Question
Hi Lawrence,

I had a laminectomy of the L4-5 a few years ago. Everything worked out great and I even resumed my daily jogging routine. A few weeks ago, I began experiencing the same exact sciatica down my right side as before the surgery. I had a new MRI with dye and the HNP at L4-5 has recurred. I'm weighing the alternatives. It was recommended I go through the usual physical therapy and series of epidural injections. My question is this:

Since it is a recurrance of the L4-5 herniation, isn't it a waste of time to go through the whole injection/therapy/conservative treatment routine again? Wouldn't it be more practical to just have surgery to repair it?


Answer
Dan,

In a word, no -- at least, not usually.

Surgery is not an appropriate treatment for sciatica or disc herniation, for that matter, because it doesn't treat the causal condition -- overcontracted muscles of the low back.

You know this because the condition recurred.  People, including surgeons, often act upon local conditions without dealing with their causes.  When what you have is a "hammer", everything looks like a "nail."

Surgery is a waste of time and money this this condition.  (Disc rupture is a different matter and requires surgery.)   You need to improve your muscular control of those muscles to the degree of being able to relax them.  Then, the overcompression comes off the discs and nerve roots.  Typically the pain fades out  within minutes of relaxation (although in some cases of herniation, the tissue is inflamed and takes a couple of weeks to quiet down).

Physical therapy, at least traditional PT, won't do it, either, because it lacks the means of teaching you the needed degree of muscular control.  You need something more sophisticated than strengthening and stretching.

Please see the brief articles at somatics.com/page4.htm on back pain and stretching for a more complete explanation.

with regard,
Lawrence Gold