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Neurology (Expert Forum)
Back Pain L5-L1
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Back Pain L5-L1
by bert523, Dec 30, 2008 09:08AM
I am a 56 year old male who has had lower back pain for the last year. Stabbing pain in lower left back with periodic (often) pains down left leg and into foot.
Neurosurgeon says L5-L1 with Herniated Disk. I have tried chiropractors, decompression, and epidural shots all with little relieve. Surgeon knows says best option is disc excision surgery.
I hear so much about failed surgery but concerned that if I treat with alternatives ( accupuncture, medicines) that I amy do permananet nerve damage. Could that happen?
Neurosurgeon says L5-L1 with Herniated Disk. I have tried chiropractors, decompression, and epidural shots all with little relieve. Surgeon knows says best option is disc excision surgery.
I hear so much about failed surgery but concerned that if I treat with alternatives ( accupuncture, medicines) that I amy do permananet nerve damage. Could that happen?
Doctor's Answer
by Lama Chahine, MD, Jan 03, 2009 09:36AM
, Jan 03, 2009 09:36AM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history from you and examine you, I can not comment on whether or not you need surgery for your disc. however, I will try to provide you with some information regarding this matter.
There is a material that cushions the space occuring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones and push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.
In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, medications for neuropathic pain (pain originating from nerves) and so on, these are best prescribed by an experienced physician, each has its own indications.
In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.
One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers.
In some patients, after conservative non-surgical therapy is tried for 4-6 weeks and the pain is still severe or if other symptoms/indications arise, surgery is the next step.
It would be best for you to discuss surgical and non-surgical options with your physician.
Thank you for using the forum, I hope you find this information useful, good luck.
Without the ability to obtain a history from you and examine you, I can not comment on whether or not you need surgery for your disc. however, I will try to provide you with some information regarding this matter.
There is a material that cushions the space occuring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones and push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.
In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muslce relaxants, medications for neuropathic pain (pain originating from nerves) and so on, these are best prescribed by an experienced physician, each has its own indications.
In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.
One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers.
In some patients, after conservative non-surgical therapy is tried for 4-6 weeks and the pain is still severe or if other symptoms/indications arise, surgery is the next step.
It would be best for you to discuss surgical and non-surgical options with your physician.
Thank you for using the forum, I hope you find this information useful, good luck.
