Question
QUESTION: Dear Dr
I have suffered from occasional back pain which usually is cured with a week or so from the attack which could be caused by a sudden sneeze, cough or movement my latest MRI reads as follows:
L3-4 minimal posterior discal bulge
L3-4, L4-5, L5-S1 right posterior parasagittal discal herniation effacing the anterior epidural fat and indenting the thecal sac
Modic end plates changesTypeII
CSF filled dilatation of the left nerve root sheath of S2
L3 and S3 vertebral body hemangioma
No para spinal masses detected

What can you advice me for treatment and
What is Atlas Orthagonal treatment is

Thanks

ANSWER: Dear Toufic

It sounds to me, and appears to be supported by your MRI results, that you are suffering substantial pain and discomfort related to significant degenerative diseases in the lumbar spine, affecting multiple discs.  Discs, when they herniate, extend into the canals through which nerves pass.  When pressure is applied to nerve tissue, sudden sharp pain is the result.  

In my mind, the best treatment would be to start conservatively with decompression traction, lower back and leg stretching, and core strengthening.  I would also consider adding in acupuncture to help control the pain.  You need to realize that NOTHING will cure your condition, and you are going to have to learn to manage the condition. Surgery should, obviously, be your last desperate action.

Regarding Atlas Orthogonal Technique:  This is a chiropractic technique that concentrates on treating the atlas/axis and occiput... segments that are in the upper part of your neck.  To me, personally, it does not make sense to treat the atlas/occiput when the degenerative disorders of your spine are clearly defined and located in the lumbar spine.  You can try this technique, but techniques and methods that are applied directly to the lower back region make more sense to me.

I hope that this helps you to make good decisions, and that you are able to feel better soon.

Keith Biggs, DC
http://www.eastmesachiropractor.com

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Biggs

How should I manage my condition if as clearly stated that NOTHING will cure my condition. Is there any routine or steps that I need to follow, please advise. And thanks

Answer
Dear Toufic,

There are many ways to try and manage the spinal condition that you have. If you were in my office, this is what I would do, and the order in which I would do them.

1) Spinal manipulation, Decompression traction lumbar spine, stretching/stregnthening exercises. Continue with these for your whole life.  These will help you to manage your condition. Even when you are out of pain, you should continue, on a less frequent basis, receiving manipulative care, while doing your exercises daily at home.  This is what I mean by managing your condition. This will not make you grow new disks in your back, nor make the damaged ones return to normal.  This just will not happen.

2) If pain continues, try acupuncture, but continue with #1 above at the same time. You might also consider oral pain medications, but the use of narcotics is not a good long-term management strategy, and advil, motrin, tylenol, etc also come with significant risks over the long-term.

3) If acupuncture is not beneficial in relieving pain, continue with #1 above, but consider visiting with a pain medicine specialist to see if there are any injections or other minimally invasive procedures (such as radiogrequency neuroablation)to help ease the pain.  Here you have to be careful, because some of these medical procedures are potentially damaging over time, and again, they do nothing to make you heal or grow new disks in the spine. A perfect example is the procedure of using steroid medications, injected, into the epidural space around the spine. This might ease your pain, but if repeated too much, it will cause significant damage to bone and joint, ultimately making your condition worse, not better.

4) As a last resort, spinal surgery is an option. Surgery, like the other procedures described above, will not give you a new back. Simply stated, they will cut away tissue, and fuse the spinal joints that are damaged. This results in loss of motion at that spinal level, and the acceleration of the same degenerative condtion in the spinal levels above and below the fusion (adjacent joint syndrome).  If you opt for surgery, then you STILL should continue with stretching, strengthening exercises, at the least.

I know that the thought process is complicated, and that it is frustrating to realize that nothing is going to cure the degenerative back condition, but yes, the condition is managable. Many patients live pain-free lives, or at the least, lives with reduced pain intensity and frequency.

I hope that this helps you to understand how I would approach your condition.

Keith Biggs, DC
http://www.eastmesachiropractor.com