Treatment Options
Common surgical procedures for these conditions include discectomy, laminectomy, and fusion. In a discectomy, the part of the disc that is stressing the spinal cord or a nerve is removed. Removing or trimming part of the bony structure around the spinal cord (the lamina) is called a laminectomy. This may be done to widen the spinal canal when it has been restricted by stenosis, or to provide access for a discectomy. Spinal fusion fixes vertebrae together using bone grafts and screws or other hardware to prevent any movement between them.

Determining when surgery is appropriate is not always easy. Most incidents of back pain resolve themselves over several weeks. Even cases of severe chronic back pain or sciatica may respond very well to more conservative treatments. Individuals with substantial disc degeneration and/or stenosis can return to an active pain-free life without surgery. Surgeons may have a skewed perspective because their patients who are diagnosed as needing surgery, but who go on to rehabilitate themselves through non-surgical means, are unlikely to report back to the surgeon.

Even when there is clear disc impingement upon a nerve, non-surgical remedies are possible. Experiments have shown that a healthy nerve root (where the nerve exits the spinal cord) can withstand substantial pressure without pain or paresthesia (tingling or burning). When a nerve root is injured, pressure on it can cause loss of feeling, reduced reflexes and eventually reduced strength and motor reflex. However, when a nerve root has a poor blood supply (ischemia), it becomes very sensitive to pressure. So, a healthy nerve root with a good blood supply can tolerate a fair amount of mechanical abuse. But once it has become irritated, swollen, inflamed or otherwise suffered decreased blood flow, it will be much more easily irritated. Therapy should therefore be aimed at reducing mechanical irritation, reducing inflammation, and improving blood perfusion.

“Conservative treatment” is a term that can be applied to anything from pain pills and bed rest to much more aggressive therapy that involves substantial patient participation. The latter requires more commitment but is likely to give better results. The patient can also learn some useful self-care techniques during treatment. Analgesics, muscle-relaxers and anti-inflammatory drugs (or herbal formulas) may also have their place in the therapy.