What are the possible treatments for a herniated disc?  

The initial treatment is almost always 'conservative', which means as much as therapy without surgery. An attempt is made to help reduce or eliminate the pain symptoms as quickly as possible.  The most important first target of this therapy are the complaints in the leg.

After thorough examination of the patient, a treatment plan is drawn up. Often the first therapy is a combination of medication and continued normal activities. Resting is not a treatment for back related complaints. It may be beneficial because the muscles relax, but it has been scientifically proven that this only weakens the trunk muscles. The back then weakens instead of healing. 

Taking sufficient pain medication, keeping moving and picking up normal life as soon as possible is the best advice. 

With some people the pain doesn't diminish or the symptoms are too severe. Then transforaminal infiltrations can be prescribed. Under local anaesthesia a cocktail of analgesic and anti-inflammatory drugs is injected through the lateral ventricles (the "foramina"). The aim of this is to cause the hernia and nerve to swell, so that the pinching of the leg nerve and thus the leg pain disappears. Usually, two transforaminal infiltrations are given over a period of three weeks. These infiltrations are carried out in our centre by experienced anaesthetist-algologists. They require a short hospital stay of two hours. If necessary, they can be organised at relatively short notice by the referring specialist. 

When is it decided to operate a herniated disc?

If the non-surgical treatments do not help or in case of paralysis, it is sometimes decided that an operation becomes necessary. Operations are performed ONLY FOR RADIATING BACK PAIN, NOT SOLITARY BACK PAIN.

Irradiating pain despite non-surgical treatment can to have the herniation removed. This hernia operation is best performed between six weeks and six months after the first symptoms. If you wait for a longer time, there is a greater risk for permanent leg pains despite the decompression of the nerve. The nerve is loose but has sufferd from more permanent damage. In our department, the operation is extremely minimally invasive. By means of a keyhole surgery on the back, a full-endoscopic discectomy, the various causes of this radiating pains can be treated efficiently. These surgeries are the least invasive procedures possible, which efficiently remove the compression without damaging normal healthy tissue.

What are the possible treatments for spinal stenosis? 

From a purely scientific point of view, there are only two therapies that have been proven to help with channel narrowing.

The use of a walking aid

Surgical decompression of the spinal canal

When bending the back forward, the diameter of the spinal canal slightly increases. Therefore, people with a canal stenosis also have a natural tendency to lean forward. However, this is an awkward and tiring posture for the body.  The walking frame makes your arms support theirs while still allowing you to step with your back bent forward a little.  In this way, you can increase the diameter of the spinal cord canal yourself (to a limited extent) without straining the muscles of the rope.

Sometimes epidural infiltrations are given in case of canal narrowing. This has no proven effect on spinal stenosis. This is not illogical as it is a problem caused (mainly) by bone growth, and bone does not disappear by injections. For this reason, the reimbursement of epidural infiltrations for lower back canal narrowing has been abolished in Belgium.

If it is decided to perform a surgical canal widening, this can also be done in our department very minimally invasive with a key-hole surgery: the full-endoscopic decompression. For the time being, this is only possible if the narrowing is present at one link. An 8mm incision is made on the most painful side. By tilting the endoscope at an angle, the other side of the canal can also be widened.