Do all Disk herniations Cause Pain?
Surprisingly, many disk herniations are not associated with pain. The classic 1990 paper written by Boden et al demonstrated the prevalence of significant lumbar MRI findings in asymptomatic individuals.
As a Doctor, and Spine Specialist, I know this to be true. I see it almost on a daily basis in my office. There is too common a scenario where a patient with back pain will insist on an MRI study of the back. By the time the MRI is authorized, and obtained, the patient is pain free. Still, most will undergo the MRI, and the images will show a disk herniation. At that point, there are often multiple factors that will lead both the Patient and the Doctor to conclude the MRI finding must have been the cause of the pain. In reality, there is no solid proof that the findings on the MRI was the cause of the transient back pain.
As a non physician, most have also heard “My Doc says I have a few bulging disks in my back” from friends, family and co-workers. Yet, strangely, the one declaring the bulging disks seem to be doing all sorts of activities that should be avoided because of the “bulged disk”. If you think about it, the “bulged or slipped disk” identified on the study probably was not causing pain, as that person is not limited in any activities.
The reality is we do not completely understand why some people with large disk herniations are completely symptom free, while others have tremendous impairment.
What we Spine Surgeons do know, is that unless the findings on the MRI correspond with a specific pattern of complaints and physical examination findings, the disk herniation may not be the source of the pain. In that scenario, any surgery to remove a disk herniation may not relieve the pain. As surgeons develop more experience, they recognize the nuances of the patterns, and are better deciding WHEN to do the surgery, not just HOW to do the surgery.
- Abdul Jalil MF, Lam MF, Wang YY. Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy. BMJ Case Rep. 2014 May 7;2014 PubMed PMID: 24811105