herniated disc treatment

What Is the Best Herniated Disc Treatment Option out There?

When you’ve hurt your back and you can’t get up what do you do?

If you can’t get up, you call for emergency help

We’re not making light of someone who truly can’t get up but most of the time when you hurt your back, you can get up and get to the doctor.

The key phrase here is get to the doctor.

Most people initially self-diagnose and take a few hours or a day or so and rest. 

A round of extra-strength over-the-counter pain medication is often taken.

But what if your back pain doesn’t go away? What is it’s something more serious like a ruptured or herniated disc?

Modern medicine has an answer for you!

If you do have a herniated disc, it’s not the end of the world. 

We’ve put together a mini-guide for people who are considering or are worried about herniated disc treatment. If you’re not sure you have a herniated disc, call your doctor today. 

In the meantime, read this guide so you’re prepared when it’s time for your doctor visit.

What Is a Herniated Disc?

Back pain is so common most people have either experienced it or have a family member who has suffered from it. A staggering 80% of adults experience back pain at least once in their lifetime.

Most people don’t immediately assume their back pain is caused by a herniated disc. The average person assumes they’ve over-exerted at the gym or lifted a heavy object the wrong way.

Back pain can be caused by either activity but it could also be caused by a herniated disc, also called a bulging or ruptured disc.

A herniated disc is a condition of the cervical or lumbar spine. The cervical spine relates to the neck. The lumbar spine refers to the lower back.

When a disc is herniated nerves around the disc compress creating pain in the back, neck, arms, and legs, depending on whether the disc is located in the cervical or lumbar spine.

Disc pain is most common in the lower back because that’s where most of the movement the spine occurs. 

Pain in the neck, arms, or legs should be investigated as well since a herniated disc in the cervical spine may be the culprit.

As soon as you tell someone you’re having severe back pain, they’re likely to tell you it’s a herniated disc. Beware of listening to anyone other than a doctor. Self-diagnosis of a herniated disk is impossible.

You may suspect you have a disc issue but your doctor is the only one who can confirm it. 

Once you have a diagnosis, your doctor will recommend the best treatment for your unique situation.

If you’ve avoided seeing a doctor because you’re afraid of surgery, keep reading because surgery isn’t normally the first treatment offered to a patient.

Rest First

Doctors don’t rush patients into surgery unless not having surgery poses a serious health risk. They prefer what is considered conservative treatment methods.

The most common first treatment for a herniated disc is rest. 

Most patients don’t have a problem resting since they’re often in so much pain they can’t do much else.

Rest means no lifting and no strenuous exercise. You won’t be joining your friends at the gym.

Some patients go overboard with rest and stay in bed way longer than they should. Rest beyond 1-2 days does more harm than good as it can cause stiff muscles

Rest is a wonderful first treatment but don’t most doctors also offer medication? 

Medication Second

Another popular conservative treatment options is medication.

Depending on your pain level, you may be prescribed one of the following medications:

  • Over-the-counter pain medication such as ibuprofen or naproxen.
  • Narcotics like codeine or an oxycodone-acetaminophen combination.
  • Anticonvulsants are usually prescribed for patients who have seizures but they can help treat nerve pain caused by a herniated disc as well.
  • Muscle relaxers if you have muscle spasms-common with a herniated disc.
  • Cortisone injections for relief of inflammation.

Patients who follow doctors orders and their pain medication regimen normally feel relief within a few days or weeks.  

You may be thinking “I’ve rested. I’m taking my pain meds. I’m still in pain.”

Doctors have another conservative treatment they suggest for patients when pain isn’t significantly reduced within a few weeks.

Physical Therapy Next

Physical therapy is also considered a conservative care treatment for a herniated disc.

During physical therapy, patients learn techniques which help avoid activity that aggravates the disc. You may also learn ways you can improve your posture so that you reduce pressure on the disc.

Physical therapy is designed for minimization of the pain of a herniated disk.

The timeline for healing ranges from 2-8 weeks. Of course, healing depends on dedication to the physical therapy program. Dedication of the patient, not the physical therapy team.

