I have a herniated disc on my MRI…do I need surgery?

This is a common question. Someone is having pain shooting into their leg, so they get an MRI and upon receiving the report back it says that they have a “herniated disc” or a “disc protrusion” with a “broad base” or a “pedunculated formation”…what the heck does this all mean in plain terms?!

Basically, consider the anatomy of the disc. It is a hockey-puck sized cushion that absorbs the shock of walking. Without them, walking feels like driving in a vehicle or piece of heavy equipment without shocks or struts, leaving the joints of your spine to take serious damage. In short–the discs are very important.

They are composed of a soft gel-like center, surrounded by layers or “laminations” of tough fibrous rings. Over time, those fibrous rings get torn when we do dumb stuff. The gel substance, which typically serves as a non-compressible ball bearing center, gets squeezed toward the back of the disc through these tears. The more out of alignment these bones are, the faster this material gets squeezed toward the periphery of the disc.

Eventually, the material reaches the outside and causes the outermost layer to “bulge.” This is the most common type of disc issue. A bulge or protrusion has a wide base, meaning where it attaches to the disc itself is wider than the furthest point of the bulge. These tend to be less serious and troublesome.

Sometimes the material leaks out through a tiny tear in the outermost layer and forms almost like a balloon outside the disc, but remains connected to the disc by a thin stalk. This is called a pedunculated herniation, and is the next level up in seriousness.

Finally, when that little stalk breaks and the disc material is floating around in the space near the spinal cord, you have what is called a sequestered disc. This is the most serious type of herniation, and most likely to be an automatic surgical case. Believe it or not, there is still a high chance that this type will self-resolve as the body reabsorbs the material, so if you can tough out the pain, rule out any red flags, and be patient, it can often resolve without surgery. But should you have any loss of control of bowel or bladder function, along with the pain, this is a fairly serious sign that surgery is needed.

Where does chiropractic fit into all of this? Three ways:

1. Preventative: Chiropractic adjustments ensure that the vertebrae are not in a “retrolisthesis” positioning or make sure that they are not tilting backward. The backward tilt puts backward pressure on the disc material and encourages the early stages of disc bulge development.
2. Early correction and pain relief as the body takes time to heal: Chiropractic adjustments can often take just enough pressure off of a broad-based bulge to take the pressure off of the nerve tissue in the area, eliminating the symptoms and need for surgery.
3. Early detection: If you have regular chiropractic appointments, and one day you present in an odd way, your chiropractor is trained in the signs and symptoms associated with a disc sequestration, and should you need a surgeon consult, your chiropractor will know when it is appropriate to refer out and to comanage your case with a spinal surgeon.

So if you received an MRI report back and saw that you have disc herniations at multiple levels, how should you proceed? Although every case is unique, you should know that 29% of asymptomatic 20 year olds have disc bulges, and 43% of asymptomatic 80 year olds have disc bulges. You should also know that protrusions have a 41% chance of spontaneous (without any intervention) regression, extrusions (pedunculated herniations) have a 70% chance of spontaneous regression and sequestrations have a whopping 96% chance of spontaneous regression as the body reabsorbs that material. For full reading of the source of this info check out this study.

The choice is yours–spinal surgery or not. Basically if you can be patient enough utilizing non-invasive methods of help, including chiropractic care, you have a really great chance of allowing your body to heal on its own. Additionally, if you are under regular care of a professional, they will know and recognize when the situation has become surgical and can refer you with confidence to the surgeon, only when absolutely necessary.