First: Modern Conservative (Non-Surgical) Treatments
These treatments are the first and primary line of treatment for most cases.
Advanced Physical Therapy:
Personalized Therapeutic Exercises: These do not rely on general exercises, but rather on exercises specifically designed for the patient after analyzing their movement and posture.
Manual Therapy (Motor Rehabilitation): Such as the McKenzie and Mulligan methods, which focus on correcting movement and reducing pain.
Neuromuscular Exercises: To restore control of the deep muscles surrounding the spine.
Local Injections into the Spinal Spine:
Cortisone Injection (Epidural): Still the most common method for rapidly reducing inflammation and pain, giving the patient the opportunity to undergo physical therapy more effectively.
Platelet-Rich Plasma (PRP) Injection: A modern treatment that aims to use growth factors found in the patient's own platelets to stimulate the healing of damaged tissue in the discs and ligaments. The results are promising but are still under investigation.
Stem Cell Injection (Mesenchymal Stem Cells): The newest area of research. The idea is to inject stem cells taken from the patient's own bone marrow or from a donor into the herniated disc to regenerate damaged tissue and repair cartilage. This treatment is still experimental in most countries and is not widely adopted.
Second: Minimally Invasive Surgical Interventions (Newer and More Advanced)
When conservative treatments fail, these options are often the best choice.
Endoscopic Spine Surgery:
Description: A very precise procedure performed through a small incision (less than 1 cm) through which a camera and delicate surgical instruments are inserted.
Advantages: Less pain, very little bleeding, short recovery time (sometimes the same day or the next), and preservation of surrounding muscles and tissues.
Endoscopic Discectomy (PELD):
Types:
Intravertebral Discectomy (ILAED): For herniated discs in the lumbar spine (lower back).
Transcervical Discectomy (PCED): For herniated discs in the cervical spine (neck).
How it works: The herniated portion of the disc that is compressing the nerve is precisely removed, preserving most of the disc tissue.
Endoscopic spinal fusion: To correct spinal instability while maintaining as much movement as possible.
Third: Traditional surgical treatments (still used for advanced cases)
Microdiscectomy: Considered the gold standard of open surgery for lumbar disc herniation. It is performed using a surgical microscope and is effective and safe.
Disc replacement (artificial disc):
A replacement for the damaged disc with an artificial disc that maintains spinal mobility. It is most commonly used in the neck region and sometimes in the lower back.
Spinal fusion: For severe cases of spinal instability. The herniated disc is removed, and the vertebrae are joined together using bone grafts and screws.
How to choose the right treatment?
The choice of treatment depends on several factors, which are determined by the specialist:
Location and size of the herniation: Cervical, thoracic, or lumbar vertebrae?
Severity of symptoms: Is there only pain, or are there muscle weakness or numbness?
Body response to conservative treatments: Have you tried physical therapy and medication without success?
Patient's general condition: Age, weight, and presence of other medical conditions.
Conclusion
The latest treatment for herniated discs is not a single magic pill, but rather a comprehensive approach that begins with advanced conservative treatments. If these treatments fail, endoscopic surgery is considered the newest and best surgical option in most cases due to its precision, fewer complications, and faster recovery.