Expert: Dr. Victor Dolan, DC, DACBSP - 5/26/2008

Question
QUESTION: I recently was diagnosed with a herniated disk in the L4-L5 area.  This was most likely caused at work when lifting a very heavy piece of equipment and simultaneously using a twisting motion.  I met with a neurosurgeon who told me I had a disk extrusion with the possibility of a free fragment in the area.  Because the disk bulged so far into the nerve area, he felt I was an excellent candidate for surgery.  He also told me to not do PT, as this may aggravate my condition.  I did have a Nerve Conduction Study done and the results show pinched nerves, but no permanent damage being done. Well, I have gone to PT recently and began doing MacKenzie stretches.  I seem to be responding well to these.  It's been about 4 weeks since my pain began.  It was real bad at first, but has subsided some.  I do walk with a pronounced limp and use a cane to keep my balance.  Do I have hope for non-surgical treatment options?  I want to avoid surgery, if possible.  Thanks for your help.

ANSWER: Hello Brian,

Herniated disc, free fragment.

Sorry to hear of your injury and resulting dysfunction.

Yes, you have hope for non-surgical treatment options.

In general:  Some HNPs (herniated nucleus pulposus = HNP = herniated disc) result in terrible pain and dysfunction.  Some herniated disc patients run marathons and lift heavy weights and play sports.  Herniated disc does not necessarily mean immediate surgery.  HNP has a variable course and wide ranging prognosis.

Herniated disc WITH bowel and/or bladder dysfunction (loss of ability to control bowel movement and / or urination) means there is such pressure/ irritation upon nerves that severe damage and dysfunction has resulted, and surgery is necessary.  'FootDrop', a weakness in the leg muscles that allows the foot to 'drop' and drag, and cause tripping and falling is another severe sign.  Foot drop could signal the need for imminent surgery, but can be recovered from.

Herniated disc WITH free fragment = surgery.  A herniated disc that has a free floating piece is a severe situation.  That free floating piece could lodge anywhere and cause severe nerve damage and severe problems.  Free fragment?, MRIs, CT scan, myelogram, emg/ncv a battery of tests should be run to rule this free fragment question in or out.

Herniated disc withOUT bowel/ bladder dysfunction, wothOUT foot drop, withOUT free fragment = give it time.  Surgery can be done in the future as the last resort.  Invasive, complicated surgery upon the spine should be the last alternative after safe, effective, noninvasive approaches have been tried for a period of time.  

Physical Therapy is treating the cause of the problem.  Chiropractic would treat the cause of the problem, the mechanical lesion, the HNP and associated nerve/ joint/ muscular dysfunctions.  Along with these conservative physical medicine approaches, nutrition would be helpful.

An anti-inflammatory regimen of diet and supplementation will bring down the inflammation of the disc, reduce pressure/ irritation of the disc, allow it to heal faster and more completely.  Proteolytic enzymes, Vitamin C, Glucosamine and Chondroitin sulfate, SAMe, MSM could all be on your anti-inflammatory joint rebuilding supplement list.

Many a Staten Island Chiropractor use techniques that are helpful for Herniated discs.  I would recommend a visit to your local family Doctor of Chiropractic for an evaluation.  Chiropractic, often called the conservative 'spine specialist'.  In my Staten Island Chiropractic office I also have non-surgical Spinal Decompression coming with new equipment due to be delivered.  Non-surgical Spinal Decompression is utilized by many Doctors of Chiropractic for HNPs.

Sorry to hear of your injury and fairly severe diagnosis.  Give it enough time, BE PATIENT, give your HNP proper safe, conservative, non invasive treatment, and you may NOT need to progress to the need for surgery.  Surgery should be the last resort.

As always this discussion is for information, education, thought provoking only.  Specific evaluation, DX, TX, RX, PX can only be performed by a treating health professional in person.

Wishing you good luck, and Good Health Naturally,

Victor Dolan, DC
http://www.GoodHealthNaturally.info
http://www.DocDolan.net
http://drvictordolan.chiroweb.com

---------- FOLLOW-UP ----------

QUESTION: Thank you for your detailed response, Dr. Dolan.  You have given me a lot of good ideas.  I will probably press for more tests to rule or rule out the question of the free fragment.  Currently, I have had only X-ray and MRI.  The neurosurgeon did not definitively state that I had a free fragment, but rather stated a possiblity after looking at the MRI.  I had a problem with his idea that I should not be doing PT, especially since I have seen results after just a few days of stretching.

I wonder if your new equipment that you speak of is perhaps the DRX 9000.  I have had numerous people tell me of its benefit.  I do plan on visiting a Chiropractor here in Colorado to see if they can help.  Thanks again for your answer.

Answer
Hello Brian,

Again- good luck with the herniated disc.  

Yes, the DRX 9000 is one type of nonsurgical spinal decompression table.  There are now many similiar tables; some that I know of are the DRX, Saunders Active Trac table, Chattanooga DTS, Chattanooga ADP trition table, there are many.

"Non surgical Decompression" is a combination of traction force with proper patient positioning.  Each table has it's proponents.  More important then the table is the Doctor involved.  One approach I have been studying recently in nonsurgical spinal decompression has neurological and rehabilitative components along with the decompression treatment.  I would recommend visiting http://www.LifeChangingCare.com to find a Doctor in your area.

This Staten Island Chiropractor has Non-surgical Spinal Decompression coming in just a few weeks to my office.   My Staten Island Chiropractic office has been in the same location for 25 years, and until recently, I was skeptical about the spinal decompression techniques effectiveness over traditional chiropractic approaches.  My study- over more then a year - show that nonsurgical spinal decompression CAN produce terrific results, regardless of the type of equipment, as long as the Doctor applies the correct technique.  Look for a Doctor of Chiropractic through the above website, look for a DC through word of mouth (reputation) referrals, look for a DC with experience with this technique.

I am certain that at least a chiropractic evaluation should be done of your herniated disc.  I am fairly certain that chiropractic and perhaps nonsurgical spinal decompression should be helpful.  Have some additional testing done to determine that free fragment question, and then proceed with the info we have discussed.

Good Luck, BE PATIENT, and Good Health Naturally!

AS always, only a treating health professional can evaluate, DX, TX, RX, PX a specific case in person.

Thanks,

Victor Dolan, DC DACBSP
http://drvictordolan.chiroweb.com
http://www.DocDolan.net
http://www.GoodHealthNaturally.info