Should i opt for surgery as recommended by my neuro surgeon?

[RajaJawad]

My name is raja jawad arif, i'm male and 27 yrs old.i have been a very active person and am a good player of vollyball.i have a history of lower back ache for the past 8 yrs but the pain used to go away after 1 or 2 weeks of physiotherapy. i was having back ache for the past 4 months and during this time i had to lift up weight at certain occassions which increased the pain.i tried physiotherapy but it didn't help.i went to the best neuro surgeon in town who recommended MRI. today i got the results of my MRI and the impression written on the MRI report by doctor  says that "there is a moderatly large left paracentral disc protrusion, encroacment of left neural recess and severe compression of left nerve root and mild compression of right nerve root at L4/S5.there is mild spinal canal stenosis at this level. At L5/S1, there is evidence of a posterior annular tear and posterior central disc protrusion with indentation of thecal sac. however ,  exiting nerve roots are not compressed."  
it also says that"at L4/L5 there is a moderately large left paracentral disc protrusion, encroacment of left neural recess and severe compression of left nerve root and mild compression of right nerve root. there is mild spinal canal stenosis at this level".
"at L5/S1 there is evidence of a posterior annular tear and posterior central  disc protrusion with indentation of thecal sac. however,exiting nerve roots are not compressed.conus medullaris ends at normal level.no evidence of intra or extra dural abnormal MR signal through out lumbar region is observed"

i wanted to get a second opinion about surgery and also want to know that can this thing be cured without surgery? i just came back from the hospital and am really confused as the doctor told me to get the surgery done ASAP. if needed i can ask the diagnostics department and send a copy of the MRI as well. i will really appreciate a quick response from you.

[Neuro Forum]

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 examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.Our role on this website does not include reviewing MRIs, so we can not comment on your MRI findings except what as per what you have written above.  

It sounds like you have been diagnosed with a herniated disc, and based on the report above, it sounds like the disc is compressing on the nerve root, and it is classified as being severe.

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, forming a herniated disc, and push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. It sounds like this is what has happened in your case.

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. 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, and so on, these are best prescribed by an experienced physician, each has its own indications.

However, in a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on a nerve, compromising it, or when it is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent 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. The risk of delaying surgery in cases where the nerve is compressed to the point of compromise of its function is permanent damage.

One means of assessing whether or not the nerve being pressed on by your herniated disc 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.

I recommend continued and close follow-up with your neurosurgeon. It is important for you to discuss your questions and concerns with him/her.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[RajaJawad]

thanks a lot for the advice. for now im not considering surgery. i went to a orthopedic doctor and am having heat and ultrasonic therapy sessions.which is kind of helping.