Can you realistically avoid surgery for an L4-5 or L5-S1 slipped disc?

Many people have highly effective spinal surgeries with great success. Despite the favourable success rate associated with lumbar surgery, a significant amount of people still choose not to have L4-5 or L5-S1 disc surgery for a variety of reasons.

If you're reading this, you may be one of those people - and you probably have a very valid reason to not want surgery.

Maybe the risks of having surgery outweigh the benefits for you, or you’ve already had a previous spinal surgery that didn’t help.

Perhaps you can't afford to take time off from work for recovery, or NHS wait lists are simply too long.

It's also possible that you also have good and bad days with your pain, and feel that things are not bad enough to have surgery.

And now you're here, reading this article because you would like to explore other options to manage your back pain.

If the above sounds like your story… you may want to read on

Have you had a diagnosis of a single or multiple herniated discs at your L4-L5 and/or L5-S1 vertebrae?

Have you already tried traditional conservative care treatments such as physiotherapy, chiropractic, osteopathy? But these treatments provided little or only short-term relief.

On your worst days, you take anti-inflammatories such as ibuprofen or naproxen, which are becoming less and less effective and require more frequent use.

Your back specialist may have recommended cortisone or epidural injections, or even surgery as a last resort to alleviate your pain and symptoms.

Your specialist says that they want to try the injections first to see if surgery can be delayed or at least help manage the pain until the surgery is scheduled.

“I have the worst slipped disc. I’ve been told I need surgery.”

We often hear from patients who experience most of the above and become frustrated with the trial-and-error approach made by medical professionals towards treating their disc bulge - ultimately being left with no other option but to consider surgery.

However, some spinal specialists will disagree with this approach - as there are other, much less invasive and yet more effective options available.

Many of these people reach out to us seeking non-surgical treatment options that can provide long-term relief, allowing them to go about their daily routine without having to rely on back braces, anti-inflammatories, or other remedies just to make it through the day.

You might be reading this article and thinking that your disc bulge shown in your MRI results is the worst ever and that surgery is your only option.

Maybe you're a business owner, someone who does physical labour, someone who sits at a computer all day, or a caregiver.

Whatever your line of work or however bad your back is... there is hope!

It’s important to understand that surgery may only be necessary if your pain is really severe, or you have significant disc degeneration, and you experience constant, radiating pain with disturbances in your bladder or bowel movement.

Fortunately, this extreme situation isn't what most people face.

You may be able to manage your daily activities and responsibilities, whilst experiencing severe pain from time to time, despite having a bad MRI result.

“I don’t care what the treatment is - even if it's surgery. I just want to get rid of my sciatica”.

We understand both the positive and negative aspects of having surgery for your herniated disc or sciatica.

On the one hand, you may be hopeful that surgery will finally alleviate years of pain.

On the other hand, you’re concerned about the possibility of the surgery being unsuccessful, as well as fears regarding recovery time and other potential drawbacks of the procedure.

While many people have successful experiences with surgery for herniated discs, it's important to note that Relieve Clinic based in Leeds, UK tends to see patients for whom surgery may not be a viable option due to unrealistic recovery times, the risks associated with the procedure, or other personal reasons.

Does a disc physically slip? The short answer is no.

The spine is made up of 24 individual bones called vertebrae that have soft discs acting as cushions sitting in between each vertebra. These discs have a firm outer layer (annulus fibrosus) and a soft inner layer (nucleus pulposus), contributing to spinal flexibility.

However, when the outer layer is weakened, the inner tissue may bulge out and press against a spinal nerve, leading to inflammation and swelling, which causes intense back pain and/or sciatica. A slipped disc in medical terms is know as a disc bulge, disc herniation, disc prolapse, or disc sequestration – depending on its severity.

Stages of degeneration for slipped discs

Slipped discs can occur anywhere in the spine, but are most common between the L4-5 and L5-S1 vertebrae in the lower back, which is also known as the lumbar spine. The severity of symptoms depends on the size of the bulge, with larger bulges typically leading to more severe symptoms.

Usually, rest, gentle exercise, and painkillers can alleviate the painful symptoms of a slipped disc over several weeks. However, if symptoms continue and interfere with daily life, medical treatment may be necessary.

llPeople between the ages of 30 and 50, especially men, are more likely to develop a slipped disc.

Several factors increase the risk of a slipped disc, including:

1.    Having a job that requires a lot of sitting

2.    Having a job that requires heavy lifting

3.    Smoking

4.    Being overweight

5.    Overdoing physical exercise – such as lifting very heavy weights at the gym

What symptoms can a bulging disc cause?

A lumbar disc bulge occurs when the soft, spongy substance inside a spinal disc presses out against its outer covering.

MRI Scan of a normal disc vs bulging disc vs herniated disc

Symptoms of a lumbar disc bulge can vary depending on the location and severity of the bulge, but some common symptoms include:

1.    Lower back pain: This is the most common symptom of a lumbar disc bulge. The pain maybe dull or sharp, and it may be localised to the lower back or radiate down into the buttocks or legs.

