Back Problems - Disc Problems and Back Surgery
The term "slipped disc" is a misnomer. It is impossible for the disc to actually slip... what can "slip" are the vertebrae. "Slipped discs" should be called "slipped vertebrae."

The intevertebral discs are little pads that lie between the vertebrae; each disc has a tough outer ring (annular fibrocartilage) and a soft gel-like center (nucleus pulposus). The discs separate the vertebrae, and because they're knitted into the bones, like little shock absorbers, cushioning the bones, the bones don't crash against each other as you walk, which would be very painful. Discs help give the spine its curve, flexibility and strength. The 23 discs in your spine also make up about a third of the length of the spinal column and that's why you are about 1/4 inch to 1/2 inch taller in the morning than you were the night before; the discs flatten out a little after a day of standing and then regain their volume when you sleep.

Disc Herniation, Protrusion and Prolapse
There are two types of herniations: protrusions and prolapses. A protrusion can occur if the nucleus pulposi bulges, pushing the annular fibrosis out of shape. In many cases, this condition can benefit from Chiropractic care, unfortunately medical doctors are often poorly educated about modern Chiropractic techniques, especially current Chiropractic research! A prolapse occurs if the nucleus bulges out so much that it actually separates from the rest of the disc. This can be diagnosed in our office and usually requires immediate surgical consideration. We have good relationships with several highly respected surgeons in the area, and don't hesitate to ask for second opinions in disc cases.

If the prolapsed disc goes into the spinal cord or puts pressure on nerves, it may cause severe pain that could make sitting, standing, walking, lifting, urinating, defecating, sneezing, coughing and moving nearly impossible. In extreme cases, foot or leg numbness or a loss of muscle control may occur. However, only a small number of those with low-back pain have any side problems.* The traction method used in our office has multiple similar research studies available at their website,

* Cassidy, J.D., Thiel, H.W. & Kirkaldy-Willis, W.H. Side posture manipulation for lumbar intervertebral disc herniation. JMPT, 1993, 16 (2), pp. 96-103.

Back Surgery
While spinal surgery is sometimes necessary, especially in cases of trauma or severe bone, disc and nerve destruction (due to a variety of causes, from infection to cancer), the vast majority of people with low-back pain and/or sciatica never need it.* The American Academy of Orthopedic Surgeons only recommend surgery when a patient exhibits:
A) functionally incapacitating pain in the leg, extending below the knee with a nerve root distribution;
B) nerve root tension signs (positive SLR) with or without neurological abnormalities, fitting the radiculopathy;
C) failure of clinical improvement after four to eight weeks of conservative therapy; and
D) a confirming imaging study: abnormal myelogram, CT or MRI correlated to the physical signs and distribution of pain.**

* British Journal of Rheumatology, Dec. 1987.tion
** Nachemson A. Lumbar disc herniation-conclusions. Acta Orthop Scand (Suppl 251) 1993; 64:49-50
*** Dommisse, Grahe. "The failures of surgery for lumbar disc disorders". IN Helfet et al: Disorders of the Lumbar Spine. Philadelphia, PA: JB Lippincott, 1978:202

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