Understanding Lumbar Disc Prolapse (Herniation)
A lumbar disc prolapse—often referred to as a herniated or slipped disc—occurs when the soft center of a spinal disc pushes through its tougher outer layer. This can irritate nearby nerves, leading to symptoms such as:
Lower back pain
Sciatica (radiating leg pain, numbness, tingling)
Muscle weakness, and in severe cases, loss of bladder/bowel control or saddle anesthesia—urgent medical signs.
Most minor herniations improve within weeks with conservative treatments such as physiotherapy.
UK Statistics: How Common Is It?
Approximately 1–2% of people in industrialised countries, including the UK, experience symptomatic lumbar disc herniation during their lifetime.
Sciatica secondary to herniated lumbar discs is seen in about 2.2% of UK patients in primary care annually.
Low back pain is the leading single cause of disability in the UK, representing about 11% of total disability burden.
Workdays lost due to musculoskeletal problems, including back pain, totaled nearly 31 million in 2016, with an estimated £12.3 billion cost to society and £1.6 billion on treatment.
These figures underscore the substantial societal and individual impact of disc-related back issues across the UK.
How Physiotherapy Can Help
Physiotherapy forms the cornerstone of conservative treatment for lumbar disc prolapse. Key benefits include:
Targeted exercises to strengthen core and back muscles, improving spinal support and resilience.
Manual therapy—such as mobilization, traction, and massage techniques—to relieve pressure and improve function.
Education on posture and body mechanics to prevent exacerbation and encourage healing.
Data shows that about 80% of patients with lumbar herniation improve with conservative care within 12–24 months
Structured rehab post-surgery varies in effectiveness, yet physiotherapy remains essential both pre- and post-intervention.
Medical Procedures: When and What?
When conservative treatments fall short—especially if leg pain, neurological deficits, or disability persist—medical interventions are considered. In the UK, common procedures include:
1. Epidural Steroid Injections (ESIs) / TFESI
Transforaminal epidural steroid injection (TFESI) delivers medication closer to the affected nerve.
The NERVES trial—a multicentre RCT across the UK—compared TFESI with surgical microdiscectomy. Both yielded similar improvements in disability scores at 18 weeks, with no serious adverse events in the injection group. Surgery carried higher cost (~£4,500 vs £700) and some risks.
From real-world data: ~9.3% of patients who received an epidural for disc herniation eventually underwent discectomy.
Conclusion: TFESI is a less invasive, cost-effective alternative that may delay or avoid surgery, though it’s usually chosen when conservative measures have already been tried.
2. Surgical Discectomy / Microdiscectomy
Lumbar discectomy (including minimally invasive microdiscectomy) involves surgically removing the herniated part of the disc to relieve nerve compression. It’s effective and commonly performed when symptoms persist or worsen.
In the UK alone, over 10,000 such procedures are performed annually.
Post-operative complication rates are low (under 1% within 30 days).
3. Advanced / Minimally Invasive Options
a) Endoscopic Techniques (e.g., TESSYS)
The TESSYS method uses a tiny endoscope to remove herniated disc tissue through a small lateral incision, often under sedation/local anesthesia.
Benefits include reduced bleeding, shorter recovery, minimal muscle disruption, and immediate pain relief in ~90% of cases.
b) Disc Replacement
Artificial disc replacement may be offered when degenerative discs cause persistent pain despite conservative care.
Success rates range from 70–96%, and it may preserve mobility better than fusion.
4. Emerging & Experimental Therapies
Non-surgical spinal decompression techniques (e.g., Hill DT therapy) have sometimes reported high satisfaction and avoidance of surgery in select settings, though evidence is still evolving.
Other evolving modalities include stem-cell therapy, but these remain investigational.
Summary: A “Stepped” Approach to Care
Start with conservative care: physiotherapy, education on posture, pain relief medications.
If symptoms persist (>6–12 weeks), consider invasive yet less risky options—like TFESI injections.
If severe symptoms or neurological signs, or persistent disability, surgery such as discectomy may be recommended.
For suitable candidates, assess minimally invasive options (e.g., endoscopic discectomy) or, in degenerative cases, disc replacement.
Final Thoughts
Lumbar disc prolapse remains a significant health concern in the UK—with real cost, disability, and quality-of-life implications. Yet, many patients recover well with conservative treatment. When needed, a range of effective, escalating options—from injections to surgery, and even dynamic replacements—offer real relief. Crucially, physiotherapy plays a pivotal role throughout recovery, not just as a first-line defense, but also as rehabilitation after interventions.