Disc Herniation and Chiropractic Care.
It has been found that at some point during their lifetime, 2/3rds of adults will suffer from back pain. The location of the pain varies from lower to upper back but back pain is something that will affect their lives. Of the people that suffer from back pain, 10% of them will have pain that spreads down below their knees. The prevalence of herniated discs as the cause of back and leg pain may be approximately 10% in primary care. Of importance is that 85% of people with sciatica have a herniated intervertebral disc (IVD). Disc-related radiculopathy is both a biomechanical and biochemical process. Lumbar radiculopathy refers specifically to pain and motor and sensory disturbances in nerve-root distribution.
In the office, there are multiple tests that can be done on a patient in order to narrow down if the pain is coming from a disc or not. By doing these tests, it will provide some clarity as to what type of treatment a patient needs. Spinal adjusting alone may be insufficient for patients suffering from a disc-related radiculopathy.
Inside the disc there is a gelatinous material called the nucleus pulposus. The nucleus pulposus is the inner core of the vertebral disc. The core is composed of a jelly-like material that consists of mainly water, as well as a loose network of collagen fibers. The elastic inner structure allows the vertebral disc to withstand forces of compression and torsion. If the nucleus pulposus comes in contact with a nerve root, it can provoke inflammation that may be necessary for mechanical compression to cause pain. This is why anti-inflammatory medication may be beneficial for some patients. Disc herniation itself does not necessarily cause pain. MRI will commonly show herniated discs in a person without pain.
Most patients with radicular sciatica who do not undergo surgery will improve. Six weeks of conservative therapy is generally recommended in patients with herniated lumbar discs, as long as there is not major neurological problems. Conservative care does not change the natural history of the disc herniation, but will offer some relief. Most herniated discs will shrink with resolution of symptoms over 3-12 months. Unless patients have major neurological deficits, surgery is generally appropriate in those who have nerve root compression that can be confirmed on CT or MRI, a corresponding sciatica syndrome, and no response after 6 weeks of conservative treatment.
The mean time for resolution of discogenic sciatica symptoms with conservative care is 12 weeks. There is no significant advantage of surgery over conservative treatment for sciatica relief at 1 to 4 years of follow up. By the end of year 1, outcomes of early surgery generally do not differ from those who were under prolonged conservative care. About 25% of those with resolution of sciatica symptoms will have a recurrence of symptoms within 1 year. Sciatica usually occurs without a specific cause.
Other treatments include opioid drugs and injections into the spine. Opioid drugs should be limited to patients with severe pain and should be time limited from the outset because of the lack of evidence of benefit and the long term effects. Glucocorticoid injections show no significant advantages over placebo for pain relief or reduced rate of subsequent surgical intervention. It also shows no advantage with respect to improvement in physical function. In patients with acute disc herniations, avoidance of prolonged inactivity in order to prevent debilitation is important. Most patients with acute disc herniations can be encouraged to stand and walk.
Overall, conservative treatment for a disc herniation has been proven to be just as effective as surgery. The main difference is that conservative treatment is less costly compared to surgery. Chiropractic care can help greatly help patients who suffer from disc herniations. By opening up the joint and putting the vertebrae where they need to be it can allow for the disc to resorb back to where it needs to.
Cory T. O’Lear-Zebroski D.C.