“Classic” disc herniation

Not that we haven’t all seen these pictures innumerable times but it is wise to recognize both the classic look on MRI and the illustration. It’s also important to recognize these presentations are neither ubiquitous nor inherently ominous if you look at population studies. Lifetime prevalence of a “true pinched nerve” is about 10% and both old and recent studies show self-healing, resolution is very common…if not ubiquitous. Many studies conclude there is shrinkage-phenomena i.e. up to 80% of hernias will shrink at least 50% in 6-9 months. And those patients presenting with HNP (typically a younger population) actually recovered with better outcomes than those having similar pain but no MRI confirmed herniation, in 6-9 months (NEJM 10.1056).

In acute presentations facilitated exercise (extension most commonly) in addition to decompression procedures has been shown to be very effective. Though this “classic” presentation is perhaps NOT the typical presentation in our offices it is good to have the treatments & knowledge available when it does show up…and recognize when referral is necessary based on typical-healing profiles.