Question
Hi Dr Shawn, I have read your answer to 'Kunche' as I seem to have a similar problem to his.  However, I am a 32 year old female, currently living in India and wanted to get some 'outside' advice about the dilemma I am currently facing.  For the past 2 years I have suffered from severe lumbar back pain.  I have tried pretty much every non-surgical treatment possible, including two spinal injections which did not relieve any pain.  MRI shows L4-5 disc bulge with postero-central disc protrusion, indents at the thecal sac, compressing left exiting nerve root and in contact with right exiting nerve root.  A left central annular tear is also seen at this level. A small Schmorl's node along inferior end plate is noted at L5.  Early degenrative spondylotic changes in the lumbar spine with marignal end plate osteophytes. Facet joint arthopathy is noted at L5-S1 level. Based on your experience, what would be your professional on how to treat this? The neuro-surgeon I have been in contact with has suggested cutting out the disc.  How risky is this procedure?  Many thanks.

Answer
Dear Tracey,

Your disk pathology sounds fairly extensive at this point.  When the thecal sac is being indented you are only a small distance away from actually compressing the spinal cord itself.  Not to mention that the bulge is affecting both of the exiting nerve roots...this means that it is a large broad based bulge rather than a smaller focal bulge.  Your prognosis with conservative care is not great, and you should consider surgical options at this point.

That being said, if you can find a local doctor who has spinal decompression technology, it is worth a try.  Spinal decompression is really a longitudinal or axial traction of the spine.  This will serve to take pressure off the disk and nerve roots and reduce your symptoms.  I have seen this technology actually result in reduced disk bulging on follow-up MRI's as well as patients becoming pain free.  However, it will not work for everyone, and I have also seen it be unsuccessful where surgery was needed.  Do your research... some units to research:  Accuspina, DRX 9000, Chatanooga DTS, Lordex, Vax-D, Spine Med, Spinal Aid, Spine Force...there are more.  They all basically do the same thing regardless of their individual claims of superiority.  If you find this option and pursue it, you must also go through functional physical rehabilitation protocols for spinal stability towards the end of the program.

Concerning the surgery..not sure what has been proposed?  Either  discectomy or an artificial disk replacement.  The first is actually pretty simple, they just go in and cut out the protrusion so that it cannot press on any of the other anatomical structures. If you have any close spurring, they will cut those off as well, and this is often termed a foraminotomy. Radiating pain will be immediately relieved, however, low back pain will remain for awhile until the tissue heals.  All surgeries have inherent risks, but this is a fairly common procedure with pretty good results.

The artificial replacement is much more intensive and often involves actually cutting away some of the bone to allow for the new disc placement. These replacements have been available and have been performed in Europe for years, but only recently became available in the United States. My knowledge of this surgery is limited so I would suggest that you ask about it from a neurosurgeon or a orthopedic surgeon with a spine fellowship.

Hope this helps Tracey.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoastehalthcare.net