Expert: Dr. Victor Dolan, DC, DACBSP - 4/15/2008

Question
MRI on my spine and w/o contrast:
Here are the results:
L5-S1- there is mild loss of disc height and signal. a lobulated bulge extending to the right. these changes plus facet:hypertrophy mainly causing mild flattening of the right lateral recess of the right neural foramen.

L4-5: There is moderate facet ligamentum hypertrophy. There is mild circumferential bulge, however the combination of the above is causing nearly moderate lateral recess narrowing, left greater than right with at least mild to mod impingement on the central canal left neural foramen. the right neural foramen is only minimally flattened.

L3-4:there is mild loss of disc height and signal. there is minimal bulge facet hypertrophy. No significant mass is noted:

L2-3 Normal

L1-2 Normal

I do have some numbness or tingling in my left leg and sometimes my foot. Is this something that can be remedy with going to a chiropractor or massage therp or both or is surgery my only answer.

Answer
Hello, sorry to hear of your damaged discs.

First, Let me confess my 'conflict of interest' or my 'bias'.  As a Doctor of Chiropractic, like most chiropractors I do not quickly refer for surgery (just as many surgeons do not quickly refer for chiropractic).  There are some cases that immediately REQUIRE surgical intervention, but often surgery is not immediately necessary. We are all blinded by our own education and experiences.

Everyday I see surgical failures in my office.  But, I am sure that everyday the surgeon has chiropractic failures in his office as well.

Some things specialists all agree upon with spinal problems, particularly disc problems:  if you lose bowel or bladder or leg control, you need surgery.  Pain alone is not a good indicator for surgery.  If you cannot control your bowel or bladder (difficulty starting or stopping) you need surgery, and the sooner the better.  A nerve that is 'pinched' so badly that you cannot control bowel or bladder habits can soon become permanently damaged, so with bowel or bladder compromise, the surgeon is the only stop.  Leg muscle control is another 'red flag',  perhaps you heard the term 'foot drop'.  Foot drop is where you cannot control your leg and in particular your foot muscles- where your foot is 'floppy' and you may literally trip over your own foot.  This is also an indication for surgery.

Pain, pain ALONE, without dysfunction; obviously hurts, but may not be a good indicator for surgery.  Chiropractic, physical therapy, acupuncture, pain management through injections may all handle the pain, allow the discs to 'calm down', and as inflammation lessens, pain can lessen.  Often surgeons do not operate quickly.  Often surgeons will recommend a 'conservative' course of care- such as PT or pain management (they will rarely recommend a Chiropractor).

If the patient fails conservative therapy- ie chiropractic, PT or pain managment does not work, or the condition worsens, after trying such conservative approaches, then the surgeon will perform a procedure.

Years ago ALL surgery was traumatic, involving opening up the body and producing trauma even though doing the appropriate thing for that body.  Nowadays with wonderful technological improvements, surgery is often performed with 'minimally invasive' procedures- perhaps you have heard of arthroscopic knee surgery, well--- such types of surgery are available in certain cases to the spine as well.

Surgical options should be discussed with a surgeon.  Acupuncture with a licensed acupuncturist.  Pain management with a PM medical doctor.  There are many options available to you, AFTER listening to all the options, then you can pick the best option for you.

Of course, I am biased towards the Chiropractic option.  Many MD's do not readily refer to DCs.  In order to get a chiropractic evaluation, you are going to have to visit a chiropractor in your area.  Sciatica, Herniated discs, back problems are epidemic in our society; ask around and I am sure you could find a few people (like you ) who may even agree on which Chiropractors, Surgeons, MDs to either see and/or avoid!

I would also try a course of conservative treatment.  Chiropractic for several weeks could be helpful.  Look for a DC in your area that offers some, if not all of these techniques:  Spinal Decompresion Traction, Cox Technique, Manipulation Under Anesthesia.  It does not sound as if the need for surgery is urgent, so you can save surgery for last resort and try other approaches first.

Your chiropractor should be able to help with structural techniques and some nutritional advice to help you heal.

Good Luck, call in the foot soldiers of conservative care, before droping the big surgical bomb.

This is not specific advice, not prescriptive. Only actual physical examination performed by a health care provider would suffice as specific advice.

Wishing you Good Health, Naturally!

Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info