Disc Herniation, Protrusion, Bulge
A 34-year-old man with severe neck, lower back and radicular pain of 1 year duration had previously received care from multiple medical specialists with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. The patient was adjusted using Grostic procedures by hand. Within one month there were dramatic improvements in all subjective and objective findings At a one year follow-up it was concluded that surgery was not necessary.
Management of cervical disc herniation with upper cervical chiropractic care: a case study. Eriksen K. Journal of Manipulative and Physiological Therapeutics 1998 21(1):51-56.
Twenty-seven patients with MRI documented and symptomatic disc herniations of the cervical or lumbar spine were given chiropractic spinal care, flexion distraction, physiotherapy and rehabilitative exercises. Post-care MRIs revealed that 63% of the patients had a reduced or completely resorbed disc herniation. 78% of the patients were able to return to work in their pre-disability occupations.
Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations Ben Eliyahu, DJ. Journal of Manipulative and Physiological Therapeutics Vol. 19 No. 19 Nov/Dec 1996.
This is the case of a 28-year-old male who suffered from urinary frequency, perineal pain and mild low back and buttock pain. An MRI confirmed a lateral L5 disc bulge and a fixation at L5/S1. After two adjustments to the 5th lumbar vertebrae the patient’s pelvic and urological symptoms disappeared.
L5 subluxation: a cause of interstitial cystitis. Hammer W. Dynamic Chiropractic, 1997 (April 7):14.
This is the case of a 39-year-old male cable technician who complained of right neck and arm pain. He had a football injury 20 years prior and had some similar, temporary pain at that time. He now had an aching, deep pain running from the base of his neck to the right elbow and sometimes running sharply down his arm. Magnetic resonance imaging (MRI), thermography and Kronamaz muscle testing apparatus documented a C5-C6 disc herniation. Under chiropractic care the patient became symptom free and a later MRI revealed a reduction in the herniation.
Reduction of a confirmed C5-C6 disc herniation following specific chiropractic spinal manipulation: a case study. Siciliano MA, Bernard TA, Bentley, NJ. Chiropractic: The Journal of Chiropractic Research and Clinical Investigation Vol. 8 No. 1 April 1992.
Two patients with sciatic neuropathy and confirmed disc herniation received chiropractic care. A follow-up CAT scan in the first patient revealed complete absence of disc herniation. A follow up scan in the second case revealed the continued presence of a silent disc bulge at the L3-4 level and partial decrease in a herniation at the L4-5 level. The bulge appeared to have shifted away from the nerve root. Both patients’ pain levels decreased from severe to minimal as they regained the ability to stand, sit and walk for longer periods without discomfort and lifting also became easier. They were able to return to full time work capacity at three and nine months respectively.
Low force chiropractic care of two patients with sciatic neuropathy and lumbar disc herniation. Richards GL et al. Am J Chiro Med Mar 1990;3(1):25-32.
Osteoarthritis has been regarded as a product of "wear and tear" of the spine. This paper reveals that chiropractic management of osteoarthritis can lead to its arrest and even reversal.
Disc regeneration: reversibility is possible in spinal osteoarthritis. Ressel, OJ. ICA Review March April 1989 pp. 39-61.
This paper lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent "red flags" that indicate the need for referral to a specialist for surgical intervention.
After patients are screened for red flags, conservative treatment should be the first line of treatment for patients without absolute signs for surgical intervention. The authors concluded:
Chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients... for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.
Low back pain and the lumbar intervertebral disc: clinical consideration for the doctor of chiropractic. Troyanovich SJ, Harrison DD, Harrison DE. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp 96-104.
A 44 year old man with a herniated cervical disc as diagnosed by magnetic resonance imaging (MRI) and adjusted utilizing chiropractic care (atlas orthogonal technique) is discussed. His symptoms included severe neck pain, constant burning, left arm pain and left shoulder pain plus paresthesia in the index finger of the left hand. Patient also had diminished grip strength on left hand, a hyporeflexive biceps and triceps on the left as well as a C6 and C7 sensory deficit on the left. The MRI scan revealed a large left lateral herniated disc at the C6-7 level. By the fifth week of care, the patient’s symptoms of severe neck, shoulder, and arm pain were completely resolved. The patient’s numbness and grip strength improved consistently during the following six months. Comparative MRI obtained 14 months following the initial exam revealed total resolution of the herniated cervical disc.
Reabsorption of a herniated cervical disc following chiropractic treatment utilizing the atlas orthogonal technique: a case report. Robinson, G. Kevin. Abstracts from the 14th annual upper cervical spine conference Nov 22-23, 1997 Life University, Marietta, Ga. Pub. In Chiropractic Research Journal, Vol. 5, No.1, spring 1998.
This is the case of a 15-year-old high school athlete with acute low back pain that began after weightlifting in preparation for a football game. MRI demonstrated disc herniations of the lumbar area. Chiropractic care resulted in long-term resolution of the symptoms. Patient returned to playing football.
Treatment of multiple lumbar disc herniations in an adolescent athlete utilizing flexion distraction and rotational manipulation. Hession EF, Donald GD. J Manipulative Physiol Ther, 1993; 16:185-192.
This is the case of a 39 year old patient presenting with severe pain in his lower back, radiating into the buttocks, the thigh and his left calf and foot. A herniated nucleus pulposus at L-4 L-5 and L-5 S-1 was confirmed by Magnetic Resonance Imaging (MRI) and surgical procedures were recommended. Chiropractic was begun utilizing the Atlas Orthogonal Percussion Instrument on the atlas vertebrae. After 4 weeks of care, he showed a 50% improvement and was not using medications. After six months of care a subsequent MRI radiologist’s report indicated that a herniation was not present.
Correction of multiple herniated lumbar disc by chiropractic intervention. Sweat R. Journal of Chiropractic Case Reports. Vol. 1 No. 1 Jan 1993..
This is the case of a 43 year old female who suffered C5-6 and C6-7 nuclear herniations as a result of an automobile collision causing whiplash. She had a reversal of her cervical curve and extensive soft tissue damage and herniations as seen on magnetic resonance imaging (MRI). Specific spinal adjustments were administered and a therapeutic exercise program was prescribed along with cervical traction and soft tissue rehabilitation. After 6 months, a repeat MRI revealed that there was a mild posterior bulging of the C5-6 level in the mid line with no evidence for significant disc herniation. The C5-6 area appeared normal.
Chiropractic adjustments, cervical traction and rehabilitation correct cervical spine herniated disc. Breakiron G. Journal of Chiropractic Case Reports. Vol. 1 No. 1 Jan 1993.
A 30 year old computer technician with an L4-L5 disc herniation had relief from back and leg pain after rotational adjustments. Interestingly, there was no change in the pre- and post-CT scans. Commenting on the type of adjustment performed, the authors write: "The treatment of lumbar intervertebral disc herniation by side posture manipulation is both safe and effective."
Lumbar intervertebral disc herniation: treatment by rotational manipulation. Quon, J.A., Cassidy, J.D., O’Connor, S.M., & Kirkaldy-Willis, W.H. Journal of Manipulative and Physiological Therapeutics 1989; 12: 220-227.
Out of 517 patients with protruded lumbar discs, 76.8% had satisfactory results. It was concluded that manipulation of the spine can be effective for lumbar disc protrusions.
Treatment of lumbar intervertebral disc protrusions by manipulation. Pang-Fu Kuo P, Loh Z. Clinical Orthopedics and Related Research, Feb. 1987; 215:47-55.
This paper describes 21 patients with CT scan diagnosed lumbar disc herniation and nerve root pain. They began chiropractic care and a follow-up CT scan at least 6 months later showed the herniations reduced or disappeared in most patients.
Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression. Delauche-Cavallier MC, Budet C, Laredo JD, et.al Spine, 1992; 17(8): 927-933.
Spinal manipulation has been shown to successfully resolve disc problems without the need for surgery in most cases.
Manipulative Therapy and Rehabilitation of the Locomotor System, second edition, Lewit, K. 1991. Butterworth-Heineman, Oxford, 272. Quoted in the Chiropractic Report July 1992. Vol. 6 No.5.
Osteoarthritis has been universally accepted as an integral consequence of aging. The condition is considered to be the product of various pathobiomechanical alterations in joint function, a "wear and tear" sequelae. Under chiropractic care this condition may be arrested and even reversed.
Disc regeneration: reversibility is possible in spinal osteoarthritis. Ressel, OJ. ICA Review March April 1989 pp. 39 -61.
A total of 725 lumbar fusion cases were compared to 725 controls who were randomly selected from a pool of WC subjects with chronic low back pain diagnoses with dates of injury between January 1, 1999 and December 31, 2001. The study ended on January 31, 2006. Main outcomes were reported as RTW status 2 years after the date of injury (for controls) or 2 years after date of surgery (for cases). Disability, reoperations, complications, opioid usage, and deaths were also deter-mined. Results. Two years after fusion surgery, 26% (n = 188) of fusion cases had RTW, while 67% (n = 483) of non-surgical controls had RTW (P <= 0.001) within 2 years from the date of injury. The reoperation rate was 27% (n = 194) for surgical patients. Of the lumbar fusion subjects, 36% (n = 264) had complications. Permanent disability rates were 11% (n = 82) for cases and 2% (n = 11) for nonoperative controls (P <= 0.001). Seventeen surgical patients and 11 controls died by the end of the study (P = 0.26). For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n = 550) of cases continuing opioid use after surgery. Total number of days off work was more prolonged for cases compared to controls, 1140 and 316 days, respectively (P < 0.001). Final multi-variate, logistic regression analysis indicated the number of days off before surgery odds ratio [OR], 0.94 (95% confidence interval [CI], 0.92-0.97); legal representation OR, 3.43 (95% CI, 1.58-7.41); daily morphine usage OR, 0.83 (95% CI, 0.71-0.98); reoperation OR, 0.42 (95% CI, 0.26-0.69); and complications OR, 0.25 (95% CI, 0.07-0.90), are significant predictors of RTW for lumbar fusion patients.
Conclusion: This Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers compensation (WC) setting is associated with significant increase in disabil-ity, opiate use, prolonged work loss, and poor return to work status.
Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects: A Historical Cohort Study. Nguyen, Trang H. MD, PhD; Randolph, David C. MD, MPH; Talmage, James MD; Succop, Paul PhD; Travis, Russell MD. Spine. 36(4):320-331, February 15, 2011.