The Prevalence of Disc Herniation

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists

Commonality

In their paper published in the American Journal of Neuroradiology, Brinjikji et al. provide insight into the commonality of lumbar intervertebral disc herniation in asymptomatic individuals stratified by age. In their systematic literature review, the authors assessed 33 articles that reported imaging findings for 3110 asymptomatic individuals. [1]

Brinjiji reported that 29% of 20-year-old and 36% of 50-year-old asymptomatic patients have disc herniations on MRI. As we get older, the numbers increase. [1]

Nakashima et al. evaluated cervical spine MR images of 1211 healthy volunteers. They reported most subjects from ages 20-70 years of age presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. [2]

Reality and Thoughts

Degenerative changes including disc herniations are present in asymptomatic patients from the ages of 20-80. This reality provides due consideration:

• Appropriate Care – Extraordinary anecdotal relief and case reports suggest the benefit of chiropractic care for patients with disc herniation. Highly powered studies support the utilization of chiropractic care to reduce pain, disability, opiate utilization and surgical interventions in this patient cohort. A high percentage of patients safely undergo effective chiropractic adjustments of disc herniation patients on a daily basis.
• Due Consideration for Consensus Utilization Guidelines – Too frequently, imaging appropriate use criteria cite the commonality of disc herniations and degenerative changes in the asymptomatic population. This finding provides insurance carriers leverage to reduce their approval of advanced imaging to avoid overutilization and excessive cost. I would suggest that utilization must be considered while affording doctors the ability to make clinical judgments and recommendations based on their experience.
• Risk Management – Their are many who believe that sharing with patients their degenerative changes and disc herniations are catastrophizing and somehow emote negative thought processes. I disagree. In the light of transparent informed consent, it is important to share with our patients the commonality of these changes. I would prefer that they understand the likely prevalence of these changes and mitigate an accusation of harm that is unwarranted.

Considerations

Patients benefit from evidence-based methodologies that incorporate evidence based practices that are clinically intuitive. They benefit from frank and earnest discussion that helps them make informed decisions regarding their healthcare. It’s important that they understand the prevalence of disc herniation and degenerative changes to make changes in their activities of daily living and reduce their need for chiropractic and medical interventions.

Reference

© 2024 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source as follows: Demetrious J. The prevalence of disc hernation. https://postgraddc.com; 2024.

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