Some patients simply don’t respond to rest, medication, or physical therapy and at that point, doctors begin discussing what are considered invasive treatment methods.

Before looking at those, however, let’s take a moment and discuss a few other ways doctors can help patients manage pain.

Alternative Pain Management

Medication isn’t the only treatment method used for pain management.

Doctors who treat disc herniation have access to a wide range of non or minimally invasive treatments.

If you’re more interested in trying pain management your doctor may suggest anything from surgical stimulation to spinal injections. Remember, each patient is unique and will respond to treatment in their own way. 

What works for a friend may not be the best pain management option for you. 

Let your doctor discuss the best options so that you have the best chance of successful treatment.

There will always be patients who don’t respond well to any of the already mentioned treatments for their herniated discs.

The best option may be surgery.

Surgical Herniated Disc Treatment

The most critical action you can take as a patient getting in for a visit with the doctor. You may only need rest or medication but the doctor is the best judge of what treatment method is best for your unique needs.

Surgery may be your answer!

Spine-health has come a long way. There are several minimally invasive surgical treatments available for treatment of a herniated or bulging disc.

Your doctor won’t make rash decisions when determining whether you’re a candidate for surgical treatment. Before any surgery is scheduled you’ll have a complete review of your MRI. Then, you’ll have a surgical consultation.

Modern surgical techniques include:

  • Minimally invasive decompression surgery
  • Endoscopic Cervical Discectomy
  • Anterior Cervical Discectomy

There are many other surgical treatments available and your doctor will go over each with you before you both determine which is best for you. 

Whichever treatment method you and your doctor decide is best, the end goal is life without the painful and debilitating effects of a herniated disc.

Which Treatment Option is Best for You?

Staff at Executive Spine Surgery get excited about helping patients enjoy spine health. 

If you’re experiencing back pain, or if you’ve already been diagnosed and are ready for herniated disc treatment, let us help you understand your treatment options. 

We invite you to get to know us and find out whether you’re a candidate

bulging disc vs herniated disc

Bulging Disc vs Herniated Disc: Is There Any Difference?

54% of Americans have had back or neck pain for at least five years. If you’re dealing with back pain, you’re not alone.

You may be wondering if you have a herniated disc or a bulging disc and whether there is any difference between them. If so, this post is for you. Read on to learn everything you need to know about a bulging disc vs herniated disc.

Bulging Disc vs Herniated Disc: What’s the Difference?

Before you look for treatment, it’s a good idea to become educated about your back pain. While it may seem like the terms ‘bulging disc’ and ‘herniated disc’ are used interchangeably, they are actually very different.

What is a Bulging Disc?

A bulging disc is sometimes called a disc protrusion. Usually, someone who has a bulging disc won’t have any symptoms. However, if the disc is compressing on the spinal cord or an adjacent nerve, this can cause disability and discomfort.

As we get older, the outer part of our discs naturally weaken. This fibrous portion can bulge when pressure from the central part of the disc stretches to the outer rim.

Since bulging discs don’t always have symptoms, many people may have a bulging disc without knowing it. However, once the disc begins pinching a nerve, they’ll feel pain traveling to the feet, legs, butt, and hips. If the disc is bulging in the cervical spine, you may feel pain radiating from the neck down your arm to your fingers.

Most of the time, bulging discs are found in the lumbar area (lower back). This will usually be between L4 and L5 of your lumbar vertebrae and between L5 and S1. Your sciatic nerve runs along here, so if the bulging disc crowds one of the six nerves along your spine, you can expect to feel sciatic pain. This can extend down your leg and all the way to your foot.

What is a Herniated Disc?

A herniated disc is what will typically happen if a bulging disc is not treated appropriately.

A bulging disc means that pressure is causing the fibrous outer part of your disc to bulge. But a herniated disc is when this outer layer has a hole or is so thin that the inner portion extrudes into the spinal canal.

One way to think of this is by picturing your favorite type of filled donut. If you put pressure on the donut, you’ll see it flatten slightly and the fluid may move towards the sides. But a herniated disc is when this “donut” ruptures and some of the filling begins leaking out.

