You can often learn a lot from other people's questions and how a spine physician might respond to those questions. Therefore we are sharing our Medical Director's responses to several reader questions that had previously been submitted. (Note: Spine-health.com no longer provides physician responses to patient questions via e-mail.)
My CT scan shows bulging at L4-5 and L5-S1, causing left side sciatica. Would chiropractic care help or hinder?
It would be reasonable to try chiropractic treatment for your condition, and it would be unlikely to hinder your care. You will not know whether or not chiropractic will help until you try it. Giving chiropractics a try is reasonable for a couple of weeks. If you feel better then continue the treatment, but if you are no better than seek care with a medical practitioner. See also Chiropractic treatments for back pain [1].
In 2001 I was diagnosed with a synovial cyst. Prior to the diagnosis, I was a fitness walker but was unable to continue until this past spring. Can you tell me what caused this cyst and the chance of recurring problems from it?
A synovial cyst is caused by osteoarthritis and degeneration of the facet joint. As the joints become more arthritic they produce more fluid and a ball valve develops to let the synovial fluid out (but not back into) the joint. This creates a cyst that usually fills into the spinal canal and causes compression (stenosis) of the nerve roots. Usually there is both the compression problem and instability at that joint.
The treatment choices generally include a facet injection, an epidural injection, or a surgical decompression of the nerve root. The surgery is usually also done with a fusion since there usually is instability. A cyst does tend to cause recurring problems until it is surgically excised. However, surgery should only be considered if the cyst limits your activity greatly. See Pain from a synