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What's New | My Diary | Current Research | Consultation Service & Image Usage Service |
This site is best viewed with FireFox or Internet Explorer 5.0 or higher and a screen resolution setting of 1024 X 768 pixels. IT IS MANDATORY THAT YOU READ MY 'DISCLAIMER' BEFORE ENTERING THIS SITE, AND REMEMBER THAT ANYTHING YOU MAY LEARN HERE SHOULD NEVER BE USED TO REPLACE OR MODIFY YOUR DOCTOR'S ADVICE!!! Welcome to chirogeek.com, a site created and managed by Douglas M. Gillard, DC. All images on this site are copyright protected and may not be used without written permission from Dr. Gillard. Some images, however, may be purchased. © Copyright 2002 – 2012 All rights reserved - Douglas Gillard, BS, DC. Absolutely no copying or printing of any of the material on this site without the written permission of Dr. Gillard. Some images, however, may be purchased. 2-21-12: I published my review of a meta-analysis of an FDA approved minimally invasive procedure called percutaneous laser disc decompression 2-20-12: I published a new Discography Page [Here]. 2-3-12: I feel like I have just given birth. After five straight days of work, I have just published a page dedicated to one of the best research papers I have ever read. This paper was devoted to reassessing the safety and efficacy of the newly FDA approved cervical artificial discs. It's a must read for any patient considering undergoing the traditional anterior cervical discectomy fusion (ACDF). It is my layperson opinion, that for a select group of patients, cervical artificial disc is the way to go (it is rare for me to jump on the bandwagon with regard to spinal procedures, but this is an exception--there has been the changing of the guard. [Here] 1-24-12: I discovered a paper worthy of making the research corner. Read about a randomized controlled trial that pitted ACDF against an Endoscopic procedure. [Here] 1-16-12: new research papers reviewed and added to the current research page. 11-30-11: Got a new MRI today. See my diary for the details.
10-23-09: I've updated my Diary, the Current Research Page, and the Disc Anatomy page. 10-11-09: I've updated the Annular Tear Page. 09-25-09: The Mini-Consult! By popular demand, I'm going to offer a mini-consultation in which I'll spend 15-20 minutes on the phone with you and even review your MRI images in attempts to identify your problem and formulate a plan of attack for recovery. I'm not sure how it's going to work out (patients typically spend 50-60 minutes with me on the phone) but I've gotten so much e-mail requesting this, I'll give it a try. I've also updated the Current Research Page with a few interesting new (2009) investigations one of which demonstrates that the mind is a power force in the process of recovery from surgery!! 01-28-09: Damn, another Injury! 10-06-08: I've updated my Current Research Page with 4 new research investigation that caught my eye. 10-06-08: Its been a while. Back's doing great, my sciatica's long gone and I've applied to many Osteopathic Schools in hopes of starting a new and exciting career change--the MCAT is my only hurdle, which I just took last month and am awaiting the what I believe to be bad new--notwithstanding my modern G.P.A. of 3.6, I need a good year to prepare for that damn test; a year that this 48-year-old doesn't have. I've also updated my history page to included my latest condition and story. Doug's Story. 07-01-07: A lot of new spinal research updates have been added to the Current Research Page. 06-21-07: PayPal has been added to my services page in order to facilitate the growing number of phone consultations. Now you can use your credit card to speak to me. Too, I have added several new investigations to the current research page. I also, finally, completed my BS degree (Applied Biology), which I need to apply for medical school. MCAT preparation with begin this fall. 11-24-06: I've added 6 new, what I consider to be, significant medical investigations published in 2006. None of these bode well for IDET, provocative discography, Infliximab, and even microdiscectomy. See my "Current Research Page" [here] Also want to thank Ferris State University for inducting me into their prestigious Athletic Hall of Fame. Thank you Ray, Dean, and all the other members of the induction committee; it is truly a great honor. 