Herniated discs are much more likely to be painful since they’ll usually protrude further, making it more likely to irritate your nerves.

Sometimes, herniated discs are also called slipped discs. While you’re more at risk of a herniated disc as you age, certain motions may cause a herniated disc- particularly if it’s already bulging. People who have a sedentary lifestyle, weak muscles, and/or are overweight are also more likely to develop a herniated disc.

The Symptoms of Bulging or Herniated Discs

Keep in mind that if you don’t have any pressure on a nerve from a bulging or herniated disc, you may not even be aware that you have a problem.

Here are some of the symptoms of bulging or herniated discs:

  • Burning sensations
  • Weakness
  • Tingling and numbness
  • Soreness and stiffness
  • Cramping
  • Muscle spasms
  • Radiating pain
  • General discomfort
  • Loss of range of motion
  • And more

You’re much more likely to have symptoms from a herniated disc as a bulging disc is more likely to stay contained in one area.

Diagnosing Disc Problems

If you think you may have a bulging or herniated disc, it’s best to get it checked out. Your doctor will check your back for any pain or discomfort and may ask you to move into various positions or lie flat.

You may need an MRI, which uses radio waves to create an image of your back’s internal structure. This will confirm where your bulging or herniated disc is, and the nerves it is affecting.

Finally, your doctor or specialist may also perform a discogram. This is when you have a special dye injected into your discs. A discogram helps narrow down the source of your disc pain.

Treating a Bulging or Herniated Disc

Once a doctor confirms that you have a bulging disc, they’ll usually recommend a few different measures. Often, a bulging disc will resolve on its own. If it doesn’t, your physician is likely to choose a more aggressive approach so any symptoms can be addressed.

As soon as you’ve been diagnosed with a bulging disc, you’re likely to try the following treatments:

  • Lifestyle changes and weight loss
  • Avoiding lifting
  • A short rest period
  • Ice packs
  • Stretching techniques
  • Heat therapy
  • Targeted exercises from a physical therapist
  • Anti-inflammatory medications and pain relievers
  • Cortisone (steroid) injections
  • Spinal decompression therapy
  • Acupuncture
  • Chiropractic treatment

Once you have a herniated disc, many specialists will start with conservative treatment such as physical therapy and medications. If your symptoms don’t improve within six weeks, you may need surgery. This is particularly true if you’re experiencing loss of bowel or bladder control, difficulty walking or standing, or weakness and numbness.

Often, a skilled surgeon will be able to just remove the portion of the disc that’s protruding. Very rarely, an entire disc will need to be removed. In this case, your vertebrae will be fused together to keep your spine stable.

Wrapping Up

If you think you may have a bulging or herniated disc, now’s the time to get it looked at. By starting treatment early, you have a greater chance of resolving the issue and avoiding surgery.

Want to talk to a professional about your back pain? We can help. Book an appointment online today so you can get to the bottom of your back pain and stop living your life in pain.

The Top 5 Questions About Recovery After Minimally Invasive Lumbar Fusion

1. How long will I have to stay in the hospital after minimally invasive lumbar fusion?
It is generally a rule of thumb to say that minimally invasive spine surgery usually will decrease the patient’s hospital stay by half. For a typical endoscopic discectomy and lumbar fusion surgery, the surgeries are performed in the same day, and the patients is usually able to go home in two to three days, compared to a hospital stay of five to seven days with traditional open lumbar surgery.

2. When can I go back to work after minimally invasive lumbar fusion?
This decision varies for each patient, depending on the type of work the individual does. If the patient has a sedentary job, he or she could likely return to part-time work a month or six weeks after lumbar fusion surgery. For more physical occupations, the patient must seek the advice of his or her surgeon on when it would be safe to return to work. Patients generally return to work much more quickly after minimally invasive surgery than after traditional open surgery.

3. What is the recovery time for endoscopic lumbar fusion?
The recovery time for each surgery is different. While some patients are able to return to full activity within only six weeks, others can require more time. Your surgeon will be able to give you a good estimate of what your recovery time will be like based on your individual needs and circumstances. I definitely encourage all of my patients to participate in a physical therapy program so that they can safely begin to return to the normal activities of their lives.

