How long does a slipped disc last?
Both the duration and the chances of healing of a herniated disc depend on its severity. The greater the extent of the leaked tissue of the disc, the longer it takes for this material to be broken down by the body, i.e. the more severe the herniated disc is, the longer the healing process can last. As a rule, the symptoms should have passed within 6-8 weeks. If this is not the case, the chances for a successful conservative treatment decrease and a chronification of the pain and discomfort caused by the herniated disc can occur. Especially older patients can often experience chronic pain.
Prophylaxis / Prevention
There is no specific precaution that protects against a herniated disc in principle. However, the risk can be reduced by changing and adapting one’s lifestyle, for example by strengthening the back and abdominal muscles through training at an adequate weight station. From our and our experience, such training is the best and most important prophylaxis.
Of course, change and adaptation also include a correct working posture for activities in professional life and in the household. For example, heavy objects should be lifted from a squatting position with stretched back (go into the hollow back). When vacuuming, for example, an upright, relaxed working position can be achieved by adjusting the suction tube.
If the activity is predominantly sedentary, it is advisable to stand up and walk around at shorter intervals. Especially for this occupational group, there are also programmes with relaxation and loosening exercises. An ergonomic adjustment of the seating by means of height-adjustable seats and seat backs can help to protect the spinal column.
This is especially true for professional drivers. A slipped disc cannot be completely prevented, but the risk can be reduced by targeted training of the trunk muscles. The diagnosis of a herniated disc includes various physical and apparatus-based forms of examination.
In addition, diseases with symptoms similar to those of the herniated disc must also be excluded within the framework of differential diagnostics. To diagnose or exclude a herniated disc, a thorough neurological examination is necessary. It can, for example, differential-diagnostically exclude a circulatory disorder of the legs, the so-called shop window disease (= Claudicatio intermittens).
Furthermore, conclusions can be drawn about the position, the severity and the involvement of the nerves. A neurological examination checks the reflexes, mobility and sensitivity, but can also include a measurement of the nerve conduction velocity. This is particularly important when the severity of the herniated disc is to be assessed and it is to be checked which nerve roots are affected or whether there is a circulatory disorder.
X-ray images in two planes:The bony structure of the spine can be assessed by means of an X-ray image, which should be taken in at least two planes (from the front, from the side). It is also possible to x-ray the patient as part of a functional imaging. These special radiographs, which are taken in a tilted position, for example, allow conclusions to be drawn about the mobility of the spinal column.
The problem of diagnosing a slipped disc through an x-ray is due to the fact that only bony structures are shown here, the remaining soft tissue and the disc itself are only indirectly imaged. Thus, the spine can be assessed from its bony structure, but not – and this seems particularly important in the case of a herniated disc – the situation of the disc and its individual problems. During myelography of a herniated disc, an X-ray contrast medium is injected into the nerve sac (dural sac).
The contrast medium in the nerve sac makes the spinal cord, including the nerve root, indirectly visible in the form of a contrast medium recess. However, since very good cross-sectional imaging techniques can now be used, myelography is now only used very rarely. Especially by the use of MRI (Myelo-MRI) and CT l(Myelo-CT), the most accurate information about the size and location of a herniated disc can be made.
However, computer tomography causes radiation exposure to the organ system. The MRI of the respective affected region is the most important and valuable diagnostic tool for a herniated disc. Depending on the affected region, an MRI of the cervical, thoracic or lumbar spine is performed.
If inflammatory processes or healing processes need to be assessed (so-called granulation tissue), an MRI with contrast medium is performed. The MRI can detect the size and location of the herniated disc, and in some cases the age can be assessed. If two MRIs ́s are performed during the course of the operation, statements about the course and duration of the symptoms can also be derived.
Today, the CT plays only a minor role in the diagnosis of a herniated disc, because it is inferior to the MRI in the level of detail. In some cases, small herniated discs cannot be detected. Furthermore, a CT leads to radiation exposure.
In contrast, an MRI is radiation-free and works via magnetism. A herniated disc can be treated both conservatively and surgically. Here it is decided individually which of these treatments is more suitable for the patient.
As a rule – except for acute herniated disks with motor and/or sensory deficits – the therapy of a herniated disk initially consists of a conservative treatment, which can consist of a variety of different treatment measures. Important in the first stage is the immobilization and relief of the spine. In order to achieve this in the best possible way, one depends on the height of the spine affected: In case of a herniated disc of the cervical spine, a cervical cuff is recommended for stabilization.
In case of a slipped disc in the lumbar spine, stepped bed positioning helps to relieve the nerve. Here, the patient positions his or her lower legs on a support in a supine position so that the upper and lower legs are at a 90° angle to each other. However, immobilisation of the spinal column in the sense of longer bed rest is not necessary.
Pain therapy is the main focus of further treatment. Only when the affected person is free of pain can subsequent measures such as physiotherapy show success. Painkillers, anti-inflammatory drugs and muscle relaxants can be used to eliminate the pain.