02-19-06: I've reviewed the Torgerson investigation of 1976. This is one of the few radiographic investigations into the false positive rate of x-ray on DDD, DJD, Spondylolysis, and Spondylolisthesis as the study compared over 100 pain free age-matched folks with over 100 low back pain patients. (here) 01-20-06: I've added so new information in the Sciatic page regarding the recent findings regarding the once touted miracle cure for sciatica: Infliximab was found no more effective than placebo when it comes to treating disc herniation induced sciatica. (here) 10-04-05: In attempts to Keep this site as "current" as possible, I shall begin to post abstracts of some of the most recent "eye catching" investigations of the medical literature: Current Research Page 09-03-05: Lots of updates - for all you Californian Chiropractors - in the Chiropractic sections including the Labor Code page, the UR page. I've also updated the disc herniation page. Also updated the Spondylolisthesis Page with new information and x-ray images. 07-31-05: Added the SPONDYLOLISTHESIS PAGE. A good 40 hours of work went into this one, which is properly foot noted. I'll be adding more real x-ray examples to this page in the near future. 07-02-05: Added the "Neck Disability Index" to the "Disability Assessment Page" and gave it a good make-over. Now you can download these tests for you personal use ONLY! 05-30-05: Introducing the 'Chiropractic Research Page'. I guess it's time to start posting some of the literature that supports spinal manipulation / mobilization / manual therapy. Although it's not as high of quality as we need, these randomized controlled trials are a start. [Chiropractic Research] 05-29-05: I've updated the Maine 5 Year Outcome study with new information gathered at 10 years. The results further the contention that although patients who underwent discectomy procedures for disc herniation-associated sciatica fared slightly better with respect to satisfaction than those who were treated non-surgically, there was no difference in the rate of future need for surgery and the ability to work. More importantly, this confirms that no matter how you treat sciatica, many folks just don't completely recover, i.e., only about 50% of patients COMPLETELY OR NEAR COMPLETELY RECOVERED!!! [Maine 10 Year Outcome Results]. 04-28-05: I've put up my new 3Tesla contrast MRI images of 04-12-05. Amazingly these images demonstrate that my left S1 root is severely inflamed, secondary to flare-up, not only at the expected L5 disc level, but all the way up to the L3 vertebral body level as well! What's even more amazing is that despite this dreadful looking root inflammation, I'm now completely recovered from this flare-up of sciatica and back to my usual Level 2-3 pain. [Gadolinium enhanced 3 Tesla MRI] 04-24-05: I've added a section on Contrast MRIs use in demonstrating Internal Disc Disruption (IDD) and included an excellent example of how well gadolinium can enhance IDD. I've also updated my diary. I also added more information to the MRI tutorial page, including how to use 'Scout Images' to find the exact disc you may be interested in visualizing. 04-17-05: I've added a new L4 axial view to the MRI Tutorial page that demonstrates how the nerve roots hand in a semi-order within the thecal sac. 04-10-05: I touched up the 'Rim Lesion' page and interjected some new animal research that confirms needle stick injuries into the superficial periphery of the disc always leads to rapid disc degeneration. I've also added some new investigations into the 'MRI Abnormalities in Asymptomatic Patients' page and the 'Sciatica' page. 04-03-05: I've added to the Disc Anatomy Page: I found some great pictures of a human dissected lumbar spine which nicely demonstrates the delicate spinal nerve roots, the dorsal root ganglion, the ventral and dorsal primary rami, and even the motor and sensory nerve roots within the cauda equina. Most fascinating. (Disc Anatomy Page look under the "real nerve anatomy tab") 04-03-05: FACE LIFT on the Internal Disc Disruption page. I've added new drawings and updated the research. 04-01-05: Sorry for the lack of Research Paper Reviews: I've just been to busy trying to survive and haven't had the time. I have updated my diary with a very strange manifestation of what appears to be extra-territorial pain. I've got to get that page on central sensitization up soon! If it wouldn't have happened to me personally, I would have never believed it possible! 