Monday, February 10, 2020

Slipped Discs Can Heal

Yes, you read correctly, our intervertebral discs (IVD) can heal after injury! Last week I wrote about how strong our IVD's are and how our discs cannot 'slip' as they are firmly attached to the vertebral end plate by very strong connective tissue. But they can get injured or herniated, especially by shearing forces.
Disc strongly attached to vertebral end plate
You probably will not believe how many times this scenario has happened. A patient coming in to our clinic telling me that they had a 'slipped' disc or "blew out a disc" years ago and have been having back problems since. And I've to go through the following evidence and healing process of our IVD with them.

Since the IVD is part of our human anatomy just like our muscles, nerves, bones, tendons, ligaments etc, the IVD can heal with correct conservative management and time. Consider the following evidence.

Chui et al (2015) did a systematic review of the literature to look for evidence of our lumbar discs healing. Their inclusion criteria was patients who had herniated lumbar discs that were treated conservatively and patients must have at least two imaging evaluations of their lumbar spine.

Patients who had previous lower back surgery, tumours, spinal infections, spondylolistheis and spinal stenosis were excluded from the review. In their systematic review, the authors found 31 studies that fit their criteria.

Their results will definitely surprise you. Here's what the author's wrote. "Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than dis disc extrusion."

The larger the disc injury, the more likely it is to revert to its former shape and heal! For disc sequestration, rate of spontaneous regression was found to be 96%. For disc extrusion 70%, 41% for disc protrusion and 13% for a disc bulge.

It does seem like (my personal opinion) the more serious the disc injury, the larger response our bodies have for healing.

In another study by Nakashima et al (2015), the authors studied the MRI's of 1211 asymptomatic adults ranging from 20 to 70 years old. They found that 87.6% of subjects presented with disc bulges, and this significantly increased with age in terms of frequency.

Even most of the subjects in the 20's had bulging discs, 73.3% of males and 78% of females respectively. The authors concluded that disc bulging was frequently observed in asymptomatic subjects including those in their 20's.

It is my hope that after reading this, patients who have been told that they have on their MRI 'slip' discs, herniated discs etc will have new found knowledge and confidence that they can definitely get better with conservative management and not require surgery.

If the healthcare professional treating your 'slip disc' tells you you need surgery, you can show them this article.


Chui CC, Chuang TY et al (2015). The Probability Of Spontaneous Regression Of Lumbar Herniated Disc: A Systematic Review. Clin Rehabil. 29(2); 184-195. DOI: 10.1177/0269215514540919

Nakashima H, Yukawa Y et al (2015). Abnormal Findings On Magentic Resonance Images Of The Cervical Spines In 1211 Asymptomatic Subjects. Spine. 40(6): 392-398. DOI: 10.1097/BRS.0000000000000775

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