Spinal decompression

**UpaLumpa** · Posted On: 7/31/2007 4:11pm

Does anyone have solid (non-anecdotal) information concerning spinal decompression as a treatment for bulging and herniated discs and the resulting sciatic pain? I've heard very positive things from training partners but am looking for some more concrete information.

Having numbness in my left leg while rolling is getting to be a bit of a drag (I can't shrimp to one side until I've been rolling a half-hour or so) and I think my NSAID intake might be a tad high. No I haven't seen a doctor lately, I was told a few years ago I would probably need surgery again and that's not something that is feasible right now.

**Phrost** · Posted On: 7/31/2007 4:46pm

I'd be interested in this too.

**siulumpai** · Posted On: 7/31/2007 5:18pm

Even though it's a competing treatment, my chiropractor said it does work for some people. Seems logical to me too that traction should relieve some of the disc compression immediately.

**bob** · Posted On: 8/01/2007 5:26am

If you're looking for hard research, the short answer is that it's lacking somewhat. This is from the Cochrane meta-analysis...

Forty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring.
Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy.
Authors' conclusions

Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).

The carefully selected patient bit is important.

My own experience (10 years as a physio) is that it works quite well for 10-15 years post operatively in reducing sciatic pain and neurological symptoms in the leg. It has relatively poor results in reducing back pain. After 10-15 years the results start to vary a bit and you tend to have increased recurrences but these tend to be more with people who either get fat and unfit (or stay fat and unfit) or do heavy manual work involving lifting and bending.

**Mr. Mantis** · Posted On: 8/01/2007 10:02am

Surgery again? You've had back surgery already? You just have a little numbness and a little pain? Any bladder or bowel dysfunction? My gut reaction is to tell you that you are too young to have back surgery unless it is absolutely necessary. Plus, have you had an MRI? Do you know what is causing the problem? Is the disc impinging on the thecal sac or is there stenosis that is made worse by disc space narrowing? Most of your pain could be due to spasm or muscular rather than neurological.

If you do need back surgery, you need a good surgeon. I have seen the wrath of multiple surgeries for recurrent disc herniation, and it's not pretty. If the pain/problem is in your back, you just have to watch for signs of cauda equina syndrome. Grin, bear it, strengthen your abs, take it easy and welcome to the old battered martial artist club.

**Goju - Joe** · Posted On: 8/01/2007 10:22am

I looked into it (going to cost $4,000 for 21 treatments Yikes)

I also was going to get an inversion table.

But I started Physio and we are working on exercises to PUSH the bulge back in. So she said not to bother.

I am starting to feel things in my right foot where the sciatica has settled so I think it's working. I am going to give it another month

HOWEVER

Upa

I was told to stop doing things that would compress it while doing rehab.

So no matter what you try and do to fix the problem if you spend a lot of time sitting or putting stress on your lower back you're going to keep compressing it.

You might have to give up grappling for a few months and take care of your back.

Believe me it sucks, I know but if you want to fix it I think it's important not to keep compressing it.

I had to quit cold turkey because trying o work through it or work around it, especially for grappling is just not possible.

**UpaLumpa** · Posted On: 8/01/2007 12:32pm

Originally Posted by Mr_Mantis

Surgery again? You've had back surgery already?

I had back surgery at 22, after a long period of physical therapy that did nothing. It was a microdiscectomy by one of the leading neurosurgeons in California.

You just have a little numbness and a little pain?

While the pain isn't like it was when I had surgery (lots of vicadon every day), it isn't quite little and walking around with your foot asleep is a bit of a pain.

Plus, have you had an MRI? Do you know what is causing the problem? Is the disc impinging on the thecal sac or is there stenosis that is made worse by disc space narrowing? Most of your pain could be due to spasm or muscular rather than neurological.

Prior to my first surgery the MRI showed that, at 22, I had two apparently asymptomatic herniated discs in my lower back as well as one that was pretty degraded and another that was bulging and pinning the cord to the inside of the spine, which is what they operated on. I also had pretty severe disc degeneration in four vertebrae in my neck. I was advised that I would most likely require surgery within the next ten years, at least once. That was 8 years ago so I'm making an educated guess that this isn't solely muscular.

The sciatic pain came back 8 or so months ago (don't recall anything that set it off) so I've been grinning and bearing it for awhile and am looking for at least some moderate level of relief.

**UpaLumpa** · Posted On: 8/01/2007 12:37pm

Originally Posted by Soju - Joe

So no matter what you try and do to fix the problem if you spend a lot of time sitting or putting stress on your lower back you're going to keep compressing it.

Wow, that basically means I couldn't work.

**poet** · Posted On: 8/01/2007 3:38pm

It was used on me before my Fusion. It did not help me.
I was told by my PT that it works more on smaller herniations.

Like someone said earlier works for some not for others. I would be an other.

**bob** · Posted On: 8/01/2007 4:21pm

Originally Posted by UpaLumpa

I had back surgery at 22, after a long period of physical therapy that did nothing. It was a microdiscectomy by one of the leading neurosurgeons in California.

While the pain isn't like it was when I had surgery (lots of vicadon every day), it isn't quite little and walking around with your foot asleep is a bit of a pain.

Prior to my first surgery the MRI showed that, at 22, I had two apparently asymptomatic herniated discs in my lower back as well as one that was pretty degraded and another that was bulging and pinning the cord to the inside of the spine, which is what they operated on. I also had pretty severe disc degeneration in four vertebrae in my neck. I was advised that I would most likely require surgery within the next ten years, at least once. That was 8 years ago so I'm making an educated guess that this isn't solely muscular.

The sciatic pain came back 8 or so months ago (don't recall anything that set it off) so I've been grinning and bearing it for awhile and am looking for at least some moderate level of relief.

With the usual disclaimer that e-diagnosis is fraught with peril, I'd say the next step, surgically, may be either a fusion or even a disc replacement surgery.