4. How long after minimally invasive lumbar fusion surgery will my pain last?
Pain generally follows that same rule of thumb as hospital stays with endoscopic spinal fusion: the patient usually experiences pain for half the time he or she would with traditional surgery. Patients typically experience the most pain in the first week with a gradual lessening of pain over the next six or so weeks. Each patient recovers differently.

5. Will I need physical therapy after endoscopic spinal fusion surgery?
I highly recommend physical therapy to all of my patients. It is an important part of a quick and easy recovery and return to full function and range of motion. While it varies from patient to patient, most patients who undergo endoscopic lumbar fusion will start physical therapy four to six weeks after the surgery.

6 Signs of Herniated Disk or Slipped Disk


  1. Leg pain – this may be pain radiating down the back or the side of the leg to the knee or foot.   Sometimes this pain is felt in the front or inner thigh or even the groin.  The pain may worsen with straightening the leg or siting up.   Arthritis pain is different from slipped disk.  arthritis pain  is usually only found in the hip, knees or ankle and does not radiate down the whole leg.
  2. Numbness and tingling – this may be felt as pins and needles, burning or decreased or absent feeling in the area of the pain or beyond it.  Sometimes numbness may appear without pain.
  3. Weakness – the leg may give out or drag.  You may have problems getting up from sitting, stepping onto a stool or moving your foot.
  4. Reflex loss – patients may loose reflexes at their knee or ankle or from the bottom of their foot.  Usually this is picked up from your doctor.
  5. Walking – the leg may drag or catch on the floor, you may have to lift the leg high to avoid this
  6. Bowel and bladder – if the disk compresses the cauda equina (the nerves to the bowel and bladder)  the bowel and bladder may stop working.  You may retention of pee or bowel movements or become incontinent of them.  If this happens you should seek medical attention immediately.

About Dr. Carl Spivak

Dr. Spivak is the president of Executive Spine Surgery and has offices in New York and New Jersey.  He is well known for his cutting-edge, minimally invasive endoscopic spine surgeries and regularly teaches courses throughout the USA.  For more information please call 908-452-5612 or click on schedule-an-appointment.

6 Best Treatments for Back Pain

1. Physical therapy focusing on core strength and flexibility.

2. Weight loss.  Weight loss alleviates back pain by reducing stress and strain on your back and decreases damage to disks and joints.

3. Steroid injections may relieve back pain.  Steroids and local anesthetics work to decrease inflammation, washout chemicals that cause pain and directly reduce pain often breaking the destructive pain cycle.  Steroid injections are an effective treatment for conditions that cause back pain such as arthritis of the spine (called facet arthropathy) and disk disease.

4. Stem Cell Therapy.  Disk regeneration is a new therapy where stem cells taken from your hip are injected  into your damaged disk to regenerate the disk.  The stem cells make new disk cells increasing the fluid and size of the disk reducing back pain and suffering.

5. Endoscopic Laser Discectomy.  As the disk wears out, or degenerates, it turns black on MRI, collapses, bulges and may tear causing back pain.  Removal of the degenerated disk and treatment of the annular tear has been found to reduce back pain and suffering.   The discectomy and annuloplasty can be done with the spinal endoscope.  A scope the size of a pencil can be placed through an incision the size of your finger nail.  The disk is found and repaired under direct visualization.

6. Endoscopic Fusion. Painful degenerated disks, spinal instability, spondylolithesis may lead to severe back and/or leg pain.  This pain can be disabling.  Patients that have failed other treatments may be a candidate for fusion surgery.  Today fusion surgery can be done through a very small incision with the aid of an spinal endoscopic to reduce soft tissue and bone damage and quicken recovery.


Dr. Spivak is the President of Executive Spine Surgery and is a leader in Endoscopic Laser Spine Surgery.  He see patients in New York and New Jersey and teaches doctors his advanced surgical techniques throughout the United States.  For more information please call 908-452-5612 or click schedule-an-appointment.

