How to Treat thoracic disc herniation?

Answer 1

If you think you may have a herniated disk, either a doctor of chiropractic (DC) or an osteopathic physician (DO) should be able to determine if this is true, or if your pain is caused by another problem. If it is determined that you indeed have a disk problem, most times the associated pain will go away on its own with time. Sometimes very severe disk problems can require a trip to a surgeon to ensure that neurological damage is not a risk. Your DC or DO should be able to inform you of whether or not you need to see a surgeon. For less severe disk problems pain control is the primary goal. Your treatment options would include pain relieving exercises, spinal manipulation, spinal decompression, medication and if all else fails, surgery. Spinal manipulation has been shown to be effective for pain control, including for herniated disks (references 1-3 below), and there are almost no risks associated. Although neither manipulation, medication, or the increasingly popular decompression therapy can "fix" a disk problem, it is likely that all of these treatments can reduce the pain you are experiencing until the inflammation goes down. Thus, personal preference will play a large role in what type of doctor you decide to see.

Current research has suggested that a bulging disk does not cause pain by compressing nerves, but more likely by sensitizing nerves through local inflammation factors released by damaged cells and cells of the immune system (cytokines). Thus, over time as the inflammation goes down the pain will also go away. Usually, even after the pain is gone the disk bulge or herniation will remain, sometimes contacting nerves or even the spinal cord. It has been suggested that as many as 30% of the population has one or more asymptomatic (non-painful) disk bulges. It is likely a normal part of aging, so unless you are in pain, don't panic :)

Whatever you do, don't rush into surgery unless things are really bad! Current research is suggesting that unless there are severe neurological issues, surgery is not a good option unless everything else has been tried, and nothing else has worked. Similarly, research suggests that imaging such as MRI is not a great indicator of the need for surgery or severeness of a herniation, as as many as 30% of the general public with no Back pain at all will have a "herniation" according to MRI (references 4-7 below). As such, it seems that sometimes what looks on MRI like a painful disk herniation may be a non-painful herniation and it is a different problem altogether that is actually causing the pain.

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2) Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131-137.

3) Liu J, Zhang S. Treatment of protrusion of lumbar intervertebral disc by pulling and turning manipulations. J Tradit Chin Med 2000;20:195-197.

4) Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69 --73.

5) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg 1990;72:403-- 8.

6) Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The longitudinal assessment of Imaging and disability of the back (LAIDBack) Study: baseline data. Spine 2001;26:1158--66.

7) Keller RB, Atlas SJ, Soule DN, Singer DE, Deyo RA. Relationship between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. J Bone Joint Surg 1999;81:752- 62.