Treatments

Treatment for a lumbar disc herniation usually does not begin with surgery. This page explains the stepwise approach, from medication, exercise and physiotherapy to image-guided procedures, and when a surgical opinion is needed.

Treatment for a cervical disc herniation usually does not begin with surgery. This page explains the stepwise approach, from medication and physiotherapy to image-guided injections, and the warning signs that call for a surgical opinion.

Nucleoplasty is a needle-based procedure that aims to reduce pressure inside the disc in selected lumbar and cervical herniations that are still contained within the disc's outer ring. It is not suitable for every herniation; the decision follows an examination and MRI review.

Percutaneous laser disc decompression (PLDD) uses a fine laser fibre passed through a needle into the disc to reduce the pressure inside it. It is considered only for selected patients with a contained herniation, and results vary from person to person.

Radiofrequency treatment delivers controlled energy through a fine, image-guided needle placed next to specific nerves that carry pain signals. It is used in selected cases such as facet joint-related back and neck pain, nerve root pain and trigeminal neuralgia.

An epidural steroid injection delivers a corticosteroid, under image guidance, into the space just outside the membrane around the spinal cord to calm inflammation around a nerve root. It is considered for leg or arm pain caused by a lumbar or cervical disc herniation.

A facet joint injection places medication, under image guidance, into the small joints at the back of the spine or next to the nerves that supply them. It is mainly used to confirm the source of pain and to decide whether radiofrequency treatment may help.

Sympathetic nerve blocks deliver medication, under image guidance, to the sympathetic nerve networks involved in carrying pain. They are used in selected situations such as complex regional pain syndrome, cancer pain and pain arising from the abdominal or pelvic organs.

A trigger point injection uses a fine needle to deliver a small amount of medicine, usually a local anaesthetic, into tender, tight spots within a muscle. In myofascial pain syndrome, it is used alongside exercise and physiotherapy to ease muscle-related pain.

An epidural catheter is a thin tube placed in the epidural space of the spine so that pain medicines can be given continuously. In cancer pain, it is considered for selected patients whose pain is not controlled by medicines, or whose doses are limited by side effects, together with the oncology and palliative care teams.

An intrathecal port is a thin catheter placed in the cerebrospinal fluid around the spinal cord (the intrathecal space) and connected to a small reservoir under the skin. Pain medicines are given through this reservoir in very low doses; it is considered for selected patients whose cancer pain cannot be controlled with medicines, after a trial.

Spinal cord stimulation (formerly known as dorsal column stimulation) uses mild electrical pulses from thin electrodes placed near the spinal cord to change how pain signals are transmitted. For selected nerve pain that has not responded to other treatments, the device is implanted only after a trial period shows enough benefit.

Vertebroplasty involves injecting bone cement through a needle into a collapsed vertebra to stabilise the fracture and ease pain. It is considered for selected patients with recent, painful vertebral fractures caused by osteoporosis or a tumour, and the evidence differs between these situations.