About five weeks ago, I herniated a disc in my lumbar spine, to the tune of 6 mm. It is impinging on the sciatic nerve, producing pain and weakness in my left leg and foot. Sitting, standing, walking, and bending are things I can do for only a short time. The healing process is slow, and I have not yet returned to work.
As soon as the results of the MRI came back, I got in to see a neurosurgeon who is, at present, teaching his minimally invasive surgical procedure to surgeons in France. I have also consulted with an orthopedic specialist. Both doctors suggested doing everything possible to avoid surgery. Therefore, I am going to physical therapy 3x/week, where I enjoy (literally, this is sometimes the highlight of the day) the electrode/wavetron machine while applying heat. I then get in traction for 15 minutes, hoping to create some space in the spine to allow the disc to go back in between the vertebrae. Then I do some abdominal exercises, spend a short time on the stationary bicycle, and then get iced.
I have had two nerve block shots, of which I can have a maximum of three. These are similar to an epidural, and are used to calm the nerve root and reduce inflammation so that the body can then heal itself. I have had relief from pain as a result, but believe that the herniation is still there. I have slight weakness in my left leg, but can go up and down stairs and can now bend down to pick a fallen object from the floor. I was also delighted to learn that I can drive without pain and without being a danger to others. My neurosurgeon plans to re-evaluate me in two weeks.
Would you advise me to see a chiropractor, or am I in the hands of the professionals who can help me the most?
I would not recommend spinal manipulation for a herniated disc that causes leg pain or muscle weakness. Manipulation will not correct a herniated disc, and there is a possibility that inappropriate manipulation might increase the herniation and further impinge the nerve root. If the disc protrusion is forced into the spinal canal, it could result in loss of bladder control.
About 80% of people with leg pain caused by a herniated disc will recover without surgery. But itâs important that you be kept under observation for signs of progressive nerve damage. If the weakness in your leg and foot increases, for example, and you are unable to toe walk or heel-walk without your foot flopping to the floor (foot drop), you might have to have surgery to relieve the nerve pressure in order to prevent a permanent foot drop.
If there is no progressive nerve damage, symptoms may diminish as the swelling subsides. Once the leg pain goes away and the nerve pressure has been relieved, surgery may not be needed. With time, a herniated disc will dehydrate and degenerate, absorbing the protruding cartilage. But if leg pain and other symptoms of nerve involvement persist after a month of conservative therapy, surgery might be indicated.
It sounds to me like you are in good hands with the neurosurgeon, orthopedist, and physical therapist working as a team. They can keep you under observation for muscle weakness, loss of reflexes, and other symptoms indicating as possible need for surgery. It also sounds as if your neurosurgeon is familiar with microsurgical discectomy and other minimally invasive surgical procedures and is conservative enough to use surgery only as a last resort. It appears that you are progressing as well as can be expected over a short period of time, so I would certainly suggest that you continue with the care you are now receiving.
Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient’s Guide provides an incisive look at chiropractic’s history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.
This article was posted on September 24, 2002.