Question
I have persistent Lower Back Pain that has been getting worse for the last 8 years.  It started with what I was told was sciatica after I had my first child.  It is now to the point that it never subsides.  I have pain/tingling or numbness in my left leg, always to the knee and sometimes down to my feet.  When I stand up, I can feel my lower back grind and it often causes a stabbing pain.  The same occurs when I do any kind of activity that requires me to bend or twist and I cannot straighten my back when holding any kind of weight.  I have my oldest son or husband help me get my 7-month old following a time where I got stuck trying to pick him up off the floor.

I went to the doctor and had an MRI about 6 months ago (before the grinding started).  Here are the results:

There are no compression deformities of the lumbar spine.  There is facet hypertrophy throughout the lumbar spine.  There is marked degenerative disc disease at L5-S1 with disc space narrowing and endplate sclerosis.  There is a mild disc bulge.  There are no findings to suggest spinal stenosis or disc herniation.

The doctor has treated me with Celebrex and Acetaminophen with Codeine when it is at it's worst, but I am concerned about taking the meds long-term from what I have read about them.  I have looked into laser surgery, but the places I have found online seem a bit shady when reading reviews.  I have also been seeing Chiropractors throughout this time and it used to work well for me, but it has become less effective lately.  I am not sure what else I can do.  Is there any course of treatment that you can suggest and what are your thoughts on laser surgery?  Have you had any patients that have had success with this?  I am willing at this point to do just about anything.

Answer
Erica,

Please read some of my other Q/A's on back pain (some fairly recent) where I discuss the Prone Instability Test (PIT).  Your MRI shows that the disc has become incompetant and the bone connection to the disc, the end plate, is taking a pounding (thus looking sclerotic);   Hopefully your chiropractors have checked the PIT on you and if positive then engaged you in a rigorous stability exercise program.  If you don't have instability but are weak, then you need a general strengthening program.  Also, if you have not tried distractive/decompressive manipulation (see my web site) then try a few treatment sessions of this procedure.  If you've got these bases covered, and simply have sciatica that is not responding to meds and manual therapy, then epidural steriod injection is the next step before considering surgery.  You would have to consult with an "interventional pain management specialist."  They often are MD Physiatrists or anesthesiologists.   I, too, haven't heard much about laser surgery for your condition, and none of the surgeons I deal with use a laser.  

'Hope this was helpful,

Dr. G