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Huge Disc! Tiny Disc! The Size Doesn't Matter

My back pain is gone! ... What happened to the disc?

A Chicago disc herniation is just as annoying as a disc herniation anywhere else in the country. We all just want relief from our pain. Does it matter what the disc looks like when the pain goes away? Not really, but it is a curiosity.

In the same way that an MRI reveals numerous disc herniations in a patient with minimal to no symptoms, the disappearance of pain in a patient with pain due to a disc herniation may be due to the disc's not reducing at all ... or reducing a little or even getting larger. The goal of treatment at Chiropractic Care in Chicago is pain relief which entails a reduction of irritating factors, be they mechanical, chemical or other.

Hmmm...

When pain due to a disc herniation disappears it is often a cause for jumping for joy, but what really caused the pain to stop in the first place? Amazingly, the size of the disc herniation may have completely shrink, stayed the same, or even enlarged as you healed and became relieved of your spine and/or extremity pain under non-surgical care. Seventy-five percent of people showing a herniated disc on a MRI experienced no symptoms (1).

A common question following care, especially if an MRI showing a disc herniation was done prior to treatment, is "how does my herniated disc appear on the MRI now" or other imaging? Well, several authors report differing percentages of disc herniation disappearance in patients who are relieved of their pain.

disc herniation in cervical spine

For example,

  • Repeat MRIs following successful relief of back and extremity pain under conservative care such as Cox Flexion Distraction and Decompression spinal manipulation showed reduced disc herniation size in 35% to 100% of cases (2).
  • Nine of 11 disc herniation fragments shrunk 50% to 100% in proven disc extrusions with muscle weakness (3).
  • Thirty six patients who had a disc herniation (protrusion, extrusion, or free fragment) identified on their initial examination had a repeat MRI which showed
    • 57% of MRI disc herniations decreased in size,
    • 39% were unchanged, and
    • 2 actually increased in size (4).
  • Interestingly, a simple pinch of the sciatic nerve for as brief a time as 2 seconds produces pain (7).

The clinical outcome does not depend upon the size of the disc herniation or degree of spinal degeneration.

  • Researchers followed twenty-one patients for 7 years after being treated non-surgically for a lumbar disc herniation.
    • At least 3 MRIs were taken at the beginning of care, at 2 years after care and at the end of the 7 year study.
    • Though there was significant reduction at the 2 years' and 7 years' studies and more degeneration of the disc, the clinical outcome did not depend on the size of the herniation or the amount of degeneration of the disc (6).
  • Even "massive" lumbar disc herniations treated non-surgically were shown at two years' follow-up to reduce by an average of 64% in size and disability reporting changed from 58% to 15%. Only 4 out of 37 patients ultimately required surgery (10).
  • Correlation of MRI-noted changes in 70 symptomatic lumbar disc herniation patients reveals that the shape and size of the protruded nucleus pulposus of the disc has no relation to a patient's clinical presentation (objective test results or self-reported pain complaints). All patients had completed a successful spinal manipulation treatment plan before the final MRI (8).

Closing Comments on Size of Disc Herniation

Regardless the size or size reduction, Chicago disc herniation patients are relieved of their pain even though the disc herniation may not 100% reduced. A factor that relieves pain is the reduced compression and inflammation on the nerve root at the spine level as a result of non-surgical care. That is also why we can have a disc herniation and experience no pain - the pressure on the nerve is below the level that causes pain. Finally, a disc herniation may regress or even disappear in a number of patients. This knowledge of the disc's behavior reduces the significance of radiological findings like MRI in deciding on surgery for a disc herniation (5). Careful monitoring of symptoms through clinical examination and treatment will result in the best clinical treatment plan.

A Chiropractic Treatment Plan in Chicago for Disc Herniation Pain Relief

Chiropractic Care's chiropractic, non-operative care is shown to be a safe and helpful treatment of cervical spine and lumbar spine disc herniations. A study of 27 patients with MRI documented disc herniations revealed that 80% of them reported a good clinical outcome after care. Their MRI scans showed that 63% had a reduced or completely reabsorbed disc herniation. 78% of the patients returned to their pre-disability occupations (9).

A disc herniation is painful. The size of the herniation doesn't affect the desired clinical outcome and goal of treatment; pain relief. Non-surgical care is shown to successfully relieve the pain, and in Chicago, Chiropractic Care is ready to help you.

Don't hesitate. Let Chiropractic Care located in Chicago help relieve your disc herniation pain with an clinical examination and treatment plan.

References

  1. Boos, Rieder, Schade, Spratt, Semmer, Aebi: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniation. Spine 1995;20(24)
  2. Jensen TS, Albert HB, Soerensen JS, Manniche C, Leboeuf-Yde C: Natural Course of Disc Morphology in Patients With Sciatica: An MRI Study Using a Standardized Qualitative Classification System. Spine 2006; 31(14):1605-1612
  3. Saal JA & JS: History of lumbar intervertebral disc extrusions treated nonoperatively. Spine 15(7)
  4. Erly, WK; Munoz, D; Beaton, R. Can MRI signal characteristics of lumbar disk herniations predict disk regression? Journal Of Computer Assisted Tomography 2006;30 (3):486-489
  5. Martinez-Quinones JV, Aso-Escario J, Consolini F, Arregui-Calvo R: Spontaneous regression from intervertebral disc herniation. Propos of a series of 37 cases. Neurocirugia 2010;21 (2):108-117
  6. Masui T; Yukawa Y; Nakamura S; Kajino G; Matsubara Y; Kato F; Ishiguro N, Department of Orthopedic Surgery, Nagoya University School of Medicine, Nagoya, Japan. Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years. J Spinal Disord Tech 2005 Apr;18(2):121-6
  7. Hirose K, Iwakura N, Orita S, et al: Evaluation Of Behavior And Neuropeptide Markers Of Pain In A Simple, Sciatic Nerve-Pinch Pain Model In Rats. European Spine Journal 2010;19(10):1746-1752
  8. Guo W, Zhao P, Zhou W, et al: Correlation studies between MRI and the symptom scores of patients with LDH (lumbar disc herniation) before and after manipulative therapy. Zhongguo Gu Shang 2010; 23(1):17-9
  9. BenEliyahu DJ: Magnetic resonance imaging and clinical follow-up: Study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J of Manipulative and Physiol Ther 1997; 20(7):495-7
  10. Benson RT, Tavares SP, Robertson SC Sharp R, Marshall RW: Conservatively treated massive prolapsed discs: a 7-year follow-up. Ann R Coll Surg Engl 2010; 9292):147-53. Epub 2009 Nov. 2.
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