12-22-04: I have reviewed Dr. Anthony's Yeung's first published paper on his 'famous' SED procedure, which is designed for the treatment of chronic discogenic low back pain and is one possible alternatives to fusion. Although this was more of a 'pilot' investigation (traditional investigational design was not followed) and contained some errors, it boldly took-on a group of severely disabled patients and certainly demonstrated its efficacy for the treatment of the severely disabled (Oswestry average 59). As an added and unexpected bonus, Dr. Yeung has, graciously, corresponded with me and explained some of the nuances of SED and his patient-inclusion rationale. (Yeung: Selective Endoscopic Discectomy - SED) 12-14-04: At long last I've reviewed an investigation into the efficacy of Endoscopic Lumbar Disc Surgery. Dr. Anthony Yeung, who is fast becoming known as the guru of endoscopic lumbar procedures, has published his endoscopic surgical outcome for over 300 patient-procedures. The paper clearly demonstrates that Endoscopic lumbar discectomy 'seems' to be just as successful for the treatment of lumbar disc herniation-associated radiculopathy as traditional open microdiscectomy; however, at what cost to the structural integrity of the disc and its long term health. Although it was a good study... it could have been GREAT had the investigators included a few of the typical patient outcome tools (Oswestry & VAS), but alas, they chose to use an un-named outcome questionnaire instead! I still, however, have my reservations about this procedure and will wait until we get some longer term data before I will endorse endoscopic discectomy: (Yeung: Endoscopic Disc Surgery - 2002) His SED procedure, which I am reviewing next, may be a different story! 11-28-04: DON'T BELIEVE EVERYTHING THAT YOU READ! I’m supposed to be taking some time-off, but after I received an e-mail claiming that a new investigation confirms that ALIF (spinal fusion from the anterior approach) is the "wonder treatment" for failed spinal surgery, I had to take a brief hiatus from my sabbatical to set the record straight. The study was fatally flawed and full of inconsistencies, which the authors admitted to on the very last page; a page that no layperson would have ever seen without purchasing the investigation! READING INVESTIGATION ABSTRACTS CAN BE DANGEROUS! [ Duggal & Dickman: ALIF for the Treatment of Failed Back Surgery Syndrome ] 11-09-04: Two make-overs on two of the investigations into the natural history of sciatica: Saal & Saal and Weber 1993. Both of these investigations demonstrate that it is fairly uncommon for the patient to COMPLETELY RECOVER from true root-related sciatica. 10-02-04: More up-dates! I've added some more MRI learning-examples to both my Disc herniation Tutorial Page, and my MRI & CT Tutorial page. The MRI & CT tutorial has been majorly overhauled and now has examples of both axial and sagittal MRI anatomy. 9-29-04: I've done a 'huge' over-haul of the Disc Herniation Tutorial. Updated pictures and better explanations. 9-26-04: I've done a complete Make-Over of the Disc Bulge Tutorial . Check-out the 'Three Faces of Disc Bulge'. 9-01-04: I've just posted a review of Karppinen's 2001 investigation into the relationship between the 'size' of a patients disc displacement, never root compression and the 'degree' of their pain and disability. Surprisingly, there was no relationship at all, i.e., the patients with large disc extrusions and sequestrations and nerve root compression suffered just as much pain and disability as those with mere disc bulges or no disc defect and no root compression! It was also quite interesting to see that 20% of the 160 sciatica-suffering patients had no MRI evidence of disc herniation at all, yet 62% of these non-herniation patients still presented with classical radicular pain - pain in a distinct dermatomal pattern below the knee. ( Karppinen 2001: Patient Symptoms versus Disc Herniation Size ) 8-22-04: I've done a lot of rewriting of some of my old, grammar-poor, pages including 'Doug's Story'. I've added my 6 month post-surgery Oswestry Disability score to my collection. As predicted by the literature, it's the same as my 3 month post-surgery score...how sad! I've added my Gadolinium enhanced MRI scans with a mini-tutorial and some side-by-side comparisons. You MRI-hounds will like this! I've also upgraded my MRI & CT Reading Tutorial to include both MRI axial anatomy and CT axial anatomy. And sadly I've had to give away my beloved 'hound-dog' Maxwell! He and his pale in crime were just too much work for me. I'll miss him but not his mischievousness. 