Disc Herniation, Degeneration, and Spinal Cord Compression in Asymptomatic Populations
Reviewed by: James Demetrious, DC, DABCO
Prevalence and Dichotomy?
What is the prevalence of disc herniation, spinal degeneration, and spinal cord compression in asymptomatic cohorts? What is the clinical importance of this relationship?
Research published by Nakashima et al. revealed frequently observed intervertebral bulging discs and spinal cord compression in their asymptomatic cohort: 
Brinjikji et al. reported, “Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging–based degenerative features are likely part of normal aging, and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.” 
The authors provide clarity with regard to the commonality of degenerative findings in the asymptomatic population of different age groups:
The informed consent process can include discussions about the presence of pre-existing conditions that may predispose patients to pain and impairment. Patients appreciate meaningful discussions regarding their conditions. From a risk management perspective, I would prefer that patients are aware of pre-existing degenerative changes.
In practice, I have found that honest discussions regarding the commonality of disc herniations and degeneration in the asymptomatic population can allay fear, provide insight, and foster compliance to recommendations.
I try to clearly convey that degenerative abnormalities are common and at times may not associated with pain. Exacerbation of these pre-existing conditions may cause patients to seek chiropractic care.
Such exacerbations may be managed through improved activities of daily living, chiropractic and ancillary care.
- Nakashima et al. Spine (Phila Pa 1976). 2015 Mar 15;40(6):392-8.
- Brinjikji et al.AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
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The views and opinions expressed in this presentation are solely those of the author. The information is not offered as a standard of care, as research and care evolve. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.
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