409- Do Lumbar Disc Herniations Resorb?

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with more research looking at a study all around the spontaneous resorption of lumbar disc herniations. This was a meta analysis. There actually was an update to this study that came out really, really recently. This one is a couple years old but it really sets the stage for the research that recently came out. And if you are somebody that sees a lot of patients with disc issues, which I think everybody listening here is, this is a great study with some take home messages. We're going to explore it together. We're going to talk about and give some clinical pearls that you can utilize when having conversations with your patients starting today. Before we get started, I want to say a few words about Patient Pilot by the smart Chiropractor. If you would like to generate more reactivations, this is Q4. This is HSAFSA time. Getting that messaging out super consistently is a great way to build revenue in Q4. It's actually the fastest, easiest, cheapest and best way to build revenue because people have already paid for these benefits. Question is, are you consistently not one message, not two messages. Are you consistently communicating throughout Q4 about their HSA FSA campaigns? That is what we do with Patient Pilot. We generate patient reactivations. The bigger your list, AKA how many people have you taken care of the the bigger opportunity you have, what are the two factors that affect how well it works? Your list size and your engagement. So if you're a doc with a pretty good list and you believe that a lot of patients that you've seen in the past would love to come back in and see at some point in the future. Patient Pilot just makes sense. If you'd like to generate more patient reactivations, have it done in an automated fashion utilizing a teach and invite consistently format. Head over to the smartchiropractor.com and schedule a quick demo. Again, that is thesmartchiropractor.com I'll drop that link down below. But as I said at the top today we're talking research. This came out in pain physician in 2017. I'll drop a link down for this as well. In the show notes, the actual title is Incidence of Spontaneous Resorption of Lumbar Disc. Herniation A meta analysis. And this is an interesting topic for a variety of different reasons, not only from the conservative care space, but also from the surgical space. Because if you don't give something time to heal and you do surgery too early, that's probably not a good situation for that patient. And we'll explore that more as we dive in on this episode. So studies have found that acute lumbar disc herniations two to five years after diagnosis, there was little difference between patients who underwent surgery and those who did not. Let me say that again, this is. You feel like you're almost in the Twilight world reading this sort of thing. So studies have shown patients with acute lumbar disc herniations two to five years after that lumbar disc herniation happens. They're pretty much the same whether they have surgery or not. Well, that lists then a whole host of questions, which is, well, why have surgical intervention? Which is a really, really good question, by the way. And one that probably, I think, comes down to something really pragmatic, which is with an acute lumbar disc herniation, there are patients that just have abject pain, and we've probably all seen it or experienced it, where somebody has an acute lumbar disc herniation, they're in 10, nine out of 10, 10 out of 10 pain. And I've literally heard patients say this multiple times, just cut it out. Now, what they don't realize is it's not exactly that easy. Can a surgeon go in there and cut the edge of a disc? Of course they can. Does that mean that they solve the issue? Absolutely not. Why? Because any time that you are doing an ablation on the exterior of the disc, to quote, unquote, seal it, it's never as good as the annulus that's undisturbed. So that's number one. So the incidence of re herniation is pretty significant. The secondary component is you can't magically get to a disc. You have to go through a lot of stuff. You have to cut through the skin, go through the muscle, tear up the fascia, teeth, take out bone and or ligament as well as disc. So you end up with a really compromised vertebral segment based upon trying to get to a disc herniation. Now, are there times where that might be the wisest thing to do? Yes. And we all know that because we know that there are red flags, cauda, equina, et cetera, saddle paresthesia, which require. It's a ticking timeline at that point, right? When you have red Flags going on, you could have permanent disability if that's not taken care of swiftly. But here's the beauty of it, like 98% of the time that's not the case at all. And it's very rare that we see those things in practice. 99, 98% of the time that's not the case in any way, shape or form. So then the question becomes, well, is surgery a good option? And I'm really hard pressed to believe that surgery is a good option when we know and it's been said for this study was 2017 and they're referencing patients studies. So this knowledge is not new. It's been around for a long time that a couple years, five years, two to five years after somebody experiences a disc herniation, they're basically the same as if they went underwent surgery as without. So the question then becomes, is the risk worth the benefit? Well, there's pretty much no benefit because it's the same as if you didn't have it, it did nothing. So no, the answer is absolutely not. And I've spoke on stages about this a lot over the last few years and quite frankly become a little bit more hardened to it, especially having worked in surgical centers. I