Expert: Dr. J. Shawn Leatherman - 3/11/2008

Question
Dear Mr. j. Shawn,

I am suffering from Slipped Disc since last one year. I have done CT Scan and MRI testing and it is showing as under:

D3-4 disc shows loss of normal disc suggestive of degeneration. Posterocentral disc herniation is seen at D3-4 with mild subligamentus superior migration compressing the underlying cord.

Mild annular bulge is seen at L4-5 & L5-S1 without causing any nerve root compression/impingement.

I am suffering from back pain and leg pain. Also at the time of having sex it causes pain at my back and leg.

Now my question is:

How to treat this?
Is this issue very serious?
Which doctors should i consult? Neurologist, Physiotherapist, Orthopedic etc.?
Is surgery is dangerous or advisable?

Please help in getting this answers as i am soo much worried about this issue.

Regards,

Aniket Hirpara

Answer
Dear Aniket,

The first problem that you need to worry about is the fact that the disk bulge at L3-L4 is pressing on the cord.  This is not good because it can affect the motor function to the legs on both sides and you can be left with a permanent weakness if damage occurs in those pathways.  If you do not have leg weakness at this time, then it is less serious, however, it can progress if left untreated.  The mild bulges lower in the spine are less of a worry at this point even though they can still be the source of pain.

I would recommend that you try conservative approaches such as decompression therapy or tractioning of the lumbar spine first to attempt alleviation of the stress on the cord by the bulge.  There are many traction/decompression machine out on the market such as DRX 9000, Accuspina, Chatanooga DTS, Lordex, Spinal Aid, Spine Med, etc... but you should look at the Vax-D website first and then at the other machines.  The reason I say this is because the Vax-D is the original manufacturer of this technology, they have a good reputation and have been in the market for over 20 years.  Chiropractors, orthopedists, neurosurgeon, and pain management doctors have all been associated with the Vax-D.  This therapy should be coupled with physical rehab protocols as well.

Now, if the decompression is not helping reduce pain and improve function, then you will likely be a surgical candidate.  A neurosurgeon or an orthopedic surgeon with a spine fellowship is who you want to consult with.  They will be able to give you an appropriate answer to whether or not surgical intervention is advisable, or they may refer you to pain management for a less invasive procedure.  If surgery is necessary for the disk, procedures such as diskectomy, and nucleoplasty (also performed by pain management docs) have good track records for immediate improvement in pain and function.  All surgical procedures carry risks, however, they have become less in the past 10 years or so as techniques have been refined, and patients generally do well.  

Bottom line is that you want to be proactive now before the issue gets any worse.  I would give decompression a look and decide if it is right for you, but realize that surgery may be the best option.  Make sure whatever doctor you consults explains the pro's and con's of all options as well as the risks and projected outcomes so that you can make an informed decision.  Good Luck Aniket.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net