Regenexx® Non-surgical Disc Bulge or Herniated Disc Treatment Options
Bending, stretching, moving your bones: All these movements are made possible by your body’s discs, and when one or more of them has problems, it can be painful to engage in any movement at all.
The discs in your body that live between your neck and back bones, or vertebrae, are the shock absorbers of your body. They have a hard fibrous outside with a softer gel on the inside that allow you to have free range of motion without your bones rubbing together. When the outer fibers that make up the side walls around the disc become damaged through trauma or just regular wear-and-tear, the inner portions cause those side walls to bulge, leading to disc protrusion or prolapse. But when the soft gel interior starts to escape the disc, that’s when the disc is herniated, and that can lead to limited range of motion, or intense pain in the area.
Left untreated, these herniated discs can also irritate the spinal nerve positioned nearby, leading to more pain and displeasure caused by sciatica, or radiculopathy.
When herniated discs get bad enough, many doctors will recommend lower back surgery. But is surgery truly the best option for a herniated disc? What are the risks and the success rate? And are there any other alternative options that don’t involve such a huge, life-altering procedure?
If your doctor has recommended surgery, you may have a lot of questions around the process, as well as the effectiveness of the surgery on your herniated disc. First, let’s examine the answers to these questions about standard lower back surgery, and see if it’s truly the right fit for your situation.
Bulging & Herniated Discs Explained
A bulging disc is also called a disc protrusion or bulge. This means that the outer covering of the disc (annulus) is partially torn or damaged and the inner gel is causing the area to bulge. This can put pressure on a spinal nerve and cause numbness and tingling (sciatica).
A herniated disc is also called a disc extrusion, slipped disc, sequestration, or “HNP” (Herniated Nucleus Pulposis). This means that the outer covering of the disc (annulus) is completely torn or damaged and the inner gel squirts out. This can put pressure on a spinal nerve or cause severe swelling and lead to numbness and tingling (sciatica).
Regenexx Procedures for Back Pain Offer the Most Effective and Least Invasive Option for You
What kind of surgery can I expect to undergo for my herniated disc?
What is the success rate?
While there are a number of different types of herniated disc surgery that all accomplish the same objective with a Discectomy, which is the cutting out of either the herniated disc material, or the bulging side wall, they all differ in terms of how invasive the procedure is for the patient.
The most common approach to herniated disc surgery is the Open Discectomy, which is a procedure that goes through the muscles of the lower back. This procedure is often accompanied by a variety of problems, to include destroying important spinal stabilizing muscles (4). Though there are a number of other smaller surgical approaches that have been developed in recent years, to include minimally invasive endoscopic procedures, the outcomes and complications remain, even with a quicker recovery time (5).
These kinds of complications are one of the primary reasons that patients seek alternatives to surgery when it comes to their herniated discs, as well as the fact that the overall failure rate of this type of procedure is anywhere between 10 and 50% (6-10).
These failure rates mean that the patients experience continued low back or leg pain, or worse, new disabling symptoms, post-surgery. This is referred to as Failed Back Surgery Syndrome, attributing to the negative public perception of back surgery overall, as well as for herniated disc issues (11).
Some research indicates that patients with sciatica may heal more quickly, but after a year’s time, there is little difference distinguishing patients who underwent surgery versus those who opted to do nothing (1-3). Surgical options may expedite nerve pain healing, but if the patient waits, that pain is likely to go away on its own over time.
There are alternatives to herniated disc surgery. Even if your doctor strongly recommends surgery to treat your herniated disc, there are less cumbersome treatment options from Centeno-Schultz that can alleviate pain and help our patients circumvent surgery altogether.
What are alternative treatment options for my herniated disc?
Instead of invasive surgical procedures, at Centeno-Schultz, we utilize the newest treatment options for herniated or bulging discs that approach treatment in a different manner, as opposed to cutting out tissue you still need. These treatment options help patients with herniated discs find lasting pain relief and regain more than just their range of motion…they regain their lives.
The first alternative treatment option we utilize is called an Orthobio Epidural. What is this treatment and what are its benefits?
- An Orthobio Epidural is tissue-friendly (24) steroid injection designed to be beneficial to nerve health (19,20).
- A nanogram dose of steroid is used, as opposed to a typical epidural steroid injection, which is at a dose as high as 1M times than the dose our procedure uses.
- Our clinic has published a large case series documenting patients treated with these Orthobio Epidurals, and have found excellent results (18).
- Many of our patients were able to successfully avoid back surgery, relying on these treatments as an alternative to surgery for their herniated discs.
An additional treatment we use at Centeno-Schultz as an alternative to surgery is called the Percutaneous Orthobio Annuloplasty Procedure:
- This treatment is used specifically for disc bulges and herniated discs.
- Instead of using a surgical procedure to cut out chunks of disc material, this procedure seeks to heal the tears in a herniated disc through injection.
- Tearing out disc material through surgery can weaken the side walls and increase the risk of the patient re-herniating (21), which is avoided entirely in this method.
- Extensive research we have conducted highlights the effectiveness of this particular non-invasive procedure to reduce disc bulge sizes and symptoms without the need for surgery (22,23).
At the end of the day, the simplest alternative to low back surgery for a herniated disc is to skip surgery altogether. In 75% of patients with herniated discs who opt out of surgery, there will still be an improvement in disc herniation size on an MRI over one to two years, as well as an increase in pain relief (12). Another 15% of those who forego surgery will see a partial regression of the disc and, subsequently, partial relief, with only 10% of patients experiencing long-term pain with no change in size of the herniated disc. However, in disc bulges, the opposite tends to be true: only roughly 10% of patients with disc bulges will experience complete resolution of the disc bulge over time, leaving a lifetime of pain ahead of them (13).
