disc bulge

Mesa Chiropractor Vs. Lumbar Disc Herniations Surgery

December 11, 2014 by James Bogash

HOW CAN WE SAVE MASSIVE AMOUNTS OF $$$ ON LUMBAR DISC HERNIATIONS??

Chiropractic care in Mesa has been shown to be effective in case control and clinical studies to be an effective option for chronic and acute low back pain. Numerous studies have shown that, if Mesa chiropractic care is the FIRST (rather than the last!!) point of entry for any musculoskeletal complaint, the cost savings are tremendous (upwards of 30%). Looking at this study, we can begin to see how chiropractic care is a net SAVINGS, not a net expense. Sometimes legislators have a hard time seeing this. Researchers looked at the costs for services prior to lumbar discectomy and chiropractic care was a measly 2% of overall costs. Based on what we know, if more people selected chiropractic care as a point of entry (driving chiropractic costs up to maybe 30%), we’d see a massive savings in the overall amount of money spent.

Slipped Disc in Back: Common Sciatic Nerve Treatment Falls Short

December 6, 2012 by James Bogash

MRI finds a slipped disc in back. Options are short, but you decide on a common sciatic nerve treatment from your doctor’s suggestion. But what’s the best option?

The task of deciding what options are the best seems daunting. Medications, injections, chiropractic (my personal favorite), acupuncture, massage, physical therapy and probably 10 others I’m forgetting.

But before you decide on a treatment, we need to back up a little. The conversation needs to start with where you got your diagnosis. The diagnosis of a disc problem (slipped disc, disc bulge, disc herniation – the actual description is quite technical, but you get the idea) can be make quite accurately in a competent physician’s office. Rarely is an MRI needed to diagnose a disc problem, and the guidelines clearly state, that in the absence of red flags, any imaging needs to wait until 4 weeks of conservative treatment. Despite this mainstream medicine seems to want to order MRIs and CT scans at the first sign of back problems.

This is were the problems begin. Numerous studies have confirmed that early MRIs are a bad thing, driving expensive, dangerous and unneeded treatments. But let’s say you made the mistake of not going to a chiropractor first for your back pain and you did get an MRI or CT scan. And this MRI or CT shows that you have some type of problem with the intervertebral discs of your lumbar spine.

Here comes the big question. Do you have leg pain or not? And is this leg pain scleratogenous, radicular or radiating? I don’t really expect you to answer that question, but hopefully you can begin to see that just because your back pain is accompanied by leg pain this does NOT mean that you have sciatica. I can’t tell you how many times I’ve seen patients with leg pain that, after some targeted soft tissue work on his or her low back and glut region (gluteus maximus, posterior hip, rump, derriere–you get the idea), the leg pain gets better or is gone. There is no way a slipped disc in back would respond that fast.

Sciatica refers to radicular pain that comes from chemical or pressure (from a disc) directly on the sciatic nerve. For those of you unsure of where the sciatic nerve goes, I’ll clarify. It goes into the leg. Despite this, I have seen patients spend tens of thousands of dollars for epidural injections for low back pain that doesn’t involve pain in the leg. I’m not sure there’s ever been an indication to use epidural injections in the lumbar spine for treatment of local back pain (without leg pain). It may be done all the time, but that doesn’t make it right.

Overall, this means that you need to see someone who understands all the nuances of back pain and leg pain. (hint, hint….a chiropractor). Anything short of that and you may get sent in the wrong direction.

Back to this particular article that looked at the effectiveness of epidural steroid injection as a common sciatic nerve treatment.

I have personally referred a small handful of patients out for epidural steroid injections over the years, but they are few and far between. I have never considered spinal injections as a stand alone therapy. At the most, they allow a small window of pain relief, where other options have failed, where other therapies can be used more aggressively.

So what happens if an epidural is the only therapy used? Basically, confirming other studies, these researchers found that they suck. Here are the specifics:

Researchers looked at 25 different studies.
Epidural corticosteroid injections improved leg pain 6.2 points (out of 100).
This was only noted in the short term (2 wks to 3 months).
Beyond 3 months, the benefits were even smaller–pretty much non-existent.

So basically, an epidural injection for sciatic pain is very expensive (I’ve seen bills as high as $5,000 per shot) and really does nothing but provide a small amount of pain relief for a short period of time. Worse, it may accelerate destruction of the disc and lead you to surgery. Of course, none of this takes into account the close to 400 cases of fungal meningitis on the East Coast from contaminated vials of the steroid used in this procedure, with almost 30 deaths so far.

Where do I sign up?

READY FOR BACK SURGERY #2..?

March 29, 2012 by James Bogash

My opinion on this matter, as a chiropractor, is clearly biased. It has been rare that a patient under our care has progressed to spinal surgery. Clearly it happens, but far more often we get patients who have had spinal surgery prior to coming into our office and likely could have avoided surgery.

The problem with spinal surgery is that it really is a crap shoot. Some do better. Some notice little change. Some do worse. And the ones who are worse after the surgery are much, much more difficult patients to manage. Problem: No one knows who is going to fall into what category. Sure–the surgeon may tell you they expect a good outcome, but these statistics frequently seem to be bloated.

This particular study gives a little bit more background on the outcomes after a lumbar decompression surgery for a disc herniation. Researchers looked at patients who underwent lumbar decompressive surgery at non-federal hospitals in the state of Washington from 1997-2007 that had to go through a second surgery.

The first surprising aspect is just how many patients had to have a second surgery within 4 years. The numbers ranged as high as 24% re-operation rates at some hospitals. Given that it probably wasn’t very fun the first time around, we can all guess the second time is not a party, either.

Now, to be fair, it is not uncommon for a patient to present to our office and be successfully treated for a lumbar disc herniation. Some of them (never figured out the percentage) even return for care within the next 4 years. But let’s compare both the costs and the impact of surgery on a patient’s life versus 2 episodes of chiropractic care. Funny how some insurance companies view chiropractic care as a “cost” at all, rather than the hundreds of millions of dollars we save the system.

DID YOU HAVE AN MRI FOR LOW BACK PAIN?

September 3, 2011 by James Bogash

There are definitely times when knowing less is a good thing. It occasionally happens where a patient who has signs and symptoms of a disc herniation presents to our office.

Based on an exam and the history given by the patient, disc involvement (bulge, herniation, rupture, etc…) can be diagnosed and treatment started. A full blown disc bulge may take several days to start to show a response, but the outcomes are usually very good.

Sometimes, it is not a disc problem that is causing the patients’ low back and leg pain. Sclerotogenous referral from the hip (I really love the word “sclerotogenous”–makes me sound smart) or involvement of the fascia is also notorious for causing leg pain.

Sometimes, it may take a few days to be able to tell the difference. Certainly an MRI would be helpful, right? Not so fast…

You see, there is a large chunk of the population that has disc abnormalities on MRI (we can argue about the percentages, but let’s just agree that not all disc abnormalities on MRI cause problems). We have also seen that MRIs done before and some time after a patient has a disc bulge don’t change much, even though the pain may be gone.

This particular study contributes to what any chiropractor can probably tell you. MRIs increase the risk of having surgery. Sounds strange…I mean–how could having an MRI affect your back?

It’s the mindset and the potential diagnosis of a disc problem, even if the disc problem is not what is causing a patient’s pain.

In this study, when the primary care doctor or orthopedic doctor had a financial incentive to order an MRI (usually because the unit was installed in their clinic) the number of MRI for low back pain went up. In addition, in the orthopedic surgeon’s office, the number of patients getting surgery went up 34%.

Just something to consider the next time you THINK you need an MRI…