Can spinal epidural steroid injection hurt my brain?

Spinal epidural injections are very common treatments for back pain and sciatica.  Sciatica is leg pain running down the back of your leg caused by a slipped disk pinching a nerve.  Imagine the disk is a marshmallow (even though it really isn’t).  The disk like a marshmallow may expand out if you squeeze it.


You can try this at home – take a marshmallow and squeeze it from the top and bottom.  See how the marshmallow expands out as you flatten it.  This is similar to a herniated disk .  The bulging disk may pinch a nerve causing the nerve to swell up and get “hot” called inflammation causing back and leg pain.

Spinal epidural steroid injections are the placement of steroid medicine into the spine onto the hot and swollen nerve to cool down the inflammation and relieve the pain and suffering.  Think of it like putting an aspirin on the nerve.

Even though spinal injections are generally safe there are risks and side effects to all medical procedures. These include bleeding, infection, dural puncture or “wet tap” causing headaches and nerve damage.  Patients may also experience increased pain, headaches, red face, anxiety, problems sleeping, fever, high blood sugar, decreased immunity, stomach ulcers, severe arthritis, cataracts and menstrual irregularities.

TO ANSWER YOUR QUESTION the most common way spinal epidural steroid injections affect your brain is through headaches.  Usually these headaches will resolve with time.  If they are related to “wet tap” you may require bed rest, caffeine, fluids and rarely blood patch.  Blood patch is the injection of blood into the spine to stop spinal fluid leak and “plug” the hole from the “wet tap”.


Dr. Spivak is a neurosurgeon fellowship trained in minimally invasive spine surgery and spinal epidural steroid injections.  He has practices in New York and New Jersey.  For more information on spinal epidural injections or laser endoscopic spine surgery please call Executive Spine Surgery at 908-452-5612 or click schedule-an-appointment.

How can I get relief from my bad back pain?

Sorry to hear about your back and sciatica. The L5-S1 disk is probably pinching your sciatic nerve causing leg pain called sciatica. Lumbar disk surgery may be considered if steroid injections have not relieved the pain. Traditionally lumbar disk surgery was done through a large incision with significant muscle retraction, damage and bone removal to get to the disk. Today most lumbar disk herniations can be removed minimally invasively with the spine endoscope. This outpatient surgery is done with a small camera the size of a pen through an incision the size of your finger nail. Most people have quick relief from their pain and decreased recovery.

Patients are admitted to the hospital or surgery center for same day surgery.  They change into a gown and IV and EKG stickers are placed by the nurse and taken to the preoperative area.  The patient is seen by the surgeon, anesthesia and nursing.  The risks and benefits of surgery are explained to the patient if not already done.  The patient then signs an informed consent sheet verifying they understand the risks and benefits of surgery and want to go ahead with surgery. The patient is then taken into the operating room.  The patient is sedated (called conscious sedation) or put to sleep (general anesthesia) by the anesthesiologist and then position face down onto the operating room bed. The back is cleaned with a disinfectant and then a drape is placed over the patient.  X-ray machine and endoscopic equipment are brought to the bed.  After the surgery is completed the patient is transferred back onto their bed and taken to the recovery room.

For more information on minimally invasive spine surgery (MISS), endoscopic spine surgery or laser spine surgery please call Executive Spine Surgery at 908-452-5612 or click on schedule-an-appointment.

Where do you get the bone for spinal fusion?

People often ask 2 questions about spinal fusion:

1) Why do you need bone?

Bone is a key ingredient in spinal fusion.  Spinal fusion is done when the spine is weak and needs to be made stronger.  One vertebral body is connected to another vertebral body with metal screws and rods.  Bone is placed in-between the vertebrae so the vertebrae will grow together and form one solid bone.  If bone isn’t placed  and a solid spinal fusion is not obtained the screws and rods will eventually loosen and fall out or break.

2) Where do you get the bone from?