If the pain is severe, the use of local anaesthetics or cortisone is also helpful. Here especially in the form of a cortisone injection. Physical therapy, i.e. heat or cold treatments, can also relieve pain.
Heat applications include heat plasters (e.g. ThermaCare®), fango and mud packs, hot baths or infrared radiation. Heat stimulates the blood circulation and thus loosens tense muscles in the back. Cold applications such as gel pads or cold compresses are more beneficial in cases of nerve irritation.
Ultrasound therapy also has a great effect in the treatment of herniated discs: sound waves generate heat in the tissue through vibrations and thus also loosen the back muscles. Likewise, massages and acupuncture can contribute to a desired reduction of pain. For a long-term elimination of pain, the back muscles must be strengthened in any case.
Accompanying physiotherapeutic measures are thus an essential part of pain therapy, since strengthening the back muscles forms a guide rail for the spine, which consequently reduces the load on the intervertebral disc. Only rarely, if the disc herniation cannot be controlled by conservative measures, surgical treatment is indicated. This is often the case if the herniated disc has damaged nerves and paralysis (motor and sensory) occurs as a result.
An example of this is a herniated disc in the lumbar spine, which, due to damage to a nerve, interferes with intestinal and bladder emptying. During a disc operation, the prolapsed part of the disc material is removed to relieve the constricted nerve. There are several possibilities to treat a herniated disc surgically.
Either the surgeon can remove the disc or the “prolapsed” tissue mass affecting the nerve during open surgery on the spine. Or a minimally invasive procedure (“keyhole surgery”) is chosen. Here, the intervertebral disc is removed similar to the open procedure, but this time the surgeon works endoscopically, i.e. he reaches the spine through a small incision.
After an intervertebral disc operation, a new herniated disc may occur. It can also happen that scars are formed by the removed tissue, thereby irritating the spinal nerve again and leaving the original symptoms intact. For the drug therapy of a herniated disc painkillers are suitable, which simultaneously inhibit the pain and the inflammation.
Non-steroidal anti-inflammatory drugs, or NSAIDs for short, are ideal for this purpose. These include drugs such as diclofenac or ibuprofen. By inhibiting an enzyme, cyclooxygenase (COX), NSAIDs prevent the production of prostaglandins, which are significantly involved in the development of pain and inflammatory reactions.
The analgesic paracetamol can be taken as an alternative to NSAIDs, mainly because of its better tolerability. It has an equally pain-relieving effect, but not as strong an anti-inflammatory effect as the NSAIDs. Corticosteroids (cortisone) have an anti-inflammatory effect and are therefore well suited to inhibit inflammation.
Especially when there is a threat of nerve damage, cortisone is a very effective drug against swelling caused by the herniated disc. Not every herniated disc needs to be treated with cortisone. Also muscle relaxants, i.e. muscle-relaxing drugs, can help with a herniated disc.
They loosen up the muscles and thus relieve tension. Opioids (morphine, tramadol) are recommended for severe and long-lasting pain. Opioids are strong painkillers which can cause severe side effects and are therefore only used under medical treatment and control.
If the pain is chronic and the effect of other painkillers was insufficient, there is still the possibility of resorting to anticonvulsants and antidepressants. These drugs set the pain threshold high, so that the patient develops better pain tolerance. Opioids (morphine, tramadol) are recommended for severe and long-lasting pain.
Opioids are strong painkillers which can cause severe side effects and are therefore only used under medical supervision and control. If the pain is chronic and the effect of other painkillers was insufficient, there is still the possibility of resorting to anticonvulsants and antidepressants. These drugs set the pain threshold high, so that the patient develops better pain tolerance.
If previous therapeutic measures such as medication, physiotherapy and physical measures are not sufficient for a noticeable improvement in an existing intervertebral disc symptomatology, PRT can be resorted to as a further pain-relieving remedy. The abbreviation PRT refers to periradicular therapy, a relatively new and non-surgical measure that can basically be performed on all sections of the spine. In this procedure, drugs are injected under local anaesthetic directly into the affected or pinched nerve in the spinal column using a PRT needle.
Even a small dose of medication can be used, since the exact placement of the medication has a soothing effect on the painful nerve root. A combination of a corticosteroid (cortisone) and a long-acting local anaesthetic is often injected: The corticosteroid (cortisone) causes the swelling of the irritated nerve root and the herniated disc to subside, thus giving the nerve more space at its exit point from the spinal column so that it is no longer trapped. The local anaesthetic leads to a decrease in inflammation and local pain radiation.
Using the medication as a depot, this effect should last for a longer period of time. For control purposes, PRT is performed using imaging techniques (X-ray, CT or MRI) to ensure that the injection needle is placed precisely where it is needed. With the help of periradicular therapy (PRT), the patient can achieve significant pain relief or even freedom from pain. As a rule, 2-4 treatments are usually sufficient for this, which should take place at weekly intervals.