8-12-04: I just posted the results of the Davis et al. investigation which used 'independent review personal' to collect the one year outcome results from some post IDET patients.The bottom line of the study was this: at one year status-post IDET, only 1 patient out of 44 reported the procedure to be a complete success! About 60% of these patients reported that their pain was either the same or worse. Over a two-year period, 23% were lost to fusion surgery, one developed severe discitis with bone destruction, and one patient developed instability. Not a very pretty picture! (Davis: IDETs efficacy for Chronic Discogenic Pain) I also updated my diary. 8-11-04: Check-out my newly designed 'Tee-Shirts'. I might think about selling these and donating the profits to Spine research.... If I can find the time to set this up. ( Tee-Shirts ) 8-06-04: A NEW TREATMENT FOR IDD? In 2003, Klein et al. proposed that by injecting a ‘biochemical soup’ into symptomatic discs of chronic back pain sufferers, they could “promote a reparative response” and lessen the patients pain and functional disability. Despite some design flaws with this investigation, the results were quite interesting in that there was a marked improvement (74%) within about one-half of the patients, although I believe that the benefits of this improvement can NOT be permanent. (Klein: Biochemical intradiscal injection for IDD) 8-02-04: Make-over of the 'Disability Assessment' page. 7-31-04: I've added TREATMENT OPTIONS to my 'Internal Disc Disruption' page. Please heed the warning above these recommendations! Here: 'Treatment Options for IDD' 7-28-04: I've updated my 'Internal Disc Disruption' page to include the new information on IDD and some of my new disc drawing which include the sinuvertebral nerve.: 'Internal Disc Disruption'. I've also posted some new pictures on my 'Disc Anatomy' page. 7-24-04: I've done a small 'Make-Over' of the 'MRI Reading Tutorial' page. Go Lance! I've also added another research paper on the subject of Internal Disc Disruption: Schwarzer et al. successfully calculated the prevalence rate of IDD in a group of chronic low back/leg pain patients. The 40% prevalence number is still used today and supports the theory that IDD is the number one cause of lower back pain in the chronically disabled who have normal MRI and normal neurological examinations. (Schwarzer: The prevalence rate of IDD) 7-09-04: I've reviewed one of the few studies that have attempted to prove the existence of 'disc referred' lower limb pain (or discogenic sciatica). The study showed that 94% of discogenic sciatica sufferers obtained 75% to 100% relief of their radiating lower leg pain from an intradiscal injection of anesthetic. This would tend to prove that some cases of sciatica are really a 'referred pain' from the disc and have nothing to do with irritations of the posterior nerve roots. (Milette: To Prove Discogenic Referred Sciatica) 6-30-04: Another Make-Over! I've updated my master disc anatomy drawing to include the pain pathways for discogenic pain. I've also added more anatomy and neurology information: Here: Disc Anatomy Page. 6-27-04: Another Famous visitor at ChiroGeek.com: On 6-13-04 I received an e-mail from one of America's leading researchers in the field of disc/nerve-root related sciatic pain. Yes, the Volvo Award winning investigator, Dr. Robert R. Myers, contacted me asking permission to use some of my drawings in a paper he was preparing. He also had this to say: see diary entry 6-21-04: I've add a New exercise page: 'Doug's Core Spinal Stabilizing Exercises'. I got my wife to take some pictures of me doing my full post-discectomy work-out. It's basically a simple Level one work-out which may seem very easy to you non-chronic pain sufferers but for many of us, it's quite a challenge! I've also got some exciting news: I've been asked to co-write a research paper with a prominent neurosurgeon from Taiwan China. Dr. Jinfu Lin, MD and I will be expounding on the theories of Dr. Ohnmeiss et al. by exploring the phenomenon of 'discogenic radicular pain' or as I like to call it, 'discogenic sciatica'. Although Dr. Lin keeps a very busy schedule, which includes some 8 spinal surgeries per week, he has been collecting cases (similar to my problem) that demonstrate that the disc can cause debilitating sciatica in patients WITHOUT the presence of nerve root compression and can be significantly helped with spinal fusion surgery. I'll keep you all posted. 