Decompression and herniated disc

SPINAL DECOMPRESSION AND HERNIATED DISC

A herniated disc is one of the most common causes of lower back pain and radicular pain. When an intervertebral disc tears, the nucleus pulposus can protrude and compress a nerve root, causing pain, numbness or weakness in the lower limb.

Neurovertebral spinal decompression is a non-surgical approach that may be considered in the management of certain herniated discs, following appropriate clinical assessment and imaging.

Consultations take place at the practice located at 9 Rue du Regard, 75006 Paris, in the 6th arrondissement.

MECHANISM OF ACTION ON THE HERNIATED DISC

Decompression relies on controlled vertebral traction, performed using a specialised device. The principle is to create negative intradiscal pressure at the level of the affected spinal segment.

This negative pressure aims to:

• encourage the retraction of the herniated disc material back toward the centre of the disc
• reduce the compression exerted on the nerve root
• improve the diffusion of nutrients into the disc (imbibition process)
• reduce local inflammation through mechanical unloading

The traction force is applied progressively and cyclically, with alternating phases of traction and release that help prevent reflex muscle contraction.

PROTOCOL FOR HERNIATED DISC

The management of a herniated disc through neurovertebral spinal decompression follows a structured protocol:

1. Initial assessment: comprehensive clinical examination, imaging analysis (MRI or CT scan), neurological evaluation
2. Indication discussion: decompression is not suitable for all herniated discs. The indication is discussed on a case-by-case basis
3. Session protocol: generally 10 to 20 sessions, at a rate of 2 to 3 per week during the initial phase, then gradually spaced out
4. Regular reassessment: clinical follow-up at each session to adjust parameters and evaluate progress
5. Associated advice: posture, adapted physical activity, daily load management

WHEN DOES SURGERY REMAIN NECESSARY?

Neurovertebral spinal decompression is a conservative option that can be offered before considering surgical intervention. However, certain situations require a priority surgical opinion:

• cauda equina syndrome: absolute surgical emergency (sphincter dysfunction, perineal anaesthesia)
• progressive motor deficit: worsening loss of strength in the foot or leg
• uncontrolled severe pain: despite appropriate medical treatment
• large herniated disc with severe stenosis: when the spinal canal is significantly narrowed

Outside of these emergency situations, the scientific literature suggests that a well-conducted conservative treatment can produce results comparable to surgery at medium term for many herniated discs.

EXPECTED OUTCOMES

The outcomes of decompression vary between patients and depend on several factors: size and location of the herniation, duration of symptoms, general condition of the patient and adherence to the protocol.

Some patients report improvement from the very first sessions, while others require a longer protocol. Improvement generally affects radicular pain first, followed by lumbar pain and functional mobility.

CLINICAL STUDIES

Choi et al. (2022)

Title: Effect of non-surgical spinal decompression on pain and herniated disc volume in patients with subacute lumbar disc herniation.

Method: Randomised clinical trial on 60 patients with a decompression group and a control group over 8 weeks.

Results:

• Significant reduction in lower back and radicular pain in the decompression group
• Visible reduction in herniated disc size on MRI
• Improvement in mobility and quality of life

Reference: PubMed

Apfel et al. (2010)

Title: Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study.

Method: Retrospective analysis of patients treated with non-surgical decompression, evaluating the correlation between disc height restoration and pain reduction.

Results:

• Significant association between increased disc height and reduced pain
• Functional improvement in the majority of treated patients

Reference: PubMed