Treatment of herniated disc

1. What is conservative treatment for herniated disc?
2. What is the rehabilitation program for a herniated disc?
3. What is the mechanism and complications of epidural steroid injection?
4. What is the mechanism and complications of chymopapain injections?
5. What are the indications for surgery?

Answers:
1. Relative rest, NSAIDs, analgesics, oral steroids, TCA, SRIs, muscle relaxants, and rehab program.
2. Stretching, strengthening, extension-based for posterolateral HNP, flexion based for lateral HNP, modalities.
3. ESI reduce inflammation causing nerve root irritation. Complications include bleeding, infection, tissue damage, anaphylaxis, convulsions, seizures, immunosuppr, adrenal suppression.
4. Chymopapain injections dissolve herniations contained by PLL. Complications include anaphylaxis, chronic pain, poor efficacy.
5. Progressive weakness, unremitting pain, cauda equina, myelopathy.