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Will My Disc Herniation Ever Heal?

Will My Disc Herniation Ever Heal?
March 5, 2016 Dr. Phillip Snell

Am I Stuck With This Thing Forever?

will-my-disc-herniation-ever-healRemember when you were a kid and you skinned your knee and as the scab healed you had a strange urge to keep picking at it?   Many of us can recall our mother’s voice in our head saying “If you keep picking it, it will never heal.”  A disc injury is not much different.  More accurately, your skinned knee healed despite your picking it but it took a bit longer, right? Similarly, your disc injury will mend nicely if you stop “picking at it” while it’s trying to heal.

Many patients in our clinic  who have suffered a disc extrusion wonder what happens to the material from the inside of the disc once it is pushed outward and is pressing on sensitive neural structures nearby. A common misunderstanding is that that material will always be there on those sensitized nerves. This is not true!

Research firmly shows that the natural order of things is for the immune system in the body to clean up the extruded disc material. How quickly this occurs and to what extent varies widely from person to person based on systemic health, genetics, and whether their movement patterns continue to provoke the disc herniation. One thing that most reliably affects the rate and extent of resorption of the extruded material is smoking. If you are a smoker with disc herniation, now might be the best time to quit! (Tsarouhas, 2011)

If you have been unfortunate enough to experience a disc extrusion and the severe sciatica in the leg that sometimes accompanies it, you may have presented to a surgeon who suggested that the problem would be best managed with the surgery to remove that disc material from the nerve root. This early default to surgery is no longer standard of care. Current evidence-based recommendations in the scientific literature suggests that surgery after disc extrusion should only be considered if:

  1. Progressive weakness of the muscles in the leg is occurring,
  1. Ability to urinate and defecate is compromised due to pressure of disc material on nerves that control those structures,
  1. Pain is not manageable with conservative care.

Here are a few snippets from the research on how the body heals an extruded disc.  This process is known as resorption.

  • Follow up MRI 6-12 months after initial injury demonstrates about 50% of patients see about 70% decrease in size of extruded material. (Fagerlund, 1990, Maigne, 1992, Bush, 1992; Jensen, 1996; Autio, 2006; Monument 2011)
  • Saal noted that lumbar disc herniation with radiculopathy can be successfully treated nonoperatively, with nonoperative treatment resulting in “good to excellent” outcomes for approximately 90% of patients. (Saal, 1996)
  • MRI findings lag behind improvement of leg symptoms (Ito, 1996)
  • Larger extrusions and sequestrations are more likely to resorb. (Maigne 1992, Bush 1992, Jensen 1996)

That last one was not a typo! A larger extrusion, while possibly creating more pressure on nerve roots, is managed more quickly and more thoroughly by the body. This is important because many times the size of the herniation is what drives the advice of the neurosurgeon to proceed with surgery.

ADDENDUM: March 10, 2017-Shanghai, China-This just-released meta-analysis (http://www.painphysicianjournal.com/current/pdf?article=NDAwNA%3D%3D&journal=101) arrives at the same conclusion of the blog here, over 2/3rds of herniated discs resorb. This continues to suggest that “conservative care” rather than surgery is warranted in these cases. We provide guidance on this site to exercise in ways to promote healing of the disc and reduce likelihood of re-injury based on the methods we’ve used successfully in our Portland, OR clinic for 15 years. Click HERE to become a member and get started!

As much as the pain sucks, toughing it out for a short period of time while working on your movement patterns, fitness level and headspace is the best way to go according to the current evidence.  Let your body work to mend the process and support it’s efforts as best as you can. We’re here to help at FixYourOwnBack.com by providing the latest evidence-informed self-help information and exercise available anywhere. We can show you how to heal a herniated or extruded disc!

References

  • Tsarouhas A, Soufla G, Katonis P, Pasku D, Vakis A, Spandidos DA. Transcript levels of major MMPs and ADAMTS-4 in relation to the clinicopathological profile of patients with lumbar disc herniation. Eur Spine J. 2011 May;20(5):781-90.
  • Henmi T, Sairyo K, Nakano S, Kanematsu Y, Kajikawa T, Katoh S, Goel VK. Natural history of extruded lumbar intervertebral disc herniation. J Med Invest. 2002 Feb;49(1-2):40-3.
  • Komori H, Shinomiya K, Nakai O, Yamaura I, Takeda S, Furuya K : The natural history of herniated nucleus pulposus with radiculopathy. Spine 21 : 225 – 229, 1996.
  • ItoT,YamadaM,IkutaF,etal.Histologic evidence of absorption of sequestration-type herniated disc. Spine 1996;21:230–4.
  • Saal JA. Natural history and nonoperative treatment of lumbar disc herniation.Spine (Phila Pa 1976). 1996 Dec 15;21(24 Suppl):2S-9S.
  • Fagerlund MK, Thelander U, Friberg S. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms. Acta Radiol 1990;31(6):555–8.
  • Maigne JY, Rime B, Deligne B. Computed tomographic follow-up study of forty-eight cases of nonoperatively treated lumbar intervertebral disc herniation. Spine (Phila Pa 1976) 1992;17(9):1071–4.
  • Bush K, Cowan N, Katz DE, et al. The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976) 1992; 17(10):1205–12.
  • Jensen TS, Albert HB, Soerensen JS, et al. Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system. Spine (Phila Pa 1976) 2006;31(14): 1605–12 [discussion: 1613].
  • Autio RA, Karppinen J, Niinimaki J, et al. Determinants of spontaneous resorption of intervertebral disc herniations. Spine (Phila Pa 1976) 2006; 31(11):1247–52.
  • Monument MJ, Salo PT. Spontaneous regression of a lumbar disk herniation. CMAJ 2011;183(7):823.
  • Liu JT, Li XF, Yu PF, Li XC, Qian Q, Liu GH, Yu ZH, Ma QH, Tang DZ, Jiang H.Spontaneous resorption of a large lumbar disc herniation within 4 months. PainPhysician. 2014 Nov-Dec;17(6):E803-6.
  • Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, Xue RR. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017 Jan-Feb;20(1):E45-E52. Review. PubMed PMID: 28072796.