The intense pain caused by a herniated disc results from the soft inner material pushing outward and pressing on nearby spinal nerves. This nerve compression can lead to radiating pain, numbness, or weakness in the arms or legs, often called sciatica when affecting the lower back. Many people search for ways to relieve this pressure on the irritated nerve roots. Decompression, the act of reducing pressure, is a primary treatment approach aimed at creating space within the spinal column to alleviate these symptoms. This concept is applied across both non-invasive and surgical procedures for disc-related issues.
Defining Spinal Decompression Treatments
Decompression treatments for a herniated disc fall into two distinct categories: non-surgical and surgical. Non-Surgical Spinal Decompression (NSSD) is a mechanical, non-invasive method utilizing motorized traction to gently stretch the spine. This conservative approach aims to relieve disc pressure without breaking the skin and is typically administered by chiropractors or physical therapists.
In contrast, surgical decompression involves invasive procedures performed by a spine surgeon. These operations physically remove the material compressing the nerve root, such as the herniated disc portion or surrounding bone. A common surgical procedure is a microdiscectomy, which targets the specific piece of disc material causing the irritation.
How Non-Surgical Decompression Works
Non-Surgical Spinal Decompression is performed on a specialized, computer-controlled traction table. The patient is secured with a harness around the pelvis and sometimes the torso, depending on the targeted spinal section. This computerized system applies a controlled distraction force to the specific segment of the spine where the herniation is located. The force is applied intermittently, alternating between periods of gentle stretching and relaxation.
This controlled pulling motion is theorized to create negative intradiscal pressure, often described as a vacuum effect, within the intervertebral disc. This negative pressure aims to encourage the disc material to move back toward the center of the disc space. The repeated distraction-relaxation cycle may also promote the movement of oxygen, water, and nutrient-rich fluids into the disc, aiding the healing process. Treatment protocols typically involve multiple sessions, often ranging from 20 to 28 treatments over five to seven weeks.
Effectiveness and Patient Selection
The question of whether Non-Surgical Spinal Decompression helps a herniated disc is met with mixed findings in the scientific community. Proponents of NSSD cite studies suggesting high rates of pain reduction, with some reporting success rates between 71% and 89% in specific patient groups. Some research, including those using Magnetic Resonance Imaging (MRI), has documented objective structural improvements, such as an increase in disc height or a reduction in the size of the disc herniation following treatment. These findings support the idea that NSSD can physically change the environment around the disc and nerve.
However, large-scale, high-quality evidence supporting NSSD over other standard conservative treatments, such as physical therapy and exercise, remains limited or inconclusive. Clinical guidelines from some major medical societies often recommend exercise and manual therapy as first-line treatments due to their stronger evidence base. Therefore, NSSD is often considered when initial conventional treatments have failed to provide lasting relief.
Patient selection is a crucial factor in determining candidacy for NSSD. Good candidates typically present with a mild to moderate herniated disc and radiating pain, without immediate signs of severe neurological compromise. NSSD is not appropriate for all patients, particularly those with contraindications. Contraindications generally exclude individuals who:
- Have undergone prior spinal fusion surgery.
- Have spinal instability.
- Suffer from severe osteoporosis.
- Are pregnant, or have tumors or infections.
- Have certain hardware implants in the spine.
Surgical Options for Disc Herniation
When non-invasive methods, including NSSD and traditional physical therapy, fail to provide relief after an extended period, or if the patient experiences progressive neurological deficits like foot drop, surgical decompression becomes the next option. The most common procedure for a herniated disc is a microdiscectomy. This minimally invasive operation involves the surgeon using a microscope or specialized tools to access the spine through a small incision.
The primary goal of a microdiscectomy is to physically remove the herniated fragment directly pressing on the nerve root. Excising this material immediately relieves mechanical pressure, often resulting in rapid pain relief. Other surgical decompression procedures include a laminectomy, where a portion of the vertebral bone is removed to create more space in the spinal canal. Surgery is generally reserved for severe or unresponsive cases after conservative care has been exhausted.