Question
QUESTION: Hi,

I am 41, 5'3, 170. pain in left buttocks, down outside left leg and foot. Some numbness in foot, Achilles tendon does not respond to reflex test. Started 4 months ago, just had MRI, all other areas of spine very good. Pain is huge and not abating over time. I am on narcotics and Lyrica, a nerve specific pain killer, works for a few hours at a time and only partially. I can't walk long, upper body bends over,left leg/foot turns outward quite alot.Hard to stand up straight due to pain in sciatica but under drugs 'in the sweet spot' of about 20 minutes every 3 hours when I feel little, I can stand upright.

Neurosurgeon only offered microdisection surgery... drill hole through my vertebra, entering through my backside, take all of my disk out except small bit in middle he can't get at. Says this bit will flatten out into thin cover between vertebra and afterwards I may have the next vertebra up, slide backwards out of position, causing disk/back issues, soon also, bone on bone as the thin bit of disk wears away.

He offered no other options, said that 'traction' by a physiotherapist won't help, when I asked.

Is there anything I can do to spread my vertebra and let the disk go back in? Is there other surgery options, like disk replacement, if only to keep the rest of my spinal structure in place? fusion? I just don't know what to ask. What can you suggest?

ANSWER: Hi there,

Have you tried any conservative therapy? Usually before getting surgery you should try atleast 6 months of conservative therapy. A combination of Mckenzie exercises, Mobilizations, Laser therapy, Manual work, Muscle release therapy and Core stabilization exercises can help reduce the disc bulge. By reducing the size of the disc bulge, pressure will be taken off of your nerves and your leg symptoms can be alleviated.

There are several forms of surgery that can be used for disc bulges but I strongly advise that you try a course of conservative therapy. You have had the symptoms for 4 months so this would be a good time to start on conservative therapy.

I have had great success in treating patients with disc bulges and alleviating their pain by atleast 90%. I would recommend that you find a Chiropractic doctor in your area that specializes in Disc bulges and herniations. They will use an array of therapies depending on the results of your physical examination.  You should not be receiving spinal adjustments when you start therapy for the first weeks so if you see someone who wants to start adjusting you right away and does not have physical therapy modalities and exercise facilities they probably don't effectively treat disc bulges.

Please feel free to add to you question if you have any questions about conservative measures that have been successful in treating disc bulges or for more information on the types of surgeries.

I hope this helps.

Dr. Liza

www.theclinic-toronto.com

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply and assistance.

I am worried about neuropathy setting in. this starts after 6 months i have been told a few times now.

The part about the bulge I wrote isn't in my question to you...must have lost it in the spell check but my bulge is 8 mil into the spinal cannal pushing onto the spinal cord badly. Its at L5 - S1. I was not told if it is a 'contained' bulge or 'non' contained, where thesurface of the disk is comparamised but I gather it must be if he insits on surgery.

Would chiropractic care help a non contained bulge go back and can it heal so it own't do it again.... before neuropathy sets in? As I understand it, if neuropathy occurs, even if the bulge is treated, the nerve will always hurt as it does now because it will be pernamently damaged. Do I have this right or maybe I have time still to try your suggestion and put off surgery?

Thanks again and this is all the questions I will have. After this next reply from you, I will make my decision taking in all the facts you have offered in to account.

Answer
Hi Karen,

By taking pressure off of the disc with conservative therapy, the disc bulge or disc herniation can heal on its own. If conservative therapy is successful, the key is to incorporate core stabilization exercises into your daily life so that the disc bulge or herniation is not re-aggravated.

Radiculopathy (the pain that occurs from the injured nerve) can be resolved with conservative therapy if the source of the problem (disc bulge) is treated. Nerves are able to heal themselves if they have not been severed (cut) and many patients have success with the treatment of radiculopathies with conservative treatment. When a nerve has been injured, it does not mean that it is permanently damaged. It is almost like when you get a burn and it is very painful but if the fire is removed and the skin is left to heal, eventually your body will grow new skin. You may be left with a scar but it will no longer be painful because your body has healed the skin. So if your disc bulge is treated effectively you will not be left with permanent nerve pain.

If conservative treatment fails then you must consider surgery. Also, surgery may offer a faster resolution of your symptoms but there are also increased risks as there are with any surgery.