Lumbar Disc Herniation: Timeframe of recovery
Low back pain is a common issue, affecting about 80% of people at least once in their lives. Among the various causes of low back pain, the most prevalent is intervertebral degeneration, leading to lumbar disc herniation and degenerative disc disease.
The majority (approximately 95%) of disc herniations in the lumbar region occur at the L4-L5 or L5-S1 levels. Lumbar disc herniation stems from multiple changes in the intervertebral disc, including decreased water retention in the nucleus pulposus, increased ratio of type 1 collagen in the nucleus pulposus and inner annulus fibrosus, degradation of collagen and extracellular material, and heightened activity of degrading systems such as matrix metalloproteinase expression, apoptosis, and inflammatory pathways. These changes ultimately lead to local inflammation and mechanical compression from the protruding nucleus pulposus on the exiting nerve.
The pressure from the herniated disc on the longitudinal ligament and the irritation caused by local inflammation result in localised back pain. Lumbar radicular pain occurs when disc material compresses or contacts the thecal sac or lumbar nerve roots, leading to nerve root ischemia and inflammation. The posterolateral aspect of the annulus fibrosus, lacking support from the posterior longitudinal ligament, is thinner and more susceptible to herniations. Consequently, posterolateral herniation is more likely to cause nerve root compression due to the proximity of the nerve root. In lumbar disc herniation, the narrowing of the space available for the thecal sac can occur due to various factors, such as disc protrusion through an intact annulus fibrosus, extrusion of the nucleus pulposus through the annulus fibrosus while maintaining disc space continuity, or obliteration of disc space continuity and sequestration of free fragments. MRI is the preferred diagnostic tool for confirming suspected lumbar disc herniation, boasting a diagnostic accuracy of 97% and high inter-observer reliability for visualising herniated discs due to its superior soft tissue visualisation capabilities.
Most symptomatic presentations of lumbar disc herniation resolve within six to eight weeks and are typically managed conservatively unless red flag symptoms indicating emergent conditions like progressive neurologic deficit or cauda equina syndrome are present. Recent evidence suggests that conservative and surgical treatments yield similar outcomes in the medium and long term, making conservative management the preferred initial approach for acute lumbar disc herniation. Primary care providers can initiate treatment with rest if necessary, patient education, recommendations for physical exercises, and prescription of pain medications and physical therapy.
While most symptomatic lumbar disc herniations resolve within 6 to 12 weeks without significant medical intervention, patients experiencing symptoms for more than six weeks are less likely to improve without intervention. Over 85% of patients with acute herniated disc symptoms experience symptom relief within 6 to 12 weeks without treatment, with those without radiculopathy symptoms noticing improvement even sooner. Patients should be advised to take a rest period free from daily activities, start early rehabilitation, and for persistent pain, consultation with a Chiropractor or Physiotherapist is recommended.