In the majority of cases<unk>  can be treated successfully conservatively, without surgical removal of the herniated material. Sciatica is a set of symptoms associated with disc<unk> . A study on sciatica showed that about one-third of patients with sciatica recover within two weeks after presentation using conservative measures alone, and about three-quarters of patients recovered after three months of conservative treatment. However the study did not indicate the number of individuals with sciatica that had disc<unk> s. Initial treatment usually consists of nonsteroidal anti-inflammatory drugs (NSAIDs), but long-term use of NSAIDs for people with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. Epidural corticosteroid injections provide a slight and questionable short-term improvement for those with sciatica, but are of no long-term benefit. Complications occur in up to 17% of cases when injections are performed on the neck, though most are minor. In 2014, the US Food and Drug Administration (FDA) suggested that the "injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death", and that "the effectiveness and safety of epidural administration of corticosteroids have not been established, and FDA has not approved corticosteroids for this use". Lumbar disc<unk>  Non-surgical methods of treatment are usually attempted first. Pain medications may be prescribed to alleviate acute pain and allow the patient to begin exercising and stretching. There are a number of non-surgical methods used in attempts to relieve the condition. They are considered indicated, contraindicated, relatively contraindicated, or inconclusive, depending on the safety profile of their risk–benefit ratio and on whether they may or may not help: Indicated * Education on proper body mechanics * Physical therapy to address mechanical factors, and may include modalities to temporarily relieve pain (i.e. traction, electrical stimulation, massage) * Nonsteroidal anti-inflammatory drugs (NSAIDs) * Weight control * Spinal manipulation. Moderate quality evidence suggests that spinal manipulation is more effective than placebo for the treatment of acute (less than 3 months duration) lumbar disc<unk>  and acute sciatica. The same study also found "low to very low" evidence for its usefulness in treating chronic lumbar symptoms (more than 3 months) and "the quality of evidence for ... cervical spine-related extremity symptoms of any duration is low or very low". A 2006 review of published research states that spinal manipulation "is likely to be safe when used by appropriately-trained practitioners", and research currently suggests that spinal manipulation is safe for the treatment of disc-related pain. Contraindicated * Spinal manipulation is contraindicated for disc<unk> s when there are progressive neurological deficits such as with cauda equina syndrome. * A review of non-surgical spinal decompression found shortcomings in most published studies and concluded that there was only "very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy". Its use and marketing have been very controversial. Surgery Surgery may be useful when a herniated disc is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. * Discectomy (the partial removal of a disc that is causing leg pain) can provide pain relief sooner than non-surgical treatments. * Small endoscopic discectomy (called nano-endoscopic discectomy) is non-invasive and does not cause failed back syndrome. * Invasive microdiscectomy with a one-inch skin opening has not been shown to result in a significantly different outcome from larger-opening discectomy with respect to pain. It might however have less risk of infection. * Failed back syndrome is a significant, potentially disabling, result that can arise following invasive spine surgery to treat disc<unk> . Smaller spine procedures such as endoscopic transforaminal lumbar discectomy cannot cause failed back syndrome, because no bone is removed. * The presence of cauda equina syndrome (in which there is incontinence, weakness, and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression. When different forms of surgical treatments including (discetomy, microdiscectomy, and chemonucleolysis) were compared evidence was suggestive rather than conclusive. A Cochrane review from 2007 reported: "surgical discectomy for carefully selected patients with sciatica due to a prolapsed lumbar disc appears to provide faster relief from the acute attack than non‐surgical management. However, any positive or negative effects on the lifetime natural history of the underlying disc disease are unclear. Microdiscectomy gives broadly comparable results to standard discectomy. There is insufficient evidence on other surgical techniques to draw firm conclusions." Regarding the role of surgery for failed medical therapy in people without a significant neurological deficit, a Cochrane review concluded that "limited evidence is now available to support some aspects of surgical practice". Following surgery, rehabilitation programmes are often implemented. There is wide variation in what these programmes entail. A Cochrane review found low- to very low-quality evidence that patients who participated in high-intensity exercise programmes had slightly less short term pain and disability compared to low-intensity exercise programmes. There was no difference between supervised and home exercise programmes.
Spinal disc herniation
Piriformis syndrome
Spinal tumor
Lumbar disc disease
Spinal stenosis
Degenerative disc disease
Lumbar spinal stenosis
Cervical spinal stenosis