Posted by: Chris Maloney | April 14, 2012

Dwight Howard has herniated disc. What Could He Do Besides Surgery?

annotated diagram of preconditions for Anterio...

annotated diagram of preconditions for Anterior cervical discectomy and fusion (Photo credit: Wikipedia)

Dwight Howard has herniated disc in back – NBA News | FOX Sports on MSN.

One of the wonderful things about modern media is that everything suddenly becomes black and white.  Diagnosis isn’t a probability, it’s a certainty.  So when they say Dwight Howard has a herniated disc, it’s certain.  How do they know?  Well, he either had a CT scan, which is 83% accurate, or an MRI which is 88% accurate.  Then he had a physical assessment, which is pretty inaccurate.  Let’s assume he had an MRI and it showed that he just blew chunks of his disc everywhere.

What now?  Surgery, of course.  But wait.   What are the long term outcomes for surgery?  Up to two years afterward, pain is lessened in the area, but we have no studies showing whether or not the discs above and below will be more prone to blow out.  And if he has sciatic pain, surgery doesn’t necessarily help him more than conservative treatment, especially after two years.

So what else could he do?  Strangely enough, ozone therapy is showing positive results similar to surgery.  I’m not a fan of ozone myself, but if he’s looking at going under the knife, then it’s worth a second look.

Stretching and gentle manipulation may help, depending on the level of his pain.  I know, not my first choice to start moving around a busted disc, but the data on manipulation again parallels the surgical outcomes.

For many of the surgical techniques being used, no one has bothered doing any studies to test their effectiveness.  So depending on his surgeon, he could end up with a technique that isn’t very effective.  Then he’s out one disc, still in pain, and has to start over again.

For many patients with herniated discs the body manages to downgrade the herniation on its own.  It doesn’t resolve the pain, but stabilizes the joint.  But we have no head-to-head trials that would let us know the long term outcomes of not doing surgery on his back.

It’s disturbing that so much information is missing about something so common.

I’ve compiled eight pages of abstracts about disc herniation here at my website:  www.maloneymedical.com. (See back pain update top of the page.)

 

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Responses

  1. I remember hearing a physician say once that he doesn’t treat MRI’s, he treats patients. I wonder if the treatment goals become less about long term health in the million dollar world of professional sports?

  2. Absolutely. I think athletes need managers to be able to look long term at their overall health rather than for the short term “return on investment.” That said, I am often frustrated by the lack of care older patients receive because they aren’t professional athletes. The rehabilitation process and sports’ treatments are reserved for the young. A torn hamstring in an older person is often regarded as a side effect of aging rather than an athletic injury.

  3. True. Some insurances will not cover treatment for anything beyond helping older adults regain the most basic functions. Sleeping through the night and walking through a grocery store aren’t necessary activities, apparently. Forget about playing golf with your buddies. I’ll get off my soap box now 🙂


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