Services & Techniques

Recently I had a patient in our office and after taking his history and performing a cervical exam, I shared my concern about a possible cervical disc involvement.  While the patient did improve much quicker than I expected, he felt more comfortable with a second opinion, in which I gladly referred him to one of our local Orthopedic Urgent Cares. With the improvement he had received since coming to Nelson Chiropractic, I shared he might have a disc bulge rather than a herniation. An MRI was ordered, and the patient asked if it was possible if he just had a bulge and not a true disc herniation.  The nurse practitioner insisted they were the same thing.  The patient then called me to inform me they were the same thing, to which I assured him they were not the same thing.  Less than a week later, I was at our state conference in Sioux Falls and the surgeon who spoke started his presentation with the following definitions.

Bulge: Age-related process (hoop stresses) where the annulus loses the ability to maintain normal height/elasticity

Herniation/Protrusion: Inner disc layers (including nucleus) under force cause annulus to protrude without tearing

Extrusion: Cartilage and nucleus fully extrude from the disc space and migrate in an epidural space

Sequestration: Fragment(s) of nucleus/disc contained in the epidural space separate from the remaining disc material.

The patient’s MRI confirmed a cervical disc extrusion.  Why is this important?  I think each health care provider, regardless of their credentials, will have different success rates and protocols with the specific type of problem.  Sadly, in this case, the patient was instructed to stop chiropractic care and take medication (likely a steroid) instead.  The patient had 6 visits in less then 2 weeks and was already 50% better by the time the MRI was taken.  It is unfortunate better communication did not happen between providers.  While medications might provide some relief in circumstances like this, the research simply doesn’t support treating such things with medications only.  A follow up call was made 10 days after his last appointment but sadly the phone call went to voicemail.

If you are seeing relief and success with any form of care, carefully consider simply stopping because of a second opinion. Have a conversation first. Ultimately, my goal for any patient is to see them doing well and living pain free. Often times, that can involve a team approach!