Is disc hernia always the source of pain?

A friend whom I’ll call John is an avid wake-boarder. For couple of years he had been having low back pain, which was treated by physiotherapy and manipulation by orthopaedic surgeon. It got better than it got worse again. In this fashion it kept improving and then coming back, but worse each time. Until one day, in lay terms, he ‘put his back out’ completely. The pain in low back and radiating pain down the left buttock and back of left leg and into left groin was so bad, that it left him incapacitated. He was unable to walk, other than shuffling by tiny steps, unable to stand for more than couple of minutes, unable to sit in certain positions etc. Standing up from sitting was the worst.

'Slipped disc' - herniated disc matter in spinal canal - transverse view

‘Slipped disc’ – herniated disc matter in spinal canal – transverse view

Herniated disc - lateral view

Herniated disc – lateral view

So what really happened? To find out, he had an MRI images taken (above). His friend surgeon explained the ‘diagnosis’ – as an absolute disc hernia and recommended immediate operation to remove the disc matter and to ‘stabilize’ – fuse, by metal rods, several vertebrae in his low back (lumbar spine). He decided to have another opinion by another surgeon, who advised an operation to remove the herniated disc matter, without spinal fusion. So he decided to have yet another opinion by a chiropractor. The doctor of chiropractic (link here: www.gonstead.co.uk ) took his x-ray films, examined his spine and performed neurologic, orthopaedic tests. He found a restriction in his left sacro-iliac joint. This was corrected in 3 sessions with great pain relief after each session. In fact straight after his first adjustment, he was able to make normal length steps with mild discomfort and stand without pain. He was virtually pain free on day 4 and started intensive focused rehabilitation programme to strengthen deconditioned muscles and work on muscular imbalances.

He lost 10kg of his weight and feels better and more fit than ever before. Without an operation.

How is this possible? The research of Dr Alison Endean, Professor Ketih T Palmer and Professor David Coggon (link here) in their systematic review and meta-analysis, suggests that:

“MRI findings of disc protrusion, nerve root displacement/compression, disc degeneration and HIZ are all associated with LBP, but individually, none of these abnormalities provides a strong indication that LBP is attributable to underlying pathology. This limits their value in refining epidemiological case definitions for LBP.”

It means that, just because you have been diagnosed with disc hernia, it doesn’t ALWAYS mean that that is the source of your pain. Hence removal of herniated disc matter can not guarantee removal of your symptoms. This case and the number of ‘failed’ operations (operations after which patients symptoms fail to resolve, despite removal of disc matter) strongly points to this fact.

It is worth to have another opinion before you decide for invasive solution.

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