understand what goes on on the other side, so to speak, meaning not only on the chiropractic side, but on the medical side. And I can tell you disc surgery is a really big money maker. I also can tell you that it's not a hard quote, unquote sell when you like people have these assumed beliefs and we know that because only about 10 to 15% of the population sees a chiropractor. So if 90% of people have neuromusculoskeletal issues, if x amount x percent of those have disc issues and only a fractional percentage are seeing a chiropractor, they clearly don't have the information or they have bias and it's normally a combination of both that pushes them towards a interventional paradigm instead of a healing paradigm. So in this study they looked at 11 trials that represented just a shade under 600 lumbar disc herniation patients managed conservatively. And they said 380 of those individuals had resorption of the disc. That's a lot. They all. So what does that come out to? 66.66%. A lot of sixes there. 66.66% of people had spontaneous resorption. So what does that mean? That means that most people, by definition over 50%, most people that have an acute lumbar Disc herniation will have resorption over time. Now, the challenge is between herniation date and whenever that resorption happens. And for many people, that's what they're trying. That's the pain zone, right? That's where people are trying to avoid, which is why they go towards medications, why they go to injections, why they go to a surgical intervention. Now, incidentally, it's also why they come into your practice. But the higher the pain, the more likely they are to seek relief of that pain. Why? One, because of the pain itself, but two, because it greatly affects your ability to live your life, your quality of life. And that's the number one reason. What drives people to inquiring about care is not the pain itself, but the life effect of that pain. So lumbar disc herniation, it's a common quote, unquote disease, but it does have a high recurrence rate. And that is another interesting aspect of this. We talked about it surgically, meaning anytime you go in, you cut off the edge of the disc and you use an ablation or whatever fancy term, it's. It's all the same thing. Let's be really clear. There's a million companies selling a million different tools to surgeons, doing it a million different ways, and all of them are miraculously better than the others. They are, generally speaking, all of the same. You are basically doing an ablation at its core level on the exterior, on the annulus of the disc to create essentially scar tissue, which then acts as the annulus. Now, what do we know about scar tissue? We know that it is not as mobile, so to speak, it's not as pliable. That's one issue. We also know that it's generally not as strong. That's another issue. We also know that it's, of course, avascular. That's another issue. So these are all reasons why it's not uncommon to see a recurrence of a disc herniation post surgically. Because it's really compromised. It doesn't like. Doing surgery on the disc does not make the disc be better. It's not better living by science here, it compromises it. And the surgeon in many cases is doing the best they can to get the disc to the best point it can be. But that does not mean in any way, shape or form that it's superior to what it was before. And we know it's not only not superior, it's dramatically compromised. And anytime there's a recurrence of a disc herniation, those have really serious impacts on quality of life with individuals. Not only from a physical standpoint, one, because often a recurrent disc herniation is significantly more severe in terms of size on an MRI than an initial one. And I've seen countless MRIs with a recurrent disc herniation that almost look like somebody's joking around. I mean, the disc is so large, like externally it looks like a cartoon practically. So. And I've seen that too often for it to be just happenstance. So that's number one. The second part about the quality of life issue is the mental toll that that takes when somebody goes through a surgery. Think about at that extreme level to heal an issue that was so severe that it drove them to a surgery to begin with. Now they have it happen again. Gosh, that is a really demoralizing place to be. And it's a serious consideration from a mental capacity that us as chiropractors also need to be aware of. Because as we see patients that come in post surgically that fail those surgeries, being able to talk level with knee to knee, heart to heart with those people is really, really important. So in this study they highlighted the fact that in Japan the resorption rate was 62%, 63% rounded up. In the United Kingdom it was about 83%. That's a big difference. 20% difference. And they highlighted the fact that the medical standards in the countries may have an impact on the incidence of lumbar disc herniation. Resorption with conservative treatment. Here we go. With conservative treatment. So does a resorption. So what can we infer from that? Well, we can infer that when somebody undergoes conservative care, they are likely more likely to have lumbar disc resorption. That's a great thing and it just totally makes sense if I just break it down brass tacks wise. When you have a disc that has a herniation and it's acute now, you want to get people moving safely and without red flags. Of course those are givens. But the gist of it is movement is what heals. Inflammation is the first step in the healing process. So as that disc herniates, becomes exceptionally inflamed, that's actually what bam, kick starts the healing process. Then going through conservative care, especially with what we do as movement based healthcare professionals, only helps that healing