6-14-04: I've added a page on the likelihood of having a 'false positive' reading on MRI. I've included all the pertinent research on the subject. Here: Abnormal MRI in Pain-Free People 6-12-04: FINALLY, after 10 months of studying, I've finished my 'Sciatica & Radiculopathy Page'! It's a big page and I'm debating whether or not to split it in half (you dial-up users please shoot me an e-mail and let me know if its to big to open). If you can master this page, you will understand everything there is to know about sciatica! You'll know more than you doctor! It's also got a big section of 'Dermatome Theory' that all your dermatome junkies will absolutely love! 6-04-04: I've 'made-over' the 'Disc Herniation Tutorial Page' in order to add some new knowledge that I've gained on the subject and to add the 'leaking disc' theory. 5-29-04: I've finally finished my Level two exercise page and completely reworked my Level one page as well. I made all the figures from scratch in Adobe Illustrator. Enjoy but be careful! Check with your doctor so you don't get hurt! Start here at the Home Exercise Page. 4-17-04: Major Face Lift! I've updated the 'Disc Anatomy' page. I've learned some new stuff and incorporated it into the Axial anatomy section and updated my axial drawing. I've added a Spinal Stabilization page as well. Did you know that the nerve roots of the cauda equina do NOT freely hang in the thecal sac?! They are highly organized which explain why a Central L4 disc herniation may clinically present with S1 and or L5 root dysfunction! The sinuvertebral nerve is amazing! Did you know that even though this nerve enters the spine at one level it reaches up and down to supply the disc above and below as well? This again may explain why a L4 disc tear or herniation my also clinically present with a L3 and L5 component as well! 4-11-04: I've added a basic Level 1, exercise program page to aid in 'core' strengthening & stabilization of the lumbar spine. I've been doing this for almost two weeks and am almost ready to move to Level 2. 3-30-04: Some big up-dates in 'My Diary', for those of you who are following my apparently 'failed' micro discectomy. 3-24-04: Check out the new look of the research corner! I made a new template and transferred them all over. I even made new 'buttons' for all you folks complaining that they were too hard to read. That was HARD! I've also touch up many of the research paper over there. There is truly some excellent reading over there, especially for any who is contemplating surgery. 3-19-04: The Famous 'Saal & Saal' Study revisited: Since my recent micro-d surgery has seemed not to have worked so well, I felt compelled to go back to some of the major, highly quoted, outcome studies of our time which were the basis for the design of my own treatment treatment plan. This study by the Saal brothers (who live and work within 20 minutes of me) took a group of 64 patients suffering from acute disc herniation induced radiculopathy (confirmed by MRI, EMG, and examination) and treated them with nothing but aggressive conservative care, i.e., exercise, education, epidural steroid injections, prednisone, selective nerve root blocks. He followed them for 2 years and found that about 90% of these patients recovered well enough to resume not only their normal occupation, but also to resume limited recreational sporting activities, WITHOUT surgical innervation! Although only 25% to 30% of them recovered enough to return to unlimited sports! Some of the patients in the group were even warned that they had better have surgery or risk severe disability! I'm adding this to my MUST READ list. (Here: Saal & Saal "Non-operative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy".) 3-18-04: I've created a new page that gives some of my recommendations that helped me through thoughts painful first few weeks after Micro-Discectomy. Check out the cool 'Ice support system' I used, and the 'Hound Support System'. (This site can't be all serious!) I've posted a big entry into my 'Diary' as well. (Here: Post Micro-Discectomy Equipment) 3-17-04: Make-Over: The 'Internal Disc Disruption' page has had some new information added, as well as a few new pictures (discography). Check it out. 3-14-04: A Big error was pointed out to me on the Ohnmeiss et al. page (thanks Wolf!). I had a rough draft posted instead of the finished product! (it took you all two months to catch this!) It's fixed now. This paper demonstrated that 84% of patients that complained chronic lower back pain & lower limb pains which passed the knee, were found to have painful disc disruption (either grade 2 or 3) on provocative discography. This supports the theory that the disc does NOT have to be herniated and smashing a nerve root in order to cause sciatica. [Ohnmeiss et al. IDDs relation to Sciatica] 3-9-04: The famous and often quoted review