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Spine and Back Health

What Really Are Disc Herniations?

01/15/2009

Question:

As everyone who has been cured using AOS/TMS treatment (John Sarno, MD) knows, disc herniations don`t cause pain. I`ve struggled to figure out exactly what they are then, because "a natural aging process" is unsatisfactory to me. To answer my own questions, I need to know: 1) How often bulging or herniated discs spontaneously resolve compared to getting worse? 2) I recall hearing that they sometimes do `resolve`, which contradicts the idea of a degenerative process. Is there any research on this??

Answer:

Hello, thank you for your question. Your first statement is based on a flawed and overly simplistic assumption, that 'disc herniations don't cause pain.' This type of blanket statement is simply not accurate. Disc herniations often cause pain. Disc herniations sometimes don't cause pain. These statements would be more accurate.

The treatment you refer to has no objective scientific evidence showing that it works, and people with chronic pain syndromes are, indeed, very difficult to treat successfully. The problem of disc herniations is far more complex than you would think. There are thousands of scientific articles examining the relationship of disc herniations and pain.

In a very simplistic view, it can be said that disc herniations usually don't cause back pain, but definitely frequently cause 'radiculopathy', which is the medical term for what people often think of as 'sciatica'. This is part (but not all) of the reason why surgery for lower back pain has very poor success rates (although comparable to the 57% success rate claimed by the people you referred to), whereas surgery for sciatica often has success rates as high as 90%.

To answer your specific questions, first you need to avoid lumping bulging discs and herniated discs together. They're not the same thing. Statistically, about 80-85% of lumbar disc herniations will resolve spontaneously. Regarding your second question, there really isn't a contradiction there. Even if someone's bulging or herniated disc gets better, the overall degenerative deterioration of the spine continues as we age. The hallmark of a degenerative process is an overall gradual worsening over time -- this doesn't imply that on a short-term basis things can get better, get worse, and fluctuate. I hope this helps clarify things for you.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University