process expedite over time. And that's a really, really powerful place to be as a chiropractor is we can actually help facilitate that healing process. And the studies that showcase that there are far more Studies that showcase that in more detail. But the statistic here is in a society that has well built, well constructed conservative care foundation, we see that the resorption rate is 20% higher than a society that might not have. So the difference there is the use of conservative care for many people. So I'm always a big fan of in the absence of red flags, nobody should undergo a spine surgery without having gone through chiropractic. Because we've also highlighted other studies showing patients that receive chiropractic. There's no downside. Patients that went through chiropractic care pre surgically and failed chiropractic care, quote, unquote they had similar results as those who, who did not or you know. So I'm saying that a little bit, a little bit confusingly, but the gist of the study was that there was no downside to experiencing chiropractic care. You had all upside. It either didn't work and you weren't worse for it or it did work and you were able to find relief, you're able to improve your quality of life. All of those objective and subjective findings improved and then you didn't need the surgery. So to me, that's why I go back and I say there is not a single person, in the absence of red flags that should undergo surgical intervention without having experienced chiropractic care. Now everybody has freedom of choice within healthcare so they can choose to do it or not. But we need to have a fair shake at the table and people need to be guided and directed in the best way possible. Not well, you took a medication, you had three injections, you went to PT 10 times and it didn't work. Quote unquote. Let's go directly to surgical intervention. Way too fast, way too aggressive and happens way too often. Those are really the big take home messages. The conclusions that they found in this study were, quote, whether lumbar disc herniation should be treated conservatively or surgically remains a source of controversy. Disagree. The phenomenon of lumbar disc herniation resorption has been recognized and its overall incidence has reached 66.66%. According to our results, conservative treatment may therefore become the first choice for treating lumbar disc herniation. Absolutely bizarre. That they say is a source of controversy. But conservative care should be the choice. Let's just get it out there and hold people accountable to making the right decisions. The cost reduction thereby achieved should benefit patients and society. Research on simultaneous resorption is still sparse. Further studies with a similar design are would Be a good idea is what they are saying. And I could not agree more. So this study was really interesting. I had forgotten the percentage and and 66% resorption rate is really, really high. That also means that you should be able to go in with confidence and people are scared. You have a disc herniation, it is scary. Even if your pain is not 9 or 10 out of not 9 or 10 out of 10, it can really be scary. So helping people understand, hey, here's the great news. You are 66% of people that have a lumbar disc herniation will have this resorb. Now how do we improve to make sure that you are as likely as possible to be in that 66% doing exactly what we're about to talk about here in our office with movement based healthcare. Let's have a conversation around that. This helps abate fears, it helps remove fear, avoidance behavior and it helps inspire people. And this is a really, really important part about this. You have to have that hope. We know that there's such a connection between somebody's desire and ability to get well that we want to inspire that desire to get well. So their body allows the ability to get well. And without that you're just pushing rocks uphill. So helping understand some of these stats, communicating some of these stats, you don't want to be overly statistical with your patients because they're going to forget a lot about it. But helping them realize, hey, most people that have a disc herniation, this thing resorbs on its own. And here's the good news. You are in the right place to maximize your opportunity to get well without needing surgery or drugs. If anything comes up where that might be a better option for you, I'm going to be the first person to tell you. But I can say you are in the right place and nobody should be going through those interventions without being here first. So. So let's get to work. There's just so much opportunity for you to have that conversation. So thank you so much for listening to this podcast. Before we wrap up, if you're going into Q4 and you're struggling with team, consider a virtual CA. This has been a game changer for me. I sent some emails out to my list about this. I've seen a lot of docs have a ton of interest. Head over to ChiroMatchmakers.com, schedule a call about virtual CAS, outbound calling, inbound calling, social media management. These are things that can be done on pennies on the dollar and if you're a lone wolf right now. A virtual assistant, absolute must have it is gonna free up time and opportunity for you to build and grow your practice. It's gonna reduce your stress. Head over to Chiromatchmakers.com and schedule that call. If you have not left a rating or review for this podcast, I would love it if you would do so. Scroll on down, tap some stars, leave some feedback, and if you have any suggestions, you can always email me. Jeff the evidencebasedchiropractor.com thank you for being a chiropractor. Have an awesome week in practice and I will talk to you soon.

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