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Date of last update: 10/01/2017.

Forum Name: Spinal problems and back pain

Question: Back Pain for over 20 Years- What to do next!

 rwhite64 - Thu May 26, 2005 11:49 am

I have been suffering from lower pack pain for over 20 years, I am now 41. I have been to orthopedic doctors who have injected me with cortizone shots, and I have been to Chiropractors for traction and therapy and nothing has worked. The latest MRI results ara as follow:
At L5-S1, there is desiccation and bulging of the intervertebral disc. This is asymmetric to the right. It abuts the ventral surface of the thecal sac and bulges into the inferior aspect of the right neural foramen. I do not see definite evidence of nerve root impingement. I do not see a discrete disc herniation at any level.

The chiropractor that I am seeing now for the last 16 weeks (twice a week), insists that I stay with traction and therapy. Should I seek another opinion from a surgeon, or orthopedic doctor. Another round of cortizone shots or eipdural is out of the question. It is a quick fix and actually gives you a false sense of security.

Please advise

Randall R
 Dr. Safaa Mahmoud - Tue Aug 08, 2006 8:36 pm

User avatar Dear rwhite64,

Degeneration of the disc tissue makes the disc more susceptible to herniation (rapture).

Each disc is formed of a central gel-like inside (nucleus pulposus), surrounded by an outer ring (annulus fibrosus).

When this softer component ruptures (herniates) through the outer ring it press directly on nerve roots and irritate adjacent nervous tissue.

These conditions can be treated in the majority of cases with medical and conservative treatment (non surgical).

Non surgical treatment include, physical therapy, certain exercises, weight reduction, epidural steroid injections, non-steroidal Anti-inflammatory medications, and decreased daily activities. The pain usually improves faster than the numbness and the weakness if present.

Surgery for disc herniation is only considered if symptoms are not controlled after at least one month (6 weeks) of medical and conservative treatment, or in very complicated cases with serious symptoms. Your MRI did not prove any nerve compression which is a good sign. MRI results are very important in the diagnosis of vertebral changes, but the clinical picture, I mean your complaints and the physical examination are more important in determine the management.

Associated, Muscle spasm alone can cause this pain.
In cases of pain due to muscle spasm, self care and avoiding the precipitating cause (proper posture) will lead to a gradual but clear improvement in the pain. Home treatment includes the use of Analgesics, cold or hot therapy.

A spinal physician is the one able to determine if surgery is the best treatment for the patient.

Hope you find this information useful.
Best regards,

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