Is surgery advisable over steroid injection for severe back pain?

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Posted on Mon, 8 Jun 2015 in Brain and Spine
Question: Have been suffering from back pain for almost last 2 years. visited couple of doctors and they suggested physiotherapy for SI joint pain etc.. but there was no improvement.
recently consulted another doctor and wen for M.R.I LUMBO - Sacral Spine.
report as follows:

Protocol: T1, T2, STIR Sagital
T2 Axial
Findings:
Transitional vertebrae lumbo-sacral spine. it is stated as L5 in current study.
Mild retrolisthesis of L4 over L5 vertebral body.
rest of the vertebral body appear normal in height, alignment and signal intensity.
small anterior marginal osteophytes, moderate degenerative end plate changes at L4-L5 level.
At L4-L5 Level, there is reduced intervertebral disc height , disc dessication , difuse disc bulge, postero- central annular tear, postero central prostrusion, right postero lateral protrusion, ligamentum flavum hypertrophy causing:
> Anterior thecal Sac indenation.
> Right moderate to severe neural foraminal stenosis abitting exiting nerve root.
> left moderate neural foraminal stenosis.

Rest of the intervertabral disc appear normal in height and signal intensity.
posterior elements appear within normal limits.
visualized spinal cord ends at L1 vertebral level and appears with in normal limit.
cauda equina nerve roots appear within normal limits.
No obvious abnormal pre /paravertebral soft tissues.
osseous spinal canal: L1:15 mm, L2:15mm,L3:14mm,L4:14mm,L5:133mmappear with in normal limits.
impression:
---> Degenerative Lumbar spine disease with:-
> Mild retrolisthesis of L4 over L5 veretbral body.
> AT L4-L5, there is reduced intervertebral disc height, Disc dessication, diffuse disc bulge, postero -central annular tear, postero central prtrusion, right postero lateral prostrusion, ligamentum flavum hypertrophy causing:
> Anterior thecal Sac indenation.
> Right moderate to severe neural foraminal stenosis abitting exiting nerve root.
>left moderate neural foraminal stenosis.

I was suggested two methods of treatment
1 A surgery to fix the above problem
or
2. steroid injection in the affted area followed by 6 to 8 months of exercises (also mentioned that success rate is only 50% but as i am just 29 chances might be more. if this doesnt surgery need to be performed)

I would like to take your opinion on recommended method to treat the above condition.
thanks in advance,
doctor
Answered by Dr. Sudhir Kumar 12 minutes later
Brief Answer:
Conservative treatment should be started.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your symptoms and MRI spine findings.

The main problem is disc bulge with pinching of nerves in the lower back.

The initial treatment is always non-surgical, also called as conservative treatment. This consists of the following:

1. Medications- such as methycobal and pregabalin capsules
2. Physiotherapy- IFT, ultrasound, back extension exercises,
3. Lifestyle modification- avoid forward bending and lifting heavy weights, maintaining correct posture while sitting or standing.

Conservative treatment should be given for six weeks. With this treatment, there is 80-90% chances of success.

Those who do not get better, can go for the other two options:

1. Epidural steroid injection,

2. Surgery

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.
     
Best wishes,     
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5945 Questions

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