Question
My husband was injured at work with a L5/S1 herniated disk that was also torn and leaking fluid, this disk is also degenerative.  Most of his pain (90%)is lower back with only about (10%) leg/buttock numbness.  The pain is constant at about a 3/10 on a pain scale.  He is going into his 3rd month of recovery and has had no relief, he has tried 2 epideral shots and 4 weeks of physical therapy. His MD says he needs surgery, either a spinal fusion or a disc replacement.  He wants to avoid surgery, what is your opinion on chiropractic intervention? Do you know of any other therapies that might be helpful that I might not be aware of it?  Any information would be helpful.  Thank you.

Answer
Anne,

I don't know what your husband's physical therapy program consisted of, so it's difficult to offer an opinion as to whether or not another manual therapeutic approach might provide better results.

There are a number of factors that play a role in predicting patient responses to certain types of care based upon their condition. In general, if a therapeutic approach hasn't produced appreciable results (assuming that the patient has also been compliant with home-care recommendations, such as specific rehabilitation exercises, ergonomics, or even job restrictions) after reasonable time, the treating practitioner should probably consider modifying the treatment approach.

Also, in general, the longer the pain has persisted without significant relief, the more difficult it tends to be to fix.

Based on the information you provided, however, I can tell you that the current medical literature recommends surgery in cases where a person has developed progressive neurological deficits (such having difficulty urinating, having uncontrolled bowel movements, or having weakness or loss of function of the lower limbs), or in cases when when the patient has failed to show improvement with aggressive, intensive, and correctly rendered conservative care, and is suffering from progressive, unremitting, severe pain. This doesn't sound like your husband's situation.

Moreover, the medical literature also states that even when a person has low back pain with sciatica resulting from a disc herniation, often the results after surgery are no better than with conservative care (unless, again, the person has progressive neurological deficits or other signs of a surgical emergency). Conservative care just typically takes significantly longer to produce desired results.

Other studies show that fusions are over-utilized in the U.S. with modest to mediocre results in most (not all) cases. While I am not surgeon, and I can't offer surgical advice to you, my understanding is that fusions are indicated predominantly in cases of instability of spinal joints. Disc replacements, as far as I am aware, are considered experimental in the U.S., although I believe that they have been used in Europe for some time.

It sounds like your husband has developed a degenerative disc (very common) with tearing of the outer annular fibers (also common). Chiropractic care, like any other intervention, may or may not be an appropriate therapeutic approach to consider. Some patients respond well to spinal manipulation, while others do not. Some patients respond better to various forms of spinal traction rather than manipulation. Most patients need to peform specific rehabilative exercises outside of the clinical setting in order to achieve optimum results. Others require some kind prescription medication (for example, an oral anti-inflammatory or pain medication) which their medical doctor prescribes in conjunction with conservative care. Some people do well with combinations of therapies; for example, a patient might see a physical therapist who may be more well-versed in rehabilitation than a chiropractor, but see a chiropractor as well for spinal manipulation, and/or see an acupuncturist for additional pain management. It depends on what works for that patient. Nothing is a panacea.

My recommendation would be to consult with a chiropractor who is willing to work with your husband's medical doctor (that is, a chiropractor who is willing to maintain open communication regarding the appropriateness of care and patient response to care) to determine if a trial course of chiropractic care is worth considering.

Most patients in chronic pain are willing to try anything to make their pain disappear... but there are rarely, if ever, any quick fixes.

I hope that this answers your question.