A retrospective study from the November 15th issue of Spine (2009) evaluated radiographs for biomechanical and other markers that would help identify patients at risk for repeat lumbar disc herniation. A repeat was defined as a herniation of the same disc after a “successful” first surgery where the patient was asymptomatic for a period of at least six months. The study analysed a group of 157 disc surgery patients to determine risk factors that might help predict which patients would have repeat herniations.
Very similar to the co-morbidities seen with low back pain in chiropractic practice, risk factors for repeat herniation included lifestyle factors; the most significant were smoking and obesity. The smoking rate of recurring disc herniation patients was 71.4% and the smoking rate for patients who did not have recurring herniation was only 38.5%. Previous studies have demonstrated that smoking promotes disc degeneration and decreases circulation that is necessary to nurture the disc and facilitate healing when there is disc damage.
In addition to smoking, disc height, reduced range of motion, and disc degeneration were significant risk factors for patients with repeat lumbar disc herniation. Patients who have had previous disc surgery are common in chiropractic practice. Educating patients about these risk factors and aiding them in making the appropriate lifestyle changes can help prevent recurrent herniation and future surgery.
Article by: ChiroAccess “Predicting Repeat of Disc Herniations: Chiropractic Implications” November 27, 2009
Spinal Surgery for Lumbar Disc Herniations
From the above article by you can see that smoking was one of the biggest risk factors for re-occurring low back pain and disc height. So as a chiropractor I do come across patients who have a disc herniation causing neck pain or leg pain that need to go for further intervention like spinal surgery. This is thankful not many but sometimes the pain and disability caused by the nerve pain needs spinal surgery techniques to give them pain relief and return to daily life functions.
I do also come across the occasional spinal surgery case where the initial sharp pain in the arm or leg has gone but the patient is left with lower back ache and pins and needles or a numb feeling in their leg or arm. This is after the spinal surgery operation.
How to Help Failed Back Surgery
In these cases the nerve that was affected by the initial disc herniation I believe became sensitised to pain and normal nerve function became disturbed. So for spinal surgery cases that still have a problem post-operation I think it is important to look to stabilise the lumbar or cervical spine through specific strengthen movements and gentle stretches. Also balance exercises to force the brain to create better control of movement. An example of balance exercising is one leg stands.
Balance Exercises
You can try the one leg stand balance exercises right now. First take you shoes and socks off. Then stand up. Now stand on one leg with the other leg not touching the leg you are standing on. Feel how your foot and lower leg work hard to keep you balanced. This is with your eyes open. To see how well trained your brain is try close your eyes. Did you find it much more difficult. A goal with rehabilitation of your balance exercises is to be able to stand on one leg for at least 30 seconds both eyes open and closed. You should be able to stand without jumping all over the place and having to hang onto the chair or wall.
Spinal Thoughts
So once the anatomy has been changed through surgery you want to also try change your brain function, muscle tone and movement patterns to try decrease abnormal load on the tissues in your back. Keeping a healthy back is definitely not only about trying to ‘click your spine’. You need to understand there are many body structures in between you skin and the nerve in your back and they can all be affected by your back pain. Learning how to move your spine properly is important pre- and definitely post-operation for spinal surgery.