A newly published case study in the Journal of Contemporary Chiropractic adds to a growing body of evidence supporting non-surgical spinal decompression (NSD) as a viable conservative option for patients with cervical disc extrusion even in cases where surgery has been recommended. While we know that surgery cannot always be avoided, it is encouraging to see a paper like this collect evidence regarding NSD as well as other conservative measures that places chiropractic well and truly in the picture when it comes to giving patients more options than going under the knife.
The paper, authored by Drs. JD Dudum, Bryan Gatterman, and Sarah Buonopane documents the management of a 50-year-old male presenting with one of the more challenging combinations of cervical spine pathology: a confirmed disc extrusion with upward migration of disc material, alongside segmental instability at the C5/C6 level. The patient had already been advised to undergo anterior spinal fusion. He declined and sought conservative chiropractic care instead.
His case is unlikely to be an isolated one, as many patients look at the list of potential side effects and recovery time and seek other options. This paper, while it is a single case report and thus we can’t generalise to the whole population, but rather, it’s a conversation we need to have in order to bring awareness to the fact that surgery need not be the only option considered.
To understand the significance of this case, it helps to know what a disc extrusion actually is. Each intervertebral disc in the spine consists of a tough outer ring (the annulus fibrosus) and a gel-like inner core (the nucleus pulposus). In a disc extrusion, the inner material breaks completely through the outer ring and spills beyond the disc space itself essentially creating a more severe form of herniation than a simple bulge or protrusion.
In this patient’s case, the extruded material had also migrated upward and an MRI confirmed it was compressing the spinal cord at C5/C6 (in his neck). On functional X-rays, the vertebra at C5 was sliding backward relative to C6 by 5.3 mm during extension, a finding indicating segmental instability. This “pincer effect” during neck movement had the potential to repeatedly narrow the spinal canal and further damage the cord.
His symptoms matched the imaging: persistent neck pain radiating to the left shoulder blade, numbness in the left hand’s second finger, and slight tremors in the fifth digit. Pain levels ranged from 4 to 8 out of 10 throughout the day, waking him multiple times each night, and interfering with walking, sitting, and daily activities.
Enter chiropractic care
Rather than proceeding to surgery, the patient underwent a multimodal conservative treatment plan over three months, comprising more than 30 visits to a chiropractor. NSD, delivered via a computerised decompression table that applies precise, controlled traction forces to the spine was the centrepiece of the protocol. This was combined with other conservative management techniques like low-level light therapy, electrical muscle stimulation, strength training with a power plate, cold pack therapy and chiropractic adjustments.
This was all deployed on order to present a holistic approach that combined subluxation-based care (chiropractic adjustments) with aspects of care that would help stabilise and restore his condition.
The numbers don’t lie.
In this particular case, and as is responsible for a complicated and severe case like this, the authors tracked outcomes rigorously across multiple imaging studies. To standardise comparison of disc herniation size across time, they used a metric called the herniation index ‚ a calculation comparing the dimensions of the disc herniation to the size of the spinal canal on axial MRI.
At initial presentation, the herniation index was 382, which is significant.
Four months into treatment, a follow-up MRI showed the index had dropped to 283‚ which represented a 26% reduction. Cord compression had eased, and the narrowest point of the spinal canal at C5/C6 had actually widened even without surgery.
Thirteen months after the start of care, a third MRI showed the herniation index had fallen further to 189.8‚ representing a 52% total reduction in disc extrusion size. The vertical measurement of the extruded disc material had shrunk from 12 mm to 7 mm. Crucially, there was no longer any evidence of spinal cord compression.
Flexion and extension X-rays taken at three timepoints showed the segmental instability persisted (the vertebra continued to slide during extension), but it did not worsen over the course of treatment ‚ an important safety finding given the severity of the initial pathology.
But beyond the numbers, the issue that matters most to a patient is the impact on their pain and ability to function. In this case, his experience tracked closely with the imaging improvements. Following the initial three-month treatment period, he reported a 60% improvement in neck pain, shoulder blade pain, hand numbness, and finger tremors, with considerably reduced frequency and intensity of symptoms. These improvements held at one-year follow-up, suggesting the results held up over time. Crucially, there were no adverse effects reported at any stage of his engagement with the chiropractor.
Again, this is a single case report. Larger, controlled trials are needed before NSD can be definitively recommended as a standard of care for this population. That said, the case raises important clinical questions in a condition where the stakes are high. Cervical spondylomyelopathy ‚ degeneration of the cervical spine resulting in spinal cord compromise‚ affects more than 85% of people over 60 in the United States and is the most common cause of spinal cord dysfunction in adults.
While surgical decompression is broadly accepted for moderate to severe presentations, the management of milder or complex cases remains genuinely contested in the literature. Some studies have found no statistically significant difference in long-term outcomes between surgical and conservative management. Surgery itself carries a complication rate of approximately 15.6% within the first 30 days, including risks such as nerve palsy, swallowing difficulties, vascular injury, and hardware failure.
Knowing this, a conservative approach that achieves measurable, MRI-confirmed reduction in disc pathology without adverse effects is clinically meaningful, even in a single patient.
The authors also used multiple forms of imaging, giving this case more weight. The flexion and extension X-rays revealed the dynamic instability (the vertebral slippage that occurs only on extension), while MRI provided the soft tissue detail necessary to assess cord compression and disc condition.
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The Takeaway
For chiropractors already incorporating NSD into their chiropractic care model, this case provides further clinical rationale. For those who haven’t yet explored the modality for cervical presentations, it offers an evidence point worth examining. It is a reminder that conservative, non-invasive options can, in select cases, produce measurable structural improvement alongside meaningful symptom relief.
As always, clinical decision-making must be individualised, and patients with signs of significant myelopathy or progressive neurological deficit require prompt and careful evaluation to determine whether the conservative pathway is appropriate for their specific presentation.
Still, it’s a compelling case with some impressive numbers. Chiropractic care as a conservative, non-surgical option in cases like this is an important part of the conversation.
Reference:
Dudum JD, Gatterman B, Buonopane S. Reduction of Cervical Intervertebral Disc Extrusion in Patients with Segmental Instability: Non-Surgical Spinal Decompression and Other Conservative Treatment. Journal of Contemporary Chiropractic. 2026;9(1):240–247.
