Having a disc injury sucks. It stops you from working, enjoying your hobbies, and exercising. They can last a short time or a long time. They can be mild or severe. Some times, people can be in so much pain that they feel as though they have no other choice but to go under the knife. I recently had a patient of mine come in having had such a surgery. It was a surprise to me since I had seen him a month or two before and he reported that his back was doing better.
To my knowledge these are the criteria for surgery.
- Back and leg pain limits normal activity or impairs your quality of life
- You develop progressive neurological deficits, such as leg weakness and/or numbness
- You experience loss of normal bowel and bladder functions
- You have difficulty standing or walking
- Medication and physical therapy are ineffective
My patient never had any leg pain, weakness or neurological deficits. He had pain in his back. Regardless of whether or not the surgery was the right decision I just hope he gets better.
For those of you who are suffering from back pain I hope this research paper gives you hope. Long story short, even the worst disc injuries can resolve over time.
Conservatively treated massive prolapsed discs: a 7-year follow-up. – PubMed – NCBI.
Ann R Coll Surg Engl. 2010 Mar;92(2):147-53. doi: 10.1308/003588410X12518836438840. Epub 2009 Nov 2.
Conservatively treated massive prolapsed discs: a 7-year follow-up.
Benson RT1, Tavares SP, Robertson SC, Sharp R, Marshall RW.
Abstract
INTRODUCTION:
The natural history of a lumbar hernia of the nucleus pulposus (HNP) is not fully known and clear indications for operative intervention cannot be established from the literature. Several studies have shown that the largest discs appear to have the greatest tendency to resolve. The aim of this study was to investigate whether massive prolapsed discs can be safely managed conservatively once clinical improvement has occurred.
PATIENTS AND METHODS:
Thirty-seven patients were studied by clinical assessments and serial magnetic resonance imaging (MRI) over 2 years. Patients had severe sciatica at first, but began to show clinical improvement despite the large disc herniations. Clinical assessment included the Lasegue test and neurological appraisal. The Oswestry Disability Index was used to measure function and changes in function. Serial MRI studies allowed measurement of volume changes of the herniated disc material over a period of time.
RESULTS:
Initial follow-up at an average of 23.2 months revealed that 83% had a complete and sustained recovery at the initial follow-up. Only four patients required a discectomy. The average Oswestry disability index improved from 58% to 15%. Volumetric analysis of serial MRI scans found an average reduction of 64% in disc size. There was a poor correlation between clinical improvement and the extent of disc resolution.
CONCLUSIONS:
A massive disc herniation can pursue a favourable clinical course. If early progress is shown, the long-term prognosis is very good and even massive disc herniations can be treated conservatively.
I hope you found this helpful
Originally posted on May 17, 2022 @ 4:38 pm