heating pads and medications. Medications generally include aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants.

Extended inactivity can cause your back muscles to weaken, so it's best to start an exercise regimen after only a day or two of bed rest. After one to two weeks, you usually can begin a more strenuous, daily aerobic exercise and physical therapy program. The program should aim to build muscle strength in your back and improve flexibility in your back and abdomen.

You may also want to consider ultrasound, massage and acupuncture. Some people find these treatments helpful. Your back pain should gradually lessen within four to six weeks.

If these measures don't work, steroid injections may provide temporary pain relief. Your doctor will carefully inject a long-acting steroid and an anesthetic into your lower back, near the herniated disk.

If all else fails, you may have to consider surgery to remove the injured disk. Traditional surgery can involve removing the whole disk, or just the part of the disk that is pushing on a nerve (called microdiscectomy). Microdiscectomy is today the more common procedure, because it involves a smaller incision and can be done as outpatient surgery.

There are also various minimally invasive techniques with even smaller incisions, some of which use lasers rather than knives to remove the part of the disk that is pressing on a nerve.

Does surgery work? There have been a number of randomized trials that compared surgery to nonsurgical treatments. These studies didn't involve the usual patient with pain from a herniated disk. Instead, they involved patients with persistent pain from a herniated disk who had not gotten better with nonsurgical treatments. In these studies, patients undergoing surgery seemed to do somewhat better than those not having surgery.

We have a lot more information on herniated disks in our Special Health Report, "Low Back Pain: Healing Your Aching Back." You can find out more about it at my website.

If your herniated disk is new and has not been a chronic condition, you will probably get good relief from nonsurgical treatment. If your treatment involves exercises, remember to stick with them. They really can help.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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