This depends totally on the underlying aetiology? Is it traumatic ( grades of trauma?), genetics, syndromic, muscular..etc..

Aetiological understanding is the fundemental element for every patient.

Can a very lare slipped disc at L5-A1 causing acute sciatica heal on its own? What are the best analgesics?

L5 s1? The sciatica pain goes away if you take proper care during initial phase of herniation. But the real question is, if thete is an annular tear, then will it seal? Will the the disk get rehydrated again. This question has been troubling me for....lets say it matters to me. Would love to hear from experts.

Serious case of slipped disc cannbe a true problem and i just hope someone is doing good research in this area.

Indeed, the down-stream events that follow a disc herniation are difficult to determine so one is best to go with the statistics; most recover, but almost none ever 'heal'. What is most customary is a certain degree of innate healing on the part of the disc that involves scarring of the annulus (to the extent that it can heal) as well as biochemical/molecular changes that occur within the disc. Almost universally however the disc will continue to degenerate over time. Most patients recover but continue with some degree of symptoms that range from mild occasional discomfort to ongoing pain and radiculopathy. The "inner pulp" does not rehydrate and no amount of "non-surgical spinal decompression' can change the biological realities of the damaged disc.

I entirely agree with Dr. Duntsch and Dr. Erwin. Unfortunately, the knowledge about damaged discs advances very slowly and there are almost no new contributions to this issue for many years. The annulus fibrosus may form some sort of scarring, but does not heal in the sense of "restitutio ad integrum". This explains the avalanche of surgical methods for treating DDD, which by the way is not always justified. The reason is that in about 70% of cases with LBP we can not identify the exact source of pain.

Very interesting - so whats the best way to manage this situation and reduce further injury in the future?

Dear Dr. Noble,

If you mean how to put the back pain under control at the level of today's knowledge, the answer should be as folows: symptomatic treatment in the cases of unknown source of pain ( predominantly conservative) and surgical treatment in the cases with established source of pain (spondylolisthesis, vertebral canal stenosis, extruded massive disc herniation refractory to medication and physiotherapy). As spinal surgeon I may confrim that a variety of surgical methods exist that can be very successful in well indicated cases. Disc surgery also involves disc replacement (disc endoprosthesis) or nucleus pulposus replacement (nucleoplasty).

If you mean how to restore ad integrum a damaged disc - I see two ways and they are lying in the field of basic research: 1. Search for the origin of pain in cases with "idiopathic" back pain and 2. Search for biologic repair of nucleus pulposus - regeneration, rehydration, restoration. I think this is a vast domain for basic researchers.

The natural history of the disease and the interpretations of the associated pathological features such as family history of hearing loss, myopia, congenital cataract, excessive stria of the skin, arthritis, fibromuscular dysplasia, ligamentous hyperlaxity and so forth are major elements to be calculated in patients with degenerative spine disease.

Frankly speaking, throwing all patients in one basket is a misleading and shortsighted process of management. Every patient should be evaluated via his own individualistic clinical criteria with no omission of the family history.

Of course, you are right, Dr. Al Kaissi. Actually, this is common knowledge. But I think we deviate from the primary question. It tackles the healing of disc degeneration (slipping,herniation,etc).

Thank you Dr. Tanchev, actually the common knowledge you mentioned is unfortunately not applied in most of the medical disciplines! Disc degeneration is mostly a symptom complex rather than a diagnosis. I believe, that every single patient should be categorized in accordance with his phenotypic characterization. All diseases, syndromes, interinsic bone disorders and their variants have their characteristic features. Thencefore, treatment and healing processes should be designed and predicted in accordance with aetiological understanding for every given case.

Thank you Dr Al Kaissi, I have no objections. The problem is that we have been trying to answer a concrete question.