Lumbar (Intervertebral) Disk Disorders Treatment & Management

Updated: Feb 18, 2016
  • Author: Jere F Baldwin, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

Prehospital Care

Little is needed in the way of prehospital care. Appropriate spinal immobilization should be considered if the patient has evidence of trauma; otherwise, simple transportation in the position of comfort is all that is indicated.

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Emergency Department Care

Patients should lie in a position in which they are most comfortable.

Muscle relaxants are of limited use, and clinical studies have not proven their efficacy. This class includes benzodiazepines, methocarbamol, and cyclobenzaprine. Patients should be warned that all of these drugs are sedating. Opioids provide very effective acute pain relief, but they should not be used in patients with chronic pain. Salicylates, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) all have been used in the treatment of pain from lumbar disk disease, but none of these has been shown to be superior to the others. Acetaminophen lacks anti-inflammatory activity. [8, 9]

Of 76 patients who presented to an emergency department with low back pain, 42 (55%) had resolution or return of pain to baseline with conservative management; 18 (24%) had improvement with intervention (epidural steroid injection or kyphoplasty); 8 (10%) improved with surgery; and 8 had persistent pain (11%). [10]

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