Lumbar (Intervertebral) Disc Disorder Management in the ED Treatment & Management

Updated: Aug 13, 2021
  • Author: Jere F Baldwin, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
  • Print
Treatment

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 disc disease, but none of these has been shown to be superior to the others. Acetaminophen lacks anti-inflammatory activity. [13, 14]

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 (11%) improved with surgery; and 8 (11%) had persistent pain. [15]

Next:

Medical Care

Bed rest is not recommended most of the time. The exception is for patients whose pain is so severe that they cannot ambulate. Prolonged immobilization may worsen pain and extend recovery time. Strict bed rest should never exceed 2 days. Patients should be encouraged to begin limited activity as soon as possible.

Whether spinal manipulation (ie, chiropractic care) improves the rate of recovery in patients with disc disease is controversial.

Multiple surgical techniques have been used in patients with disc herniation who have not responded to 6 weeks of conservative therapy. These surgical techniques include discectomy, spinal fusion, and injection of chymopapain. [16, 17, 18, 19]

The Spine Patient Outcomes Research Trial (SPORT) failed to find any statistical superiority of surgical treatment versus conservative treatment for lumbar disc herniation. [20, 21]  This occurred because the study design allowed crossover of treatment based on the patients' preference. These findings suggest that, in most cases, there is no clear reason to advocate for surgery apart. Patient choice appears to be the most important predictive factor.

Previous