In the old days the bone was taken from your body.  Usually a piece of your hip would be cut out and then used as graft for the fusion.  Sometimes only the inside of the hip bone would be scraped out.  Today  donor bone or synthetic bone alternatives like hydroxyapatite are usually used.. Bone removed during the operation is rarely used.  This may still be done if the person last fusion surgery failed to fuse and now the surgery was been redone or if they are very high risk for the fusion failing such as smoker, sick or on chronic anti-inflammatory medications.

About Dr. Carl Spivak and Executive Spine Surgery

Dr Spivak is a neurosurgeon with expertise in minimally invasive spine surgery and is a pioneer in endoscopic spine surgery.  He routinely teaches workshops and courses for doctors throughout the United States for JOIMAX USA.  For more information on how Dr. Spivak can help you, please call 908-452-5612 or click schedule-an-appointment.

When can I have Sex after back surgery?

Patients often ask when they can safely have sex after back surgery.  This is a common concern for the patient and for their significant other.

Often their sex life has already been affected.  Back pain may interfere with intimacy, decrease sex drive (libido) and interfere with sexual enjoyment.  Patients with pelvic numbness or nerve dysfunction may feel less stimulation and pleasure or have difficulties developing or sustaining an erection or orgasm. Even worse, sex might aggravate the back injury, causing a great deal of pain and ultimately making sex unpleasant and unwanted.  Back pain can also lead to depression or be associated with depression, another factor that can affect your sex life.

No wonder people are concerned!

I am happy to tell you that sex is safe after back surgery.  For patients undergoing traditional back surgery, doctors commonly recommended waiting 6 to 12 weeks before resuming sexual activity. These operations involved a large midline incision, muscle retraction and bone resection, and patients suffered intense pain from muscle damage. These surgeries are very different from today’s advanced endoscopic spinal surgery. Endoscopic surgery is done through a tiny incision the size of your finger nail, using a little high definition video camera the size of a pen! There is minimal skin, muscle and bone damage.  Most people recover in a few weeks and the incision is small and less likely to be torn open.

The great advancements that have been made in minimally invasive back surgery means that patients treated endoscopically can start having sex again after only 2 weeks if their incision is healing well, their pain has resolved or significantly improved, and their sex drive has returned.  The healing time will increase for other more invasive surgeries or surgeries involving spinal instrumentation.  As with all activity, the patient should approach sex in a safe, gentle manner and take on a passive role. The patient should avoid heavy lifting, bending and twisting. They should stop if pain develops. As an old colleague of mine told his patients, “No shaking the trailer!”

They may benefit from small pillow under their low back, stacked pillows under their knees to bend the hips and support the legs, and taking a well-supported position.  They may also benefit from taking pain medication prior to sex. Their partner should avoid putting their full weight on them.  The patient may have less pain starting with missionary position, lying down on their side or standing and bending over a chair.

Since all patients and surgeries are different, you should discuss your return to sexual activity with your doctor. Though you might feel awkward bringing it up, don’t worry. It’s a very normal, healthy concern.


What is the sciatic nerve?

The sciatic nerve is made up of the spinal nerve roots exiting the lower spine. The sciatic nerve travels through the pelvis and down the leg. When disk or bone spur pinches the sciatic nerve in the back it causes back and leg pain called sciatica. This pain tends to be in the back of the thigh and calf.  This may be associated with numbness in the little toes and difficulty walking on your toes.  Bending forward or lifting your leg may aggravate the pain.  People with sciatica benefit from rest, anti-inflammatories, pain medicine, physical therapy, steroid injections and spine surgery.

Today spine surgery is not like how it used to be.  Most spine surgeries can be done with laser or spinal endoscope.  The arthroscopic procedure is done through a small incision the size of your finer nail through a tube the size of a pen.  The herniated disk is found and removed under direct visualization un-pinching the nerve relieving pain and suffering.  Patients are discharged home the same day after one to two hours.  Many people have little post-operative pain and need for pain medication after surgery and can return to most activities within a few weeks after surgery.

To learn more about sciatica and endoscopic spine surgery please see What is Sciatica? and Laser Spine Surgery.

Click to schedule-an-appointment or call 908-452-5612.

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