For individuals experiencing back pain from a herniated disc, can understanding the difference between surgery and chiropractic help individuals find the right treatment plan?

Surgery or Chiropractic

Living with back pain can be a nightmare, and yet many struggle without seeking care. Today, there are a vast number of surgeries and noninvasive techniques that are better at treating spine and back problems and managing symptoms. For individuals who may have a herniated disc or are curious about ways to relieve their back pain, a health care provider, physical therapist, spine specialist, and chiropractor can inform them of treatment options. Surgery and chiropractic therapy are popular treatments for a herniated, bulging, or slipped disc.

• A herniated disc is when the cartilage discs that cushion the vertebrae shift out of position and leak out.
• Surgery for a herniated disc involves removing or repairing the disc.
• Chiropractic nonsurgically repositions the disc and realigns the spine.
• Both treatments have the same goals with key differences.

Chiropractic Care

Chiropractic is a system of therapy that focuses on adjusting and maintaining spinal alignment to help with back and posture problems. Chiropractors are trained and licensed medical professionals who take a nonsurgical approach, a proven therapy for chronic pain, flexibility, and mobility issues.

The Way It Works

Chiropractic treatment encourages and supports the body’s natural healing processes. It is considered for joint pain in the back, neck, legs, arms, feet, and hands. It typically involves sessions in which the chiropractor physically and carefully adjusts the vertebrae by hand, also known as spinal manipulation or chiropractic adjustments. (MedlinePlus. 2023). A chiropractor performs a thorough medical evaluation and runs tests to establish a diagnosis. A chiropractor will develop a treatment plan that may involve a team of massage and physical therapists, acupuncturists, health coaches, and nutritionists to treat affected areas with various techniques, recommend targeted exercises, adjust lifestyle and nutrition to support the treatment, and monitor progress. Combined with stretching and sustained pressure, the multiple methods can increase joint mobility and relieve pain symptoms. (National Center for Complimentary and Integrative Health. 2019) Added protocols to support or enhance chiropractic therapy include:

• Heating and ice therapies to reduce inflammation and increase blood circulation.
• Using devices to stimulate muscles and nerves electrically.
• Developing relaxation and deep breathing techniques.
• Incorporating exercises to promote rehabilitation.
• Establishing a regular fitness routine.
• Making adjustments to diet and lifestyle.
• Taking certain dietary supplements.

Spinal manipulation and chiropractic adjustments have been shown to improve symptoms and restore mobility in cases of chronic back pain. One review found that individuals with chronic lumbar/low back pain reported significant improvement after six weeks of chiropractic treatment. (Ian D. Coulter et al., 2018)

Prices

The out-of-pocket expenses of chiropractic treatment depend on a variety of factors.
Insurance may or may not cover the treatment, and the amount an individual has to pay can vary based on the severity of their case, what their plan covers, and where they live. One review found the cost can range between $264 and $6,171. (Simon Dagenais et al., 2015)

Surgery

There is a range of minimally invasive surgical procedures to treat herniated discs. These work to ease nerve compression by removing or replacing damaged discs or stabilizing the vertebrae, relieving pain and inflammation.

The Way It Works

A herniated disc can happen in any part of the spine but is more common in the lower back/lumbar spine and in the neck/cervical spine. Surgery is recommended when: (American Academy of Orthopaedic Surgeons. 2022)

• More conservative treatments, like medications and physical therapy, are unable to manage symptoms.
• The pain and symptoms impact daily life and functioning.
• Standing or walking becomes difficult or impossible.
• The herniated disc causes difficulty walking, muscle weakness, and bladder or bowel control loss.
• The individual is reasonably healthy, without infection, osteoporosis, or arthritis.

Specific surgical procedures used include:

Fusion Surgery

• Spinal fusion is the most common procedure for a lower back herniated disc.
• It involves using artificial bone material to fuse vertebrae to increase stability and release and prevent nerve irritation and compression. (American Academy of Neurological Surgeons. 2024)

Laminotomy and Laminectomy

• Herniated disc symptoms appear from compression placed on the nerves.
• Laminotomy involves making a small cut in the lamina, or the arch of the spinal vertebrae, to release the pressure.
• Sometimes, the entire lamina is removed, known as a laminectomy. (American Academy of Neurological Surgeons. 2024)

Discectomy

• Discectomy, also known as microdiscectomy, can be performed on the lumbar or cervical spine.
• The surgeon accesses the affected disc through a small incision and removes portions of the disc. (American Academy of Orthopaedic Surgeons. 2022)

Artificial Disc Surgery

• Another approach involves implanting an artificial disc.
• This is most often used for hernia in the lower spine; the worn or damaged disc is removed, and a specialized prosthetic replaces the removed disc. (American Academy of Orthopaedic Surgeons. 2022)
• This allows for more mobility.

The success of herniated disc surgery depends on different factors. Advances in minimally invasive techniques have significantly improved long-term outcomes, with one review finding that around 80% reported good—excellent results at a six-year follow-up. (George J. Dohrmann, Nassir Mansour 2015) However, there is the possibility of recurrence. About 20% to 25% of individuals with herniated lumbar discs experience re-herniation at some point. (American Academy of Neurological Surgeons. 2024)

Prices

• Surgery for a herniated disc is specialized, and the costs depend on the scope and scale of the treatment.
• The individual’s specific insurance plan also determines the expenses.
• The typical costs of surgery range between $14,000 and $30,000. (Anna N A Tosteson et al., 2008)

Choosing Treatment

When choosing between chiropractic and surgery for a herniated disc, a number of factors can determine the decision, including:

• Chiropractic is the less invasive nonsurgical option.
• Chiropractic adjustments cannot help certain severe cases of herniated discs.
• Chiropractic adjustments prevent the herniated disc from getting worse and ease symptoms.
• Surgery provides pain and symptom relief faster than chiropractic or conservative treatment but requires significant recovery time and is expensive. (Anna N A Tosteson et al., 2008)
• Surgery may not be appropriate for individuals with osteoarthritis or osteoporosis.

Chiropractic therapy is among the more conservative treatment options for a herniated disc and may be tried first before proceeding with surgery. Generally, surgery is only recommended when noninvasive methods haven’t been able to stop or manage the pain and symptoms. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution that fully benefits the individual to get back to normal.

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References

MedlinePlus.MedlinePlus. (2023). Chiropractic. Retrieved from https://medlineplus.gov/chiropractic.html

National Center for Complimentary and Integrative Health. (2019). Chiropractic: in depth. Retrieved from https://www.nccih.nih.gov/health/chiropractic-in-depth

Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013

Dagenais, S., Brady, O., Haldeman, S., & Manga, P. (2015). A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC health services research, 15, 474. https://doi.org/10.1186/s12913-015-1140-5

American Academy of Orthopaedic Surgeons. (2022). Herniated disk in the lower back. https://orthoinfo.aaos.org/en/diseases–conditions/herniated-disk-in-the-lower-back/

American Academy of Neurological Surgeons. Surgeons, A. A. o. N. (2024). Herniated disc. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc

Dohrmann, G. J., & Mansour, N. (2015). Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 24(3), 285–290. https://doi.org/10.1159/000375499

Tosteson, A. N., Skinner, J. S., Tosteson, T. D., Lurie, J. D., Andersson, G. B., Berven, S., Grove, M. R., Hanscom, B., Blood, E. A., & Weinstein, J. N. (2008). The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine, 33(19), 2108–2115. https://doi.org/10.1097/brs.0b013e318182e390