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Looking at the picture below, nothing in the herniated disc seems to be able to correct itself over time. Yet, the article I took the picture from says that surgical treatment is used only if the pain is not resolved within a few weeks.

My question is: How exactly can this condition be resolved within a few weeks, with drugs only? What happens to the mechanical deformation - the root cause?

enter image description here

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The herniated part of the disc can be resorbed by the inflammatory process, which means that inflammatory cells, such as macrophages, can remove the damaged tissue. The healing time can range from several weeks to months.

Conservatively treated massive prolapsed discs: a 7-year follow-up (The Royal College of Surgeons, 2010):

The mechanism by which herniated discs are resorbed is not fully understood. It is generally thought that an immune response develops to the disc tissue and inflammation helps to remove the invading tissue.

Massive disc herniations usually reduce in volume and by 6 months most are only a third of their original size. Several studies have shown that the largest discs appear to have the greatest tendency to resolve.

Long-Term Course to Lumbar Disc Resorption Patients and Predictive Factors Associated with Disc Resorption (Evidence-Based Complementary and Alternative Medicine, 2017):

Of 505 participants, 19 did not show disc resorption, while 486 did. A total of 220 displayed resorption rates of ≥50%.

There is insufficient evidence that any treatment, including analgesics, physical therapy, spinal manipulation, steroid injections and surgery result in greater symptom relief 1-2 years after the onset of symptoms than no specific treatment at all (BMJ, 2007, European Spine Journal, 2007).

Early surgery should be considered when symptoms are unbearable, are bilateral, involve the perineum (the area between the legs) or bladder or bowel dysfunction (cauda equina syndrome).

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    Great answer. Might also add that the evidence for whether conservative care (which isn't just meds as OP suggests, it's robust physical therapy + usually ergonomic changes at work/home + possibly some pain meds + sometimes cognitive behavioral therapy!) or surgery is better in the long term is mixed. Current evidence suggests no difference in long term outcomes, and although surgery often has better short term outcomes it has additional potential complications. – DoctorWhom Jun 18 at 18:10
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    I usually do not promote surgery, but I must say that I've seen excellent long-term results in few people with lumbosacral disc herniation. Surgery should be done in cauda equina syndrome. Conservative therapy may relieve pain but does not speed up healing because you can't "exercise" the herniated disc. – Jan Jun 19 at 7:18
  • Jan, thank you very much for your sensible and competent answer. So, the "few weeks" period mentioned in the article I found is generally too short; the real progress should be expected in terms of months or even years. – sigil Jun 19 at 13:11
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    The pain can actually resolve in few weeks, but the actual healing time of the disc is usually longer. The healing time can depend on the extent of the herniation and personal factors...If there is no improvement in a year, the chance for further improvement decreases with time... – Jan Jun 19 at 13:14

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