Carl Nottoli, DC
That’s a massive sequestration! If I had to guess without seeing the patient myself, I would say he will need surgery first. It’s great he doesn’t have any neurological deficits…yet.
Some factors to consider is the pain level he has to endure on a daily basis, how much it effects work and family, and how willing he is to let conservative care work.
I had a patient like this years ago. I did about 4 treatments and he had some positive change, but had to go back to work. As soon as he did it flared up worse. I sent him for surgery. I followed up with him the week after and he said he was feeling much better and I haven’t heard from him since.
In hindsight I would’ve sent him for surgery sooner and really hammered home the importance of his follow up with me because the adhesion is what is causing the herniation due to poor function.