of Kuslich et al is up. This study use 193 humans as 'guinea pigs' during disc and stenosis surgery by keeping the patients awake (only local anesthesia) and "stimulating" (via compression or shock) all sorts of different spinal tissues in order to see where the patient would feel that stimulation. Amazing stimulation of the posterior disc NEVER reproduced sciatica. Only stimulation of a pre-surgically compressed nerve root (because of disc herniation or stenosis) resulted in a reproduction of the patients concordant sciatica! A direct blow to the work of Ohnmeiss et al. (Kuslich 1991: The Tissue Origin of Low Back Pain and Sciatica) 3-6-04: NEW DEGENERATIVE DISC DISEASE PAGE: I feel like I just gave birth! I've been working on a revision of my disc aging and disc degeneration page to bring it truly to the cutting edge of all research (47 papers total ($470.00 and over four months of work!). There is NOTHING on the internet as complete or as accurate as this! I needed a full page just to handle all the references! Lots of cool new pictures as well. Now, finally, I can finish the sciatica page. 3-2-04: MAKE-OVER: I've made-over three pages: the [Disc Anatomy Page] in which I've added a new and improved 'Disc Physiology' section to and added things here and there. I've also made-over and renamed the [Discectomy Failure Rate] (I wonder why!) and the [Rim Lesion Page]. 2-19-04: Just what us back pain sufferers need, another source of disc pain! Unfortunately, discogenic pain has grown another dimension. This study confirms that in severely degenerated discs, not only does pain carrying nerve fiber grow deep into the depths of the disc (even the nucleus), but this neural ingrowth is strongly associated with discogenic pain on discogram! Freemont et al. proudly boasts that this is the first study to relate this neural ingrowth with concordant pain on provocative discography. Another reason for IDET failure! (Here: Freemont 1997: Neural Ingrowth in DDD) 2-11-04: Discectomy surgery is on for tomorrow AM: my Pre-Surgery Oswestry score is 22% (how stupid I was, for a 22 Oswestry [which I've later learned] is already considered a successful surgery! 4-17-05), which is just unacceptable! At 16 month post incident, there is just not much more room for improvement the 'natural way' and its time to get aggressive. I would say that I've come along way from the 42% disability I had in November 2003 but I'm out of time and patients. If I'm ever going to get more of my life back, I'm going to have to try something more invasive. (here's my latest Oswestry Test.) I'm pretty darn scared for I know that the odds are often not the best for some of my circumstances: 1) small contained herniations, (MRI pictures & report here) 2) long pre-surgical sciatica duration, 3) weak neurological examination (negative SLR, reflexes now OK, ROM OK, and slight weakness of peroneal's.) and 4) the involvement of 'root irritation' other than the surgical target. My neurosurgeon, Dr. XXX of Los Gatos CA, feels confident that the surgery will succeed, especially since I have virtually NO lower back pain; just sciatica - especially in my left foot. He does not believe that a patient MUST have severe neurological deficit and in severe pain to qualify for discectomy. He is convinced that a good size 'fragment' is hiding beneath that 3-4mm HNP, which is super-imposed on top of a moderate bulge. There's a lot of hiding room in there! Specifically, he is going to make a small incision in the PLL and then "squeeze" around the margins of the HNP in an attempt to "pop-out" that fragments - like popping a zit is the analogy he used. He will only superficially debris the anular tear and NOT go fishing and cutting deeper inside the disc. It is his experience that this exploration will lead to an increased risk of reherniation. So, I guess my 16 months of suffering and current 22% disability is enough reason to give it a try, and as a fellow spiny & friend of mine has just so elegantly put it, "sometimes you just got to say, what the fuck" - Risky Business. WISH ME LUCK!!!!!!! SEE MY DIARY for the continuing saga. 2-10-04: Big day tomorrow! I'm scheduled for surgery on the 02-12-04 and tomorrows the final pre-surgical evaluation. I've also posted my latest MRI (closed tube) pictures (here): 1-30-04: The quiz answers are up (here) to the MRI Axial test (test you knowledge of reading MRIs here). I've also included the lateral MRI image that goes with the axial image that you all were tested on, as well as the patients case history. 