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Exciting news for evidence-based chiropractors! 

Research from the Global Spine Journal has shown that more than 97% of lumbar disc lesions will respond to conservative care. (7) However, there is a vast difference between merely treating something and consistently applying best practice knowledge

Speaking of knowledge, this week’s blog shares three little-known facts about the disc nucleus and disc lesions that can impact your understanding and outcomes. We hope you’ll enjoy it!

Fact #1

A Healthy Disc Nucleus Is Fluid

Do you know what substance a healthy disc nucleus resembles?

A. Water

B. Jelly

C. Toothpaste

D. Crabmeat

We could write a book about this topic, but here’s a 30-second video worth a thousand words. If you’ve not yet seen it, check out this viral clip.

Fact #2

The Disc Nucleus Can Change Stiffness Instantly

You’ve likely seen the study by Nachemson (1) showing that intradiscal pressures vary based upon body position (sitting produces the highest posture, followed by standing, which is followed by lying side posture, and finally lying supine produces the least). 

But in 2019, Newell demonstrated that the disc nucleus could also change stiffness based upon load rate. (2) Check out this 60-second live demo of how a jelly-like nucleus instantly changes to a consistency that can dent bone. 

Pro Tip: Up to one-third of disc herniations occur as endplate invaginations (Schmoral’s nodes). Consider this possibility next time your younger patient with a well-hydrated nucleus reports hearing a “pop” after rapid axial loading (i.e., jumping from a height) and has increased pain with a heel drop test.

Fact #3

The Majority of Disc Herniations Self-Resolve 

(at speed inversely proportionate to their size)

In the past three years, several studies have proven that the majority of disc herniations will self-reabsorb over time with non-surgical care. (3-6) One extensive study reported that 97% of all symptomatic herniations will not require surgery. (7) 

And the size of the nuclear herniation has no predictive value concerning the failure of conservative management or likelihood of requiring surgery. (11) Large “herniations” trigger a significant inflammatory response and generally regress more quickly when compared to contained “bulges” that do not benefit from rapid reabsorption. (3,7,8-10) 

While this fact is not surprising to most chiropractors, it has not apparently been grasped by the majority of PCP’s and patients.

Want to Up the level of understanding? 

Download this new ChiroUp infographic showing that structural changes like degeneration and disc lesions do not necessarily require surgery.

Bottom Line: The Facts Don’t Give a S#!t About Opinions

These facts empower how evidence-based practices assess, manage, and communicate. And the future of healthcare is data-driven and evidence-based. 

ChiroUp subscribers can practice with the assurance of knowing each component of their care is based upon facts. We’re proud to have you in our evidence-based network and look forward to the exciting journey ahead. Together, we WILL become the undeniable best choice for patients and payors alike!

References
  1. Nachemson A, Elfstrom GO. Intravital dynamic pressure measurements in lumbar discs. Scand J Rehabil Med. 1970;2(suppl 1):1-40. Link
  2. Newell N, Carpanen D, Grigoriadis G, Little JP, Masouros SD. Material properties of human lumbar intervertebral discs across strain rates. The Spine Journal. 2019 Dec 1;19(12):2013-24. Link
  3. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation. 2015 Feb;29(2):184-95. Link
  4. Ming Zhong MD, Liu JT. Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain physician. 2017 Jan;20:E45-52. Link
  5. Kesikburun B, Eksioglu E, Turan A, Adiguzel E, Kesikburun S, Cakci A. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pakistan journal of medical sciences. 2019 Jul;35(4):974. Link
  6. Elkholy AR, Farid AM, Shamhoot EA. Spontaneous Resorption of Herniated Lumbar Disk: Observational Retrospective Study in 9 Patients. World neurosurgery. 2019 Apr 1;124:e453-9. Link
  7. Lilly DT, Davison MA, Eldridge CM, Singh R, Montgomery EY, Bagley C, Adogwa O. An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures. Global Spine Journal. 2020 Jul 7:2192568220936217. Link
  8. Morgan W. Management of Lumbar Disc Derangements. Presentation at the 2015 American College of Chiropractic Orthopedists Convention. Las Vegas NV April 25, 2015.
  9. Kjaer P, Tunset A, Boyle E, Jensen TS. Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population–a longitudinal MRI study using quantitative measures. BMC musculoskeletal disorders. 2016 Dec;17(1):26. Link
  10. Djuric N, Yang X, El Barzouhi A, Ostelo R, van Duinen SG, à Nijeholt GL, van der Kallen BF, Peul WC, Vleggeert-Lankamp CL. Lumbar disc extrusions reduce faster than bulging discs due to an active role of macrophages in sciatica. Acta Neurochirurgica. 2019 Dec 4:1-7. Link
  11. Gupta A, Upadhyaya S, Yeung CM, Ostergaard PJ, Fogel HA, Cha T, Schwab J, Bono C, Hershman S. Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment. Global Spine Journal. 2019 Oct 10:2192568219880822. Link

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