Severe Non-Operative Disc Herniation Case Study

The advancements in medical knowledge and interventions are at an all time high these days!  Which is absolutely amazing and fantastic. But at the same time in this information age how do you ascertain what is the best route you should take for various medical conditions, illnesses, or injuries?

It depends.

I wish things were more black and white when it comes to medical intervention, and for some issues and conditions the lines are definitely a little more definitive. But for the most part everything is open to interpretation.

BUT!!! The most important thing to remember is that you have a say!  It is your body and you need to advocate for yourself about what you feel comfortable and understand, so ask the questions!

You may find yourself asking right now, “Why is he yelling at me?”

No yelling just a strong emphasis to be speak up because I have a story to share with you about a patient that did speak up (figuratively) by asking questions and making a decision based on the facts.

Before and even partially during my training and postgraduate education even I thought:

• Extreme pain
• Leg weakness
• Numbness and burning pain
• Back surgery

You are not wrong if these thoughts come to mind, but keep it mind it is a gray area.

Does everyone who has a disc herniation experience these pain cycles or interventions?  NO!

Do people have surgery without these symptoms? Sometimes.

Signs that you should seek orthopedic evaluations:

• Progressive neurological symptoms or worsening of symptoms. This is usually seen or described as the pain is traveling further down the leg and the intensity has been progressively getting worse.
• Progressive muscle weakness. Often times there is some minor motor weakness associated with disc herniations, if this progress further assessment and evaluations should be explored.

Lastly if you are experiencing any sign of what is known as cauda equina syndrome or saddle paresthesia or symptoms, please seek out immediate medical attention at your local urgent care or ER and let them know what is explicitly going on.  This is no time for prudeness explain all the symptoms you may be having below the belt.

Jessica was referred to our office for lower back pain that began just after she had given birth to her son Geoff.  The pain was almost felt immediately after birth once the adrenaline and hormones leveled out. She was managing being a new mother well with nursing and the 1,000 other things that are involved, but her lower back pain was persistent and at times very painful.

Jessica’s pain was worse after prolonged sitting, and as a new mother picking up nursing for the first time with cluster feeds and all, you may find yourself sitting for some time.  This pain began to progress and turn into some additional hip tightness and mild burning pain in the hip. Soon waking up in the morning began painfully and getting dressed and putting on socks and shoes turned into sweats and sandals.

After our detailed evaluation and exam, we believed that there was some degree of disc irritation present.  Although we did not have an MRI to confirm we would treat it as such with our disc protocols and training the patient how to hinge at the hips properly and manage the loading of the lower back in addition to her postpartum rehab exercises to rebuild the core.  Her progress and pain had been doing very well to the point where she decided to reduce the frequency of her home care and lost some of the training principles we discussed in regards to hinging and picking up the baby, etc.

Needless to say, Jessica’s pain started to return and was a little more aggressive this time around. One morning she was getting up off the ground with her son and started to feel some mild numbness and pain in the saddle region of her pelvis.  (Think of the area of your body that would be touching a saddle when riding a horse, yeah this is a do take chances kind of area)

Jessica reached out to her PCP and was able to get in with an orthopedic doctor 2 days later, and then reached out to us after the appointment.  They performed an immediate MRI that revealed a L5/S1 disc sequestration that was putting pressure on the nerves. They prescribed a steroid pack to help reduce the inflammation to prevent further pressure.  Now a disc sequestration is when the disc completely opens as an opposed to just bulging out. This can actually cause more progressive symptoms but in some regard, this can actually start a quicker healing process compared to standard disc bulges.

** It must be stated that this is a scenario that immediately needs to be brought to an orthopedic surgeon attention**

While being managed by the orthopedic doctor Jessica was inquisitive and began asking as many questions as she could.  Our discussions pointed out that there have been positive outcomes without doing surgery if symptoms do not progress and the that the body will eventually reabsorb the disc material that has been pushed from within the disc.

The orthopedic surgeon stated that if she would have come in a day earlier he would have recommended an emergency surgery based on her symptoms, but a day later Jessica came in and now indicating she wanted to wait to see if symptoms progress she is able to hold off on what would have been an “emergency surgery”.

Continuing to manage inflammation and reduce pressure on the disc with movement-based principles.  Jessica’s symptoms slowly began to subside and reduce as time went on. Her saddle numbness was still present but pain was down, and slowly the radius of the numb area was dropping as well.  One day Jessica reached out to us stated that all of her symptoms have returned back to normal.

This can be a very serious issue if not managed properly, evaluate and explore what you are feeling to give your provider the best insight as to what is going on and ask for alternative therapies if that is something that you are interested in.  There are times when symptoms include the listed provided above as well as other progressive symptoms that involve bowel and bladder symptoms where one should NOT wait to seek medical attention.

The take-home message here is there are multiple roads to Rome.  Often times the recommended intervention might be too invasive or extensive for what you were hoping to do, so explore your options and ask your providers questions.  In this case, the patient was fortunate enough to not have her symptoms progress and she was able to rehab and get back to leading an active life with her toddler without going through surgery for an extensive disc herniation or sequestration.

This again is one of the more extreme cases to show one end of the spectrum, if you are diagnosed with a disc herniation or bulge and you might have symptoms that are down your leg without progressive motor loss or progressive neurological conditions you are most likely able to return and rehab without undergoing any surgery.

If you are unsure whether or not you are in a position to continue down more conservative options and/or you are concerned about going down more invasive protocols please reach out to us and we would be happy to discuss your options!