Micro-Disectomy vs IDET or Radio Nucleoplasty?

[KimSb]

MRI Results: L4-L5 mild posterior bulge with facet changes causing mild central stenoisis. Neural foramina are patent. L5-S1 left posterolateral bulge is seen causing mild narrowing of the left lateral recess and neural foramina. No significant central stenosis is seen. My MD claims my MRI isn't bad and that many with disc bulges are asymptomatic, yet the lower back pain(right above the buttock)persists. It has been about 1.5 years since I hurt my back. I did 9 months of PT, steroid injection, swim, chiro, etc. and while the sciatica has improved, the nagging lwr back pain persists. I've consulted a neurosurgeon & an Int. radiologist at 2 renown "academic" hospitals who claim that pain can flare, is transient & subjective, & not always seen on an MRI. The neurosurgeon claimed that if the pain persists a microdisectomy may be helpful. Likewise, the Int radiologist feels that IDET or Radio Nucleoplasty may be helpful.

1. I've heard anectdotally that Microdisectomy and IDET/Nucl can be hit or miss. What are the pros and cons of Microdisectomy vs. IDET or Radio Nucleoplasty, & do you feel either would be appropriate for my condition? Naturally, I don't want to exacerbate the pain and/or find that a surgery caused new numbness, paresthesias, etc.

2. If the disc bulge is hiding an anular tear, would a Microdi or IDET/Nucleo be effective?

3. Do you know if Prolotherapy is safe & efficacious, or just a band-aid?

4. Should I do nothing? Might my condition improve with more time? Thank you very much for answering my question & being so helpful and courteous to us all

[CCF-Neuro-M.D.-CS]

I can give you some general information on the above procedures, however I cannot pick which one is best for you without knowing your case

Not all patients benefit from these procedures, so the selection of patients who will benefit is very important. Not all back pain is caused by a disc, and disc protrusions are very common and may be asymptomatic as we get older - hence the less than good outcomes reported for the above techniques. Other soft tissues in the back may irritate sensory nerve endings/organs and cause pain also.

the less invasive procedures like microdicectomy and IDET have less surgical risks and complications than open surgery, so it is less likely that the pain will become worse. A more likely outcome is some releif or no releif. Forexample in a recent trial of IDET - 97% of patients continued to have back pain after the procedure, 50% were dissatisfied with the procedure and only 39% reported some improvement. As these new techniques get better, the results may get better.

Microdiscectomy will not be sufficient if there is anything other than a focal disc bulge, as far as I am aware.

Prolotherapy is even less proven and involved the injection of iriitative solutions into ligaments which are supposedly weak, to strengthen them. A recent revew found that it is not a proven therapy, may have some benefit when combined with other therapies (but then which one really worked!), and may cause transient increased stiffness and pain afterwards.

It is a difficult decision to make, you need to trust your doctor to give you the best advice for your individual case.
Good luck

[T.M.]

The difficulty is figuring were the pain originates.  I had (perhaps) similar pain.  I thought was at L4-5, but just last week had a nerve block to the SI joint (diagnostic).  Now that pain is completely gone.  I'll go back for neurotomy for longer lasting results.  
I did have nucleoplasty last year with great results.  A 3mm central disc protrusion was no longer present on the subsequent MRI.  The pain with the procedure is intense but so brief.  Its only a half hour in the OR.  Rapid recovery.  You don't seem to have a measurement of central protrusion.
I have been told that IDET is better for herniated discs.   It is supposed to heal tears.
I don't have a medical background.  
If you try nucleoplasty it doesn't preclude any later procedure, because its harmless.  
I suppose you know about the medial branch nerve neurotomy.
These procedures are helping me tremendously.
I think you are going to have  great luck.  Just don't let anyone discourage you.  There are all these wonderful MDs with vision.
Have you found spineuniverse.com?