Question
i have a question regarding my back injury, i have my mri result the result is, disc protrusion ventral  and left paracentral at L4-5 indenting the left nerve root accompanied by disc desiccation change and central and neural foraminal stenosis.
no compression deformities nor spondylolisthesis.
is this kind of injury needed a surgery? and if i dont have a surgery what is the risk? thanks for your advice.

Answer
Dear Vans,

I am sorry to hear about your spinal condition.  Every case is different, but I can tell you that most disc problems do not require surgery.  The determination to have surgery is dependent upon not only your MRI results, but your symptoms and the findings of a complete orthopedic and neurological examination.  You asked me what the risks were if you did not have surgery.  I can only think of one.  If you are having severe nerve compression resulting in a loss of muscular function, you might develop a permanent loss of muscle function.  Only you and your neurosurgeon can determine if this is a potential in your case.

The real question that you should be asking yourself and your surgeon is: What are the risks if you DO have spinal surgery!

Here are just a few of them.  It is actually a short list. A quick search on the internet regarding spinal surgical risks brought up this article:  http://health.nytimes.com/health/guides/surgery/spinal-surgery-lumbar/overview.h

1)There is the risk of the general anesthetic, which can be, in some cases, be deadly.
2)There is the risk of the introduction of a serious infectious organism deep in the spine, resulting in bone, joint, or neural canal infection. This can also be deadly.
3)There is the risk of a serious response to medications used. This can be deadly.
4)There is the risk of paralysis.
5)There is the risk of failed surgery, leaving you with the same or worse symptoms.
6)There is the risk of the formation of significant scar tissue, resulting in the need of additional surgery, which causes additional scar tissue...
7)There is the risk of developing adjacent joint syndrome.
8)There is the risk of serious blood loss, resulting in transfusions of blood and all the risks associated with transfusions.
9)There is the risk of brain injury due to low blood oxygen levels during the procedure.
10)There is the risk of sexual dysfunction after spinal surgery.
11)There is the risk of lung diseases after surgery.
12)There is the risk of deep vein thrombosis. This can be deadly.

If you decide to have surgery, your surgeon and the hospital will make you sign a disclosure statement indicating that you understand the risks and that you accept them, and that you, of your free will and choice, desire to have the surgical procedure done.

Finally, you need to remember that if you have surgery, there is nothing that is actually "fixed".  Surgeons will simply cut away tissue that is pressing upon nerves, whether it be bone, cartilage, disc, ligament, or a combination of all the above.  He/She will then very likely want to fuse two or more vertebrae together, if he feels that they are unstable.  This type of insult to your body, as I stated above, will result in the formation of scar tissue, often resulting in additional joint dysfunctional problems and even additional nerve compression.

What you really need to consider is whether or not you have EXHAUSTED all non-surgical options for dealing with your spinal problem.  You should always start with non-invasive, less risky, non-surgical treatment options first, and ONLY have spinal surgery when EVERYTHING ELSE has failed to help you with your pain.

I often have patients say: "yes, chiropractic/physical therapy/ acupuncture/ traction etc all help, but nothing cures it."  The truth is, yes, nothing cures it...  NOT EVEN surgery.  Once you have a significant injury to the spine, you will have to learn methods and techniques that help you to deal with the problem, even AFTER surgery.  A steady habit of chiropractic and home exercises, over a lifetime, is often what is needed to keep the injured back functioning at its best.

I know that this is a long answer. I know that you are in pain.  Please take a long hard look at the pros AND CONS of surgery, because once you have spinal surgery, you can never go back.  On the other hand, the non-invasive methods of chiropractic, massage, acupuncture, physical therapy, etc  do not result in permanent injury or damage. If they fail, you can still always have spinal surgery.

Good luck with your back. I hope that you are able to find the relief that you are looking for.

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