Disc Bulges
As a chiropractor in the great state of Texas, the most common conditions that I treat in office are low back pain and neck pain. Among these two groups there is a common thread: disc bulges. Disc bulges are behind the vast majority of low back and neck pain cases. It is often, after the fact that the suspicion of a disc bulge is confirmed with an MRI. If I had my way all patients would get an MRI on their first visit but such a practice is not backed by national physician guidelines and is often financially prohibitive. To make matters worse, private insurers have inflated the prices for MRI scans to a point that most people simply cannot afford the vital imaging needed to confirm the diagnosis and establish a prognosis and treatment plan.
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What is a disc bulge?
I probably should start with what a disc is before trying to explain the nuances of disc injuries. In our spine we have a bunch a vertebrae, each of which is connected by a disc which is this onion-like fibrous tissue that provides for some flexibility and shock absorption for everyday movements like turning your head or walking. You can read more about the spine here.
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A disc bulge is generally a lay term describing one of many forms of injury to the disc material. Disc injuries happen for a number of reasons, including genetics, trauma, cumulative overuse, etc. Discs injuries are generally classified into bulges, protrusions and extrusions depending on the shape which can only be determined with an MRI. I am a stickler for accurate information which gets me into trouble as a chiropractor because I know what a disc injury looks like in clinical practice and have the clinical expertise to quickly diagnose one without an MRI. When I tell a patient they may have a disc bulge before obtaining imaging, I have to add some disclaimers like "but i cant rule out and infection or tumor" and "we can't say for sure its a disc bulge and not something more severe like an extrusion". Although I may be near 100% confidence in a diagnosis, disclaimers and vague language does not inspire confidence in my diagnosis and patient compliance suffers for it which may lead to poorer patient outcomes. So, yeah, certainly I would love to have an MRI on all new patients before I see them but its unrealistic so I do my best to communicate accurately and effectively in the interim.
What can be done?
Interestingly, about 90% people over the age of 50 have disc bulges, while only a small fraction of them have symptoms like low back pain, neck pain, or nerve pain/sciatica. What does that mean? The consensus is that discs generally wear down over time much like the rest of our bodies. Think gray hair and wrinkles. So this may be a normal ageing process but when it is causing pain that is abnormal and something often needs to be done. The simplest and by far the most effective long term solution is often lifestyle modifications like diet, exercise and ergonomics. Treatments like chiropractic adjustments, physical therapy, spinal traction decompression, electrical muscle stimulation, and acupuncture can help a lot and fore most folks are all that is needed.
I tell patients that 9/10 people with a disc injury do not end up having surgery with an appropriate regimen of treatment. For those who do not get better with conservative treatments like chiropractic and physical therapy, injections and surgery are the next step with escalating treatment. Nobody wants to have surgery and I am generally against unnecessary surgeries. Surgical outcomes vary widely between procedures and providers and I hate to say it like this but outcomes with surgery are often a gamble with a long recovery at best and permanent disability or death at worst. The key factor in producing good surgical outcomes boils down to finding good candidates and making sure that patients take all the necessary steps before considering surgery.
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There is no debate or question when it comes to most disc injuries, we exhaust conservative options first. If the time comes for a referral to an orthopedic surgeon, I will get that process started without delay.
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Se ya soon, Dr Malone