Question
Hi Scott, Thank you for your expertise, I have found very little literature regarding an anterior disc herniation. What little I can find states that it can compress or rupture the anterior longitudinal ligament, the symptoms partially describe mine. I have an mri that show a large anterior disc herniation at L5-S1, an annular tear centrally and paracentrally on the left and a small protruding disc herniation  centrally and paracentrally, disc herniation is 9mm. Can you explain an anterior disc herniation and if it would be causing the extreme pain when I walk. The Docs say I am not a surgical candidate. Do you think Chiro can help>?

Answer
Anelie,

It is generally believed that anterior disc herniation is not a problem since there is no direct impingement of neural tissue.  But, tell that to the person with lower back pain...  We do not always know the cause of back pain.  There are cases where the MRI shows evidence of disc herniation that abuts a nerve root, but the patient has no pain or there is pain on the opposite side (e.g. a left nerve root irritation causes left sided back and sciatic pain).  So while your pain may or may not have anything to do with the disc herniation, the bottom line regarding whether you need to have surgery is whether you have compression of your nerves or spinal cord or whether you have intractable back pain that has failed all conservative methods.   If you have nerve or cord compression, then you would have neurologic signs: loss of reflexes, loss of lower extremity muscle strength on one side, loss of bowel/bladder function, "saddle" anesthesia (loss of feeling around your butt and thighs.    Some folks with debilitating back pain where all conservative methods fail undergo surgical fusion when there is consensus that the disc is the cause of the problem.  In these cases it could be that the disc lesion causes the bone segments to be unstable, causing a constant wear/tear and irritation to the area.  The only way to truly reveal segment instability is to have an MRI in a sitting position and compare it to in a laying-down position.  There are not many of these MRI units available.   Some still try to assess this with x-rays in standing-bent-back and standing-bent-forward position, measuring the excursion of movement.  One study, years ago, showed better results comparing hanging (by hands) from a bar verses standing with a back pack, when assessing for instability to the lumbar segments.    Still, without good reason, surgeons will not do the surgery.   And getting back to that anterior disc protrusion: in general they are not considered to be problematic, but it is only recently that the mechanics of discs have been studied.

'Hope this was helpful.  

Dr. G'