A 40-year-old patient suddenly experienced severe pain in the small of his back and left leg while lifting a case of water. Since the incident, he suffers from strong pain and visits his family doctor. An MRI examination of the lumbar spine shows an acute herniated vertebral disc at level L4-5, with compression of the left L5 nerve root, which corresponds to the patient's complaints.
Since the patient has no weakness in the leg, that is, acute paralysis or other deficits, nonoperative treatment is sensible if the pain is tolerable in everyday life. Pain medication is prescribed for the patient. In addition, a nerve root infiltration is performed. For this method, the medication is injected directly at the nerve root affected by the herniated disc. A hospital stay is not necessary and the method is performed on an outpatient basis. The syringe is applied by means of a computer tomography (CT) or X-ray image intensifier. In this way, the precise position of the needle tip is controlled to inject a small amount of a local anaesthetic-cortisone mixture directly into the area of the irritated nerve root. A few minutes later, a pain-relieving effect occurs, which lasts for various lengths of time.
If the pain is unbearable despite therapy or if leg or muscle weakness is caused by nerve root compression, surgery is appropriate. The intervertebral disc defect and interfering intervertebral disc tissue are surgically removed to relieve nerve roots (decompression). The disruptive intervertebral disc tissue is removed by means of a microsurgical procedure with an incision of approx. 2-3 cm made at the back (posterior access). As a rule, only a few days are required for surgery and aftercare. After hospital discharge, physical rest is recommended for another 4 to 6 weeks. Small walks and movements without extreme bending and rotational movements of the upper body are immediately possible. In most cases, faster pain relief can be achieved and permanent nerve damage can be avoided.