1-28-04: Introducing a new page: "How to Read your CT Scan". I've gotten so many questions on 'how do I read my CT/MRI that I've decided to add a page on the subject. This will show you the normal anatomy of an axial (the most important, and hardest for the lay person to read) CT myelogram image, and show you what a fill defect looks like. It also covers the 'zone of herniation', which radiologists use to describe just where your herniation is located, and best of all, there's a quiz at the end to test your knowledge, and the full case history of a patient of mine, whose MRI shows a very nasty disc lesion! (Here - How to read your CT Scan & MRI Quiz ) 1-25-04: I've done a major 'over-haul' on my disc herniation tutorial. I've incorporated new information and changed the nomenclature to: disc bulge, disc protrusion, disc extrusion, and disc sequestration. (here - Birth of a disc herniation) I've also updated my Diary. 1-10-04: Gave 'my diary' its own page and took it 'way back to 2-03 (here - My Diary) and updated my History Page (here - Doug's History) 1-09-04: The Internal Disc Disruption or IDD page is finally done. Check it out, for I've put about four weeks into updating it with all the latest research. (here - IDD Page) Of the tons of e-mails I get, questions about IDD are by far the most frequently. And YES, that normal looking MRI of yours can be hiding IDD which is, according to Bogduk, one of the most common causes of chronic lower back pain. 1-07-04: NEW Research entry - I've just completed a very interesting review of Ohnmeiss's work on the relationship between sciatica, and the degree of disc disruption. Amazingly they found that completely disrupted disc (bulges and herniations) and non-ruptured disc (IDD) BOTH were associated with lower extremity pain (sciatica) that passed the knee. (So yes, IDD can cause the symptoms of sciatica!) I also included a cool little CT discogram tutorial. (here - Ohnmeiss 1997) 12-28-03: I have given my Disc Anatomy page a make over. I'm still waiting on two articles which I need in order to finish my sciatica page. (here) 12-17-03: Attention 'Limbo-Club': You're not going to like this study! This 2003 British paper studied the surgical revision rate (re-do rate) of 531 lumbar discectomy patients, 64% of whom were confirmed disc protrusion (aka: contained herniation patients) patients. These small protrusion are known not to do very well with surgery, although Carragee did discover that IF the small protrusion contained a nuclear 'fragment', then the surgery seemed to do very well. This study found that disc protrusion patients had a 2 to 3 time higher surgical revision rate, as compared to the bigger disc extrusions, and sequestrations in this study. They also had a very interesting theory as to why they believe protrusions re-herniated more often than extrusions (Here - Morgan-Hough: 2003) 12-02-03: THIS STUDY IS AN ABSOLUTE 'MUST READ' FOR ANYONE CONSIDERING DISCECTOMY! What a master piece by Stanford's Eugene Carragee. In this 2003 outcome study, he used surgical exploration and visualization to create four classes of disc herniation based on: 1) the size and appearance of the herniation, and 2) the size and magnitude of the anular tear which spawned the herniation. He was able to predict patient outcome based on the type of herniation and anular defect discovered on surgery. The exciting thing for me about this study was the fact that a group of 'contained' disc herniation patients, had one of the best outcomes! I had always been under the impression that small contained herniations ALWAYS did poorly with discectomy. NOT SO! I will bet you all that Carragee will win another Volvo Award for this study this year!!! (Here - Carragee 2003:) I've also just posted my 'second MRI' (nice axial) and my second EMG results. Both of these tests were done on 11-25-03. (Here- MRI & EMG: 11-25-03) The EMG improved but the S1 radiculopathy still lingers as does this F*ucking pain! 11-28-03: I've cleaned up the 'How disabled are you' page, and added a new outcome assessment tool: The Stanford Score. I've also retaken the Oswestry to reflex my recent downward spiral. 