2.   Numbness or tingling: A lumbar disc bulge can put pressure on the nerves that run through the lower back and legs, causing numbness, tingling, or a pins-and-needles sensation in the legs, feet, or toes. This can often be referred to as sciatica.

3.    Weakness: Pressure on the nerves can also cause weakness in the legs, making it difficult to stand or walk.

4.    Loss of bladder or bowel control: In rare cases, a severe lumbar disc bulge can cause a loss of control over bladder or bowel function. This is a medical emergency and requires immediate attention.

It's relatively common for a disc herniation to occur in the lower portion of the spine, specifically between the L4-L5 or L5-S1 vertebrae. This can cause additional symptoms to arise - see below.

L5 nerve compression at the L4-L5 level can lead to a number of symptoms such as:

·       Pain radiating from the buttock, down the outside of the leg to the inside of the foot.

·       Weakness in the big toe and ankle (known as foot drop).

·       Numbness and pain on the top of the foot.

S1 nerve compression at the L5-S1 level of the spine may result in:

·       Pain radiating from the buttock, down the back of the thigh and/or calf, and outside of the foot.

·       Weakness around the ankle.

·       Difficulty in pushing off the ground with your toes. 

It's important to note that many people with a lumbar disc bulge may not experience any symptoms at all; whilst others may experience severe symptoms. If you're experiencing any of the symptoms listed above, you should see a healthcare provider for evaluation.


The disc must be the problem for successful treatment

If you are experiencing symptoms of a disc bulge, such as back pain, numbness, or weakness into your legs, your healthcare provider may order one or more of these following diagnostic tests to diagnose the condition:

1.    Magnetic Resonance Imaging (MRI): An MRI scan produces detailed images of the spine, showing the health of soft tissues, including the spinal discs. An MRI can show the location and size of a disc bulge. This is the gold-standard for detecting a disc bulge.

2.    Computed Tomography (CT) scan: A CT scan is a diagnostic imaging test that uses X-rays to produce detailed images of the spine. It can also show the location and size of a disc bulge.

3.    X-ray: An X-ray can show the condition of the bones of the spine but not the soft tissues, so it is not the most effective test for detecting a disc bulge. However, an X-ray may be ordered to rule out other conditions that can cause similar symptoms.

4.    Physical exam: During a physical exam, a healthcare provider may look for signs of a disc bulge, such as limited range of motion, tenderness, muscle weakness, or numbness or tingling in the legs.

Should you require a private referral for any of the above diagnostic scans, our spinal specialists at Relieve Clinic, Leeds can refer you for a scan.

What are the surgical treatment options for disc bulge?

The surgical treatment options for lumbar disc bulge depend on the severity of the condition and the symptoms experienced by a patient. Here are some common surgical treatments for lumbar disc bulge:

1.    Microdiscectomy: This minimally invasive procedure involves removing the portion of the herniated disc that is pressing on the nerve root or spinal cord. It is performed under general anaesthesia through a small incision and can be done as an outpatient procedure.

2.    Endoscopic discectomy: This is a minimally invasive procedure that uses an endoscope to remove the herniated disc material. The endoscope is inserted through a small incision in the back and allows the surgeon to visualise the herniated disc and remove the affected tissue.

3.    Laminectomy: This procedure involves removing the lamina, a portion of the vertebral bone that covers the spinal canal. It is usually performed when there is spinal stenosis or pressure on the spinal cord.

4.    Spinal fusion: This procedure involves fusing two or more vertebrae together to stabilise the spine. It is usually done when there is instability in the spine due to a severe herniated disc or other spinal conditions.

It is important to note that surgery is usually considered a last resort for treating lumbar disc herniation, and non-surgical options are typically recommended first. Your doctor can help you determine which treatment option is best for your specific condition.

What are the non-surgical options for disc bulge?

 If you would prefer not to go down the surgical route for treating your disc bulge - there are various non-surgical treatment options available. Non-surgical treatments for a disc bulge include:

1.    Physiotherapy: Physiotherapy is one of the most common non-surgical treatments for lumbar disc bulge. A physical therapist can design a specific exercise program that focuses on strengthening the muscles surrounding the lumbar spine, reducing pain, and increasing mobility.

2.  Pain medication: Over-the-counter pain medications like ibuprofen, or naproxen can help relieve pain and inflammation associated with lumbar disc bulge. Prescription medications like muscle relaxants or opioids may also be prescribed for severe pain.

3.  Epidural steroid injection: this is a medical procedure in which a healthcare provider injects potent anti-inflammatory into the epidural space around the spinal cord to reduce inflammation and swelling caused by a disc bulge. The injection typically contains a combination of a steroid and a local anaesthetic.

