It never ceases to amaze me how the medical spine industry ignores its own research when it interferes with them making more money. Now another study confirms that the ‘bad disc’ diagnosis is dead, but spine surgeons won’t be telling their patients of this study despite the fact that it confirms research that began twenty five years ago.
This renaissance in spine diagnosis began in 1990 with MRI research by Scott Boden, MD, Director of the Spine Center at Emory University.[1] His research was followed in 1994 by another study by Maureen Jensen that again found no clear correlation between disc abnormalities and back pain.
Dr. Jensen’s study confirmed early suspicions that herniated discs were “coincidental” and not the holy grail of back pain causation:
“The relation between abnormalities in the lumbar spine and low back pain is controversial. We examined the prevalence of abnormal findings on magnetic resonance imaging (MRI) scans of the lumbar spine in people without back pain.
“On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”[2]
Drs. Boden’s and Jensen’s landmark studies were followed in 1994 by the most comprehensive study ever done at that point on acute low back pain in adults by an agency of the US Public Health Service, the Agency for Health Care Policy & Research (AHCPR) that revealed more ugly truths about fusions for ‘bad discs’:
“Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
“Moreover, surgery increases the chance of future procedures with higher complication rates…There appears to be no good evidence from controlled trails that spinal fusion alone is effective for treatment of any type of acute low back problems in the absence of spinal fracture or dislocations…Moreover, there is no good evidence that patients who undergo fusion will return to their prior functional level.”[3]
Subsequent studies from around the world have also debunked the disc theory that back pain was mainly due to herniated, bulging, or degenerated discs, but this misguided ‘bad disc’ diagnosis remains as medical folklore. Now a new study from the Mayo Clinic once again discredits the ‘bad disc’ concept, but most likely it too will fall on deaf ears among spine practitioners who will remain mute telling their patients.
Waleed Brinjikji, MD, of the Mayo Clinic and his colleagues performed a systematic review of all studies that reported on the prevalence of lumbar degenerative findings on MRI scans among individuals with no history of low back pain. The researchers found 33 studies of 3110 individuals published through April of 2014 and found the vast prevalence of ‘bad disc’ in pain-free people.[4]
Asymptomatic disc degeneration was exceedingly common and its prevalence increased with age from 37% of 20-year-olds to 96% of 80-year-olds.
The prevalence of a disc bulge rose from 30% of 20-year-olds to 43% of 80-year olds.
The prevalence of a disc protrusion climbed from 29% of 20-year-olds to 43% of 80-year-olds.
The prevalence of asymptomatic annular fissures rose from 19% of 20-year-olds to 29% of 80-year-olds.
More than 50% of the asymptomatic individuals older than 40 years had a “black discs” (i.e. disc signal loss on MRI).
Even more impressively, 86% of those aged 60+ years had a black disc.
“Our study suggests that imaging findings of degenerative changes such as disc degeneration, disc signal loss, disc height loss, disc protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention,” according to the reviewers.
According to Mark Schoene, the editor of The BACKLetter, “The largest systematic review to date drives home the point that spinal degeneration visualized on imaging scans often has no relationship to low back pain—and should not be routinely viewed as evidence of the source of low back symptoms.”[5]
According to the Mayo Clinic, most of the disc changes are no more significant than “gray hair or crow’s feet around their eyes.” In other words, they are not the cause of the back pain despite what the family physician or spine surgeon tells you—they are just a natural part of the aging process.
Remarkably, the common sales pitch of ‘bad discs’ has again been proven wrong, but that hasn’t stopped MDs from convincing uninformed patients of their wares of drugs, shots, and surgery. There is just too much money for them to stop, plus most people are convinced of the ‘bad disc’ concept since that’s all they’ve heard since 1934 when the ‘bad disc’ diagnosis was invented.
The best advice for anyone diagnosed with a ‘bad disc’ is to follow the guidelines that call for conservative (non-drug, non-surgical) chiropractic care first. This includes nearly 90% of cases where spinal mechanics, principally joint dysfunction, is the main cause of back pain. The only people who need drugs, shots, or surgery are those who suffer from cancer, fractures, serious infection like TB or staph, or the one in 100 disc case that doesn’t respond to chiropractic care.
So, the next time you hear someone way, “I have a slipped disc and need surgery,” tell them the truth that ‘you don’t slip discs, but you can slip joints,’ and encourage them to seek chiropractic care before drugs, shots, or surgery as the guidelines recommend.
[1] SD Boden, DO Davis, TS Dina, NJ Patronas, SW Wiesel, “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatic Subjects: A Prospective Investigation,” J Bone Joint Surg Am. 72 (1990):403–408.
[2] MC Jensen, MN Brant-Zawadzki, N Obuchowski, MT Modic, D Malkasian, and JS Ross, “Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain,” NEJM, 331/2 (July 14, 1994):69-73
[3] S. Bigos, et al., “Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14,” U.S. Public Health Service, U.S. Dept. of Health and Human Services, AHCPR Pub. No. 95-0642, Rockville, MD: Dec. 1994.
[4] Brinjikji W, et al., Systematic literature review of imaging features of spinal degeneration in asymptomatic populations, American Journal of Neuroradiology, 2014, prepub ahead of print; www.ajnr.org/content/early/2014/11/27/ajnr.A4173.long.
[5] Painless Aging, BackLetter: February 2015 – Volume 30 – Issue 2 – p 13–22