Up to 40% patients continue to suffer from low-back pain and sciatica even after surgery. In patients undergoing lumbar discectomy in particular, an estimated 10-30% experience postoperative pain, commonly referred to as failed back surgery syndrome.
Nearly a quarter of those patients develop scar tissue near the nerve root, called epidural fibrosis, and as many 76% of patients with epidural fibrosis require reoperation.
Despite the prevalence of failed back surgery syndrome, there are still no established clinical guidelines for treating recurrent lumbar disc hernaition after lumbar discectomy.
Previous case studies have pointed to the potential benefits of chiropractic for failed back surgery syndrome, but the role of chiropractic in managing recurrent lumbar disc herniation is poorly documented in the scientific literature.
To fill this gap in the literature, researchers from the Logan College of Chiropractic recently published a case study of successful chiropractic treatment of recurrent lumbar disc herniation.
The case study involved a 24-year man who managed a family construction and property maintenance business. He presented at a chiropractic clinic with sciatic pain in his lower back radiating down his right leg. The flare up was triggered after his work required him to shovel snow on multiple properties. Three years before that, the man had received a lumbar disc herniation that was treated surgically with a discectomy and partial laminectomy. The patient said his pain had improved after surgery, although he still had localized pain while working.
After his symptoms reemerged, he visited his orthopedic surgeon who used MRI scans to identify a new lumbar disc herniation and mild scarring. The orthopedic surgeon prescribed pain medications and recommended revision surgery. However, the patient was unable to take the necessary time off work for recuperating from surgery. Instead he opted for chiropractic management so he could continue supporting his family business during treatment.
The man received a chiropractic treatment lasting for 12 weeks, during which he continued to work with modified posture and lifting. A chiropractor treated him with flexion/distraction chiropractic manipulation of the lumbar spine, postisometric relaxation techniques of the lumbar erector spinae, and core stabilization exercises performed at home and at clinic. He also wore a lumbar stabilization brace while working, but used the brace less and less as his pain improved.
After ten weeks of chiropractic care, the man said his pain had dropped from a 10 out 10 at worst to a 3 out of 10 at worst. His disability scores also decreased by 32%, and he had significantly better back and leg range of motion. He continued to experience “no flare ups” in pain for additional nine visits before discontinuing treatment.
Although larger scale studies are needed, this case study suggests that chiropractic care could successfully treat patients with recurrent lumbar disc herniation after failed back surgery. Conservative treatments like chiropractic could allow patients to avoid the need additional surgeries.
Welk, AB. Conservative management of recurrent lumbar disc herniation with epidural fibrosis: a case report. Journal of Chiropractic Medicine 2012; 11: 249-253.