The good news is that, while surgery is invasive, scary, and can come with extended periods of recovery and healing, there are other options, such as the ones we offer at Centeno-Schultz. You don’t have to undergo painful, invasive procedures for your herniated disc, nor do you have to play the odds in skipping treatment and hoping for the best. Our procedures are backed by extensive research and published patient outcome data, and all of our doctors are musculoskeletal specialists with advanced training. Our non-surgical options offer precise, image-guided injections that ensure the best possible results for our patients.
Ready to find relief?
Life is too short to live in pain. If you’ve been recommended spinal fusion surgery, we want to provide you an alternative that minimizes complications and ensures optimal and lasting results. Take advantage of our innovative treatments that help people just like you avoid joint replacement and other invasive surgeries, allowing them to get back to doing the activities they love, faster and without surgery.
(1) Lurie JD, Tosteson TD, Tosteson AN, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial [published correction appears in Spine (Phila Pa 1976). 2015 Jan;40(1):E59]. Spine (Phila Pa 1976). 2014;39(1):3–16. doi: 10.1097/BRS.0000000000000088
(2) Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ. 2008;336(7657):1355–1358. doi: 10.1136/bmj.a143
(3) Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983 Mar;8(2):131-40. https://www.ncbi.nlm.nih.gov/pubmed/6857385
(4) Kotil K, Tunckale T, Tatar Z, Koldas M, Kural A, Bilge T. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine. 2007 Feb;6(2):121-5. https://www.ncbi.nlm.nih.gov/pubmed/17330578
(5) Harrington JF, French P. Open versus minimally invasive lumbar microdiscectomy: comparison of operative times, length of hospital stay, narcotic use and complications. Minim Invasive Neurosurg. 2008 Feb;51(1):30-5. doi: 10.1055/s-2007-1004543.
(6) Thomson S. Failed back surgery syndrome – definition, epidemiology and demographics. Br J Pain. 2013 Feb;7(1):56-9. doi: 10.1177/2049463713479096.
(7) Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. J Pain Res. 2016;9:979–987. Published 2016 Nov 7. doi: 10.2147/JPR.S92776
(8) Clancy C, Quinn A, Wilson F. The aetiologies of failed back surgery syndrome: a systematic review. J Back MusculoskeletRehabil. 2017;30(3):395–402 https://www.ncbi.nlm.nih.gov/pubmed/27689601
(9) Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976). 2007;32(19):2119–2126. https://www.ncbi.nlm.nih.gov/pubmed/17762814
(10) Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers’ compensation setting. Spine (Phila Pa 1976). 2015;40(22):1775–1784 https://www.ncbi.nlm.nih.gov/pubmed/26192725
(11) “Doctors getting rich with fusion surgery debunked by studies:” Bloomberg, Dec 30 2010. Accessed 10/12/19. https://www.bloomberg.com/news/articles/2010-12-30/highest-paid-u-s-doctors-get-rich-with-fusion-surgery-debunked-by-studies
(12) Kesikburun B, Eksioglu E, Turan A, Adiguzel E, Kesikburun S, Cakci A. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci. 2019;35(4):974–980. doi: 10.12669/pjms.35.4.346
(13) Keskil S, Ayberk G, Evliyaoğlu C, Kizartici T, Yücel E, Anbarci H. Spontaneous resolution of “protruded” lumbar discs. Minim Invasive Neurosurg. 2004 Aug;47(4):226-9. https://www.ncbi.nlm.nih.gov/pubmed/15346319
(14) Manchikanti L, Knezevic NN, Boswell MV1, Kaye AD, Hirsch JA. Epidural Injections for Lumbar Radiculopathy and Spinal Stenosis: A Comparative Systematic Review and Meta-Analysis. Pain Physician. 2016 Mar;19(3):E365-410. https://www.ncbi.nlm.nih.gov/pubmed/27008296
(15) Mather LE, Copeland SE, Ladd LA. Acute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts. Reg Anesth Pain Med. 2005 Nov-Dec;30(6):553-66. https://www.ncbi.nlm.nih.gov/pubmed/16326341
(16) Mackinnon SE, Hudson AR, Gentili F, Kline DG, Hunter D. Peripheral nerve injection injury with steroid agents. Plast Reconstr Surg. 1982 Mar;69(3):482-90. https://www.ncbi.nlm.nih.gov/pubmed/7063571
(17) Eder C, Pinsger A, Schildboeck S, Falkner E, Becker P, Ogon M. Influence of intradiscal medication on nucleus pulposus cells. Spine J. 2013 Nov;13(11):1556-62. doi: 10.1016/j.spinee.2013.03.021
(18) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injections for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5
(19) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.
(20) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. A source of autologous biomimetic scaffold for peripheral nerves. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.
(21) Shin BJ. Risk factors for recurrent lumbar disc herniations. Asian Spine J. 2014;8(2):211–215. doi: 10.4184/asj.2014.8.2.211
(22) Elabd C, Centeno CJ, Schultz JR, Lutz G, Ichim T, Silva FJ. Intra-discal autologous, hypoxic cultured injections in five patients with chronic lower back pain: a long-term safety and feasibility study. J Transl Med. 2016;14(1):253. Published 2016 Sep 1. doi: 10.1186/s12967-016-1015-5
(23) Centeno C, Markle J, Dodson E, et al. Treatment of lumbar degenerative disc disease-associated radicular pain: a pilot study on safety and efficacy. J Transl Med. 2017;15(1):197. Published 2017 Sep 22. doi: 10.1186/s12967-017-1300-y
(24) Dregalla RC, Lyons NF, Reischling PD, Centeno CJ. Amide-type local anesthetics: clinical implications. Transl Med. 2014;3(3):365–374. doi: 10.5966/sctm.2013-0058