4.    Heat and ice therapy: Applying heat or ice to the affected area can help reduce pain and inflammation. Heat therapy is usually more effective for chronic pain, while ice therapy is best for acute pain.

5.    Osteopathy or chiropractic: Osteopaths and chiropractors use spinal manipulation and soft tissue massage techniques to improve joint mobility and reduce pain.

6.    Hill DT spinal decompression therapy: This therapy uses a computer-controlled table or device to apply a decompression force specifically to the affected disc of the spine. The goal of this therapy is to reduce pressure on the affected discs and naturally promote blood flow to the disc. This allows the disc to heal naturally and alleviates pain. It has proved to be most effective for disc herniations, bulging discs, degenerative disc disease, and spinal stenosis.

It's important to note that these treatments may not be effective for everyone, and in rare cases, surgery may still be necessary to relieve symptoms. We would advise you to consult with a healthcare professional to determine the best course of treatment for your specific condition.


What is Hill DT therapy?

Hill DT non-surgical spinal decompression therapy is a type of treatment that utilises a motorised device that gently, yet specifically targets and decompresses bulged discs. Hill DT therapy is designed to relieve pressure on the spinal cord or nerves within the spinal column, which can help alleviate pain and other symptoms.

Hill DT therapy treatment for lumbar disc herniation

Through gentle, repetitive axial loading or distraction of the spine, negative pressure is created within the disc over time, creating a vacuum effect.

This vacuum effect draws any herniated disc material back into the disc (see illustration below).

Negative pressure applied to the disc rehydrates of the disc and the surrounding tissues, which promotes the body’s natural healing process.

The goal of Hill DT therapy is to ease pressure on the spinal discs and nerves, while also enhancing spinal alignment and aiding in the healing of herniated discs or degenerated discs.

Case Study: 42 year old school teacher with l4-5 disc prolapse

Amy, a 42-year-old female school teacher presented with severe low back pain with right-sided sciatica (pain radiating into her right leg). The severity of symptoms had her wheelchair bound. Surgical history included a discectomy at L5-S1 two years prior. Recent physical examination revealed current signs of disc related pain.

An updated MRI revealed a disc prolapse at L4-L5. Amy wanted to avoid another surgery at all costs due to the extended recovery time associated with her previous operation.

Amy was recommended a protocol of 24 sessions of Hill DT therapy.

Results after Hill DT therapy

Hill DT non-surgical spinal decompression with exercise rehabilitation was deemed to be the best option for Amy. After 4-5 sessions, she was able to walk without assistance from the wheelchair. The pain levels improved from a complaint of 9 out of 10 pain to no pain by the 10th session. She returned to full-time work after 12 sessions. Full recovery occurred within 24 sessions.

Amy's L4-5 disc prolapse before and after Hill DT Therapy

Download our FREE Hill DT Therapy info pack to see another patient case study - CLICK HERE

How successful is Hill DT therapy for bulging discs?

Hill DT therapy has been shown to have a success rate of 91%, with little to no post-treatment complications, and no recovery time needed – allowing you to continue to work whilst undergoing treatment.

During a clinical evaluation of 163 patients on Hill DT non-surgical spinal decompression therapy, 91% of patients (149 out of 163 patients) were "satisfied" or "very satisfied" with the results of their treatment, indicating an excellent success rate.

The majority of patients looked forward to their treatment due to positive results and many were able to avoid surgery. Patients reported feeling better and experiencing minimal pain after treatment, and were optimistic about future Hill DT decompression treatment.

When is Hill DT therapy recommended?

Hill DT non-surgical spinal decompression therapy is recommended for patients with conditions such as, but not limited to, herniated discs or bulging discs, degenerative disc disease, sciatica, spinal stenosis, and facet syndrome. It can be considered for patients with chronic neck or back pain who have not responded to other treatments such as medication, chiropractic, physiotherapy or surgery.

However, it is important to note that Hill DT spinal decompression therapy is not suitable for everyone. Patients with certain medical conditions, such as spinal tumours, fractures, or infections, may not be suitable candidates for this type of therapy.

It is essential to consult with a qualified healthcare professional to determine if Hill DT Therapy is appropriate for your specific condition.

Download our free Hill DT Therapy info pack for further information - CLICK HERE

Want to know more about what we can offer for your disc bulge?

We hope this article has provided you with valuable insights and information about disc bulges and the available treatment options. At Relieve Clinic, Leeds, we understand that dealing with a disc bulge can be overwhelming and requires personalised attention. Our dedicated team of spinal specialists are here to support you every step of the way.

If you have any questions, concerns, or would like to explore treatment options tailored to your specific needs, please don't hesitate to reach out. We are committed to helping you in finding relief and reclaiming your life. Contact us today for any assistance you may need!


back pain getting you down?

At Relieve Clinic, Leeds, we are the first clinic in the UK to offer Hill DT therapy - a leading non-surgical approach to treating slipped discs.


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