Slipped disc

Treatment

In most cases, a slipped disc will slowly improve with rest, gentle exercise and medication. Recovery can take between one and three months.

Keeping active

It's very important to keep active if you have a slipped disc.

Initially, it may be difficult to move around. If you're in severe pain, you may need to rest completely for the first couple of days.

However, after this period, you should start to move around as soon as you can. This will keep your back mobile and speed up your recovery.

Make sure any exercise you do is gentle and doesn't put astrain on your back. Swimming is an ideal form of exercise because the water supports your weight and it puts very little strain on your joints.

Movement and exercise will also help strengthen any muscles that have become weak. Avoid any activities that could aggravate your condition, such as those that involve:

reaching
lifting
sitting for a prolonged period of time

You may find your pain increases at first when you start moving around.

This is normal and doesn't mean you're causing more damage to your spine or the slipped disc. The pain should settle down quite quickly, allowing you to gradually increase the amount of exercise you're doing.

Physiotherapy

You may be referred to a physiotherapist as part of your treatment programme.

Physiotherapists are qualified healthcare professionals who use a range of techniques, including massage and manipulation, to restore movement and function.

A physiotherapist will be able to draw up an individually tailored exercise plan for you. This will keep you active, minimise pain, and help prevent any further damage to your back.

Osteopathy and chiropractic

Some people choose to try osteopathy or see a chiropractor. Both types of therapy are used to treat back pain.

Osteopathy and chiropractic aren't widely available on the NHS, and you'll usually have to pay for treatment privately.

Medication

You may be prescribed a number of different medicines to help ease any painful symptoms of a slipped disc. These are outlined below.

Painkillers

Simple painkillers, such as paracetamol, are available over the counter from pharmacies or on prescription.

Some people worry that taking painkillers may mask something more serious going on with their back.

This isn't true regularly taking painkillers can ease your pain and help you to begin moving around, which will speed up your recovery.

However, always read the manufacturer's instructions before using them.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac and naproxen, can help relieve pain and reduce any inflammation.

NSAIDs may not be suitable for people with high blood pressure (hypertension), asthma, heart failure or kidney failure. Again, you should always read the manufacturer's instructions before use.

Codeine

Codeine is a stronger painkiller that's often taken in combination with paracetamol.

It's usually only prescribed when other painkillers and NSAIDs can't be used or tolerated or haven't worked.

Codeinecan cause a number of side effects, includingfeeling or being sick, constipation, dizziness and a dry mouth.

Corticosteroids

Corticosteroids, often known as steroids, are an anti-inflammatory medicine. They may be injected into your lower spine to help reduce inflammation.

Muscle relaxants

You may be prescribed a muscle relaxant, such as diazepam, to take for a few days if your back or leg muscles are very tense.

Surgery

Surgery isrequired in about 1 in 10 cases of a slipped disc.

It may be considered if:

there's evidence of severe nerve compression
your symptoms haven't improved using other treatments
you're having difficulty standing or walking
you have very severe symptoms, such as progressive muscle weakness or altered bladder function

The aim of surgery is to cut away the piece of the disc that bulges outto release the pressure on your spinal nerves. This is known as a discectomy and can be carried out in several ways.

Some of these procedures are explained in more detail below.

Open discectomy

An open discectomy is a procedure to remove part of the slipped disc. It's carried out under general anaesthetic, which means you'll be unconscious during the operation.

The surgeon will make a cut (incision) over the affected area of your spine down to the lamina, the bony arch of your vertebra.

They'll gently pull the nerve away to expose the prolapsed or bulging disc, and remove just enough to prevent pressure on the nerves.

To complete the operation, the surgeon will close the incision with stitches or surgical staples.

Endoscopic laser discectomy

During endoscopic laser surgery, a small incision is made to gain access to the spine. Along,thin, flexible tube with a light and camera at one end (endoscope) is used to examine the disc.

The procedure is carried out under either local anaesthetic orgeneral anaesthetic, depending on where in your spine your slipped disc is.

After the affected disc has been identified, the compressed nerve causing you pain will be released and part of the disc will be removed with a laser.

A study found 67% of people could move around more easily six months after having endoscopic laser surgery, and around 30% needed less pain-relieving medication. Around 2-4% of people needed another operation.

Another study reported that, on average, people were able to return to work seven weeks after having endoscopic laser surgery.

Endoscopic laser surgery is still a relatively new procedure, so it's often only performed with special arrangements for example, as part of a clinical trial.

Read the National Institute for Health and Care Excellence (NICE) guidance about endoscopic laser lumbar discectomy.

Recovery

For most people with a slipped disc, back surgery helps ease their symptoms.

Depending on the procedure you've had and the type of work you do,you'll be able to return to work after two to eight weeks.

However, the surgery doesn't work for everyone, and you may need to have further operations and treatment if the initial surgery isn't effective.

Possible complications resulting from surgery may include:

infection
nerve injury and paralysis
severe bleeding (haemorrhage)
temporary impaired sense(dysaesthesia) for example, losing the sense of touch

Before deciding to have surgery, ask your surgeon about their experience doing the surgery, and their success and complication rates.

They'll tell you whether you're at risk of developing complications and how long it will take to recover. You may be given a rehabilitation programme to follow.