The Best Way to Treat Herniated DiscsJanuary 8, 2019 January 8, 2019
We have seen countless patients in our over 30 years experience who suffer from back pain. Not just short-term back pain, but back pain that has challenged the patient for years and decades. These people continue to suffer from back pain while their doctors try to figure out what is wrong with them. Why is it so hard to figure out what is wrong with them? Why have so many treatments, and even possibly surgery, failed them? It should be easy to figure out, shouldn’t it? Back pain must mean bulging or herniated disc, correct? No it is not always the discs that are causing back pain and that is why we see some patients who go on for years and years with back pain. Someone is always trying to treat the disc problem when the discs are not the problem.
Here is an example of a patient we see: A man came into our office in Cherry Hill, New Jersey. He has horrible back pain that is shooting down his legs.
He is trying to avoid surgery so he has researched and looked into Platelet Rich Plasma (PRP) injections for his back pain. He researched PRP because he already had the epidurals, the chiropractic manipulation, and other conservative care options that did not help him. Satisfied PRP would help him, this patient went to see physicians who offered this treatment before coming to see us.
At the other PRP doctor’s office, the patient received a PRP injection right into his suspect herniated disc. It did not help. The injection was very uncomfortable and left him hardly able to move. The results of this treatment were: “terrible.” When doctors see herniated disc, they jump to treatments that treats the disc. In many people, this is ineffective treatment.
But the MRI says it must be a herniated disc that is causing the problem
The patient we are describing had an obvious herniated disc on his MRI. You can see his MRI is my short video presentation below
A doctor looking at that MRI would immediately see the herniated disc and possibly suggest that this patient get a discectomy, a surgery to remove the disc and replace it with an artificial disc or a spinal fusion surgery.
Yet there are many structures in the spine that can cause the patient’s pain beyond a herniated disc on an MRI.
Let’s look at the evidence from new and recent medical studies that tell doctors that they have to stop looking at the MRI as the ultimate source of what is hurting the patient.
A report in the Journal of neurosurgery suggests that patients will undergo a surgery, even if they have no pain, if their MRI showed an abnormality.
- More than 50% of the 121 patients in the study patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms
- More than 40% of patients indicated the same for plain radiographs (such as an x-ray).
- Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain.
- Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery.
In this study the investigators admitted that they were surprised by the level of misconception regarding the treatment and diagnosis
- These results show that a surprisingly high percentage of patients have misconceptions regarding the diagnosis and treatment of lumbar spondylosis (degenerative discs).
- Patients overemphasize the value of radiological studies and have mixed perceptions of the relative risk and effectiveness of surgical intervention compared with more conservative management.
- These misconceptions have the potential to alter patient expectations and decrease satisfaction, which could negatively impact patient outcomes and subjective valuations of physician performance. (1)
What you just read is something we see all the time in our office. A patient with a lot of images insisting that we treat the herniated disc. After we do a detailed physical examination we explain to the patient, on many occasions, that we do not believe the disc is the cause of their problems but micro tears of the spinal ligaments, muscles, tendons and fasica that is causing their spine to rotate out of position.
But how can the MRI be the wrong path to treatment? In the medical journal Spine, doctors looked at the top 100 cited medical research papers on back pain. The number one and number two articles tackled the problem of how doctors needed to explain the peculiar problem of why a patient has no symptoms or pain but their MRI suggests extensive spinal abnormalities including herniated discs.(2) Obviously this is a point of great concern for doctors, what to do with an MRI reading that shows something on film but not in the patient. How do you treat the patient?
Confusing diagnosis sends people to back surgery they did not need
As pointed out, there are many things that can cause spinal instability and back pain. The MRI shows a disc problem, but it may not show ligament strain or sprain. It may not show muscle spasms. Soft tissue injury can cause significant pain and instability while the herniated disc causes no pain, but if captured on film – will send the patient off to a surgical recommendation and a date for fusion or other procedure.
A study published in the journal Surgical neurology international suggested that “of 274 patients seen in consultation in a single year, 45 were scheduled for “unnecessary surgery.” Further, while these patients did experience pain, a vague MRI sent them for a surgery while there “was no clear surgical procedure that would benefit the patient.” 3
In the Journal of Orthopaedic Surgery and Research it was noted that MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of surgical cases.(4)
If it is not the disc, it must be the structure
We often tell patients that you cannot fix a disc without fixing the entire spinal supporting structure around it. When we see the patients with chronic, debilitating back pain and they have an MRI that shows a disc pressing on the nerves, we do not go in and treat the disc. We treat the supporting structures around it with Platelet Rich Plasma injections. We treat the ligaments, the tendon attachments, the connective soft tissue. We also treat and strengthen the supporting structures of the pelvis with PRP injections and correct Pelvic Tilt in patients.
In the video, you can see an MRI before of a patient with a herniated disc pressing on the nerves. After the PRP treatments you can see in the patient’s MRI that the disc was back in place, no longer pressing on the nerves. We never touched the disc. Strengthening the supportive strictures of the spine pulled the disc back into place.
If you would like to explore PRP injections for your spinal problems, please contact our office.
- Franz EW, Bentley JN, Yee PP, Chang KW, Kendall-Thomas J, Park P, Yang LJ. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine. 2015 May;22(5):496-502. doi: 10.3171/2014.10.SPINE14537. Epub 2015 Feb 27.
2.Steinberger J, Skovrlj B, Caridi JM, Cho SK. The top 100 classic papers in lumbar spine surgery. Spine 2015 May 15;40(10):740-7. doi: 10.1097/BRS.0000000000000847.
3. Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg Neurol Int 2011;2:83
4. Weiner BK, Patel R. The accuracy of MRI in the detection of Lumbar Disc Containment. Journal of Orthopaedic Surgery and Research 2008, 3:46