Question
There was a car accident and the lady was rear ended. she had physical therapy for 6 months then chiropractic care for 6 months then started pain management. Referral for neurosurgery to do epidural injections started at about 10 months.  

Diagnosis :Acute neck and upper back sprain/strain Left shoulder strain
C5 - C6 left lateral disc protrusion with moderate narrowing of the neural foramen

Are there guidelines for how long someone has physical therapy and/or chiropractic therapy before being referred to a surgeon for surgery

Answer
Dear Jane,

Every case is different. There are so many factors that determine when it is time for spinal surgery.

For me, one of the critical things that I consider is whether or not the patient is beginning to exhibit neurological deficits, such a loss of strength in the arm and hands. I also will talk with the patient and give them ideas of alternative treatments, such as epidural injections and surgery.

At this point, having sustained the injury more than one year ago, it is probably a good idea for this patient to consult with a surgeon to see what can and can't be obtained with spinal surgery. Remember, surgery of the spine does not "fix" the damaged disc. The disc will continue to be damaged after the surgery, and will continue to go through degenerative changes. If the spine is fused, the adjacent joint degenerative changes will be accelerated as well. The goals of surgery are to stabilize a damaged joint and to decompress irritated nerve tissue through disc tissue removal and bone material resection.

If, on the other hand, the patient can treat and control the pain through conservative care, such as physiotherpy, chiropractic, and medication or injections, the patient will typically slowly stabilize over time. That is the hope of conservative care.  The disc at C5-C6 has been damaged, and whether or not surgery is performed, the disc and joint will deteriorate.

I hope that this gives you some ideas. I know that the decision to undergo surgery or not can be a very difficult one.  

Keith Biggs, DC
http://www.eastmesachiropractor.com