'Oswestry 11-28-03' 11-27-03: This is an excellent paper / tutorial by Professor Franco Postacchini of Italy. This famous researcher and author goes through the pros and cons of surgery versus conservative care. A MUST read for anyone who has moderate to severe sciatica. (Here - Postacchini 1996) 11-26-03: What a disappointment! I paid $35 dollars for this study and was so disappointed. It was one of the few studies that MRI'ed and EMG'ed 245 patients and then classified the herniation types, and followed their outcome with conservative care. It was filled with 'stupidities' but did give us some interesting data. Contained disc herniation don't do well with conservative care. (were going to learn from Stanford's Carragee, that contained disc herniation's don't do well with conservative care either!) (Here - Komori 2002) 11-23-03: Here we have a very, very, long term study on the effectiveness of 'traditional wide laminectomy' at 12 years. Amazingly the study reported a zero percent reoperation rate, and a 95% "patient satisfaction rate". The trade off? Instability. Only a small percentage of the original 150 patients were re x-rayed, however there was a 60% rate of instability seen at 12 years. There was a 0% instability rate before surgery. (Here - Padua 1999) 11-22-03: Here is another very important paper on 'how long should one wait before having a surgery'. There is not a whole lot of research in this area but here Rothoeri et al. 2002 did follow 219 patient who had a surgery for lumbar disc herniation induced sciatica. He looked at the 'pre-surgery suffering time' and found that after 2 month, your chances for having a successful surgery seem to decrease. I've also got five other researcher opinion on 'when to have surgery' in there as well. (Here - Rothoerl 2002) 11-21-03: Here is my favorite outcome study of all time! Its a 'must read'! It is better written then the famous Weber study but was not randomized. Nykvist & Hurme followed 276 patients for five years. Some had surgery and other chose conservative care. The follow-up examinations were 6 to 8 hours long. They were thoroughly examined and questioned. My conclusion: "If you're hospitalized for sciatica - you're f*cked; especially if you don't get or qualify for surgery. Surgery was much more satisfying and satisfactory for the patients. (Here - Nykvist 1989) I've added another study by Weber et al. that was done in 1993. It was one of the few 'Double Blind' studies done on the effectiveness of NSAIDS versus Placebo, for relieving lower back pain and sciatica, and lowering disability. (Here - Weber 1993 NSAID study) I've also added a 'Research Page' that will contain nothing but research papers that I have reviewed and posted. 11-18-03: I just added Weber's 'famous', 'Volvo Award Winning', Randomized, Out-Come Study of 1982. Today, this study still sands as the Gold Standard for outcome studies. Again, it follows a rather large group of randomly selected surgical and non-surgical disc herniation sufferers. You're going to be surprised by the out-come. (Here - Weber Study 1982) 11-15-03: I just added the 'meat and potato's' of the famous 'Maine Study of 2001', which is one of our best '5 year follow-up studies' on the comparison between surgery and conservative (non-surgery) care for 'disc herniation induced sciatica'. The result were very very similar to the Volvo Award winning study of Weber in 1982. (Here - Maine Study) 11-07-03: I got side tracked! I must have gotten 20 e-mails this week asking me what a 'disc bulge' was. So, I've made a very, informative page called "Birth of a Disc Bulge", that should answer all your questions and then some. I've also got some nice, new MRI pictures of a pure eccentric disc herniation, and a not some pure bulge/herniation combination. Very cool!! I've also added a page where you low back patients can see how your disability rates: "How Disabled are You". You can take the Oswestry and Roland-Morris there. Also feel free to hop on over to my favorite forum MGH Spinal Disorders 3 and take my latest quizzes on MRI. As many of you know, I also field questions over there so if you have a question just post it over there and I'll respond or you can e-mail me, although I like to answer question there because it often helps others as well. An NO, nobody pays me to answer questions over there! I do all this to help others who are going through the same thing I'm going through. 10-29-03: Neurosurgical Evaluation today - see 'my diary'. 10-25-03: I've added my One Year disability assessment page (Here) including my current Roland Morris and Oswestry disability questionnaire scores. Why do we still suffer sciatica, even after surgery or after the passage of time (2 years). I'm going to begin work on some of the theories of 'chronic pain'. This will include a detailed anatomy discussion of nerve root structure, which are amazingly complex and delicate. © Copyright 2002 – 2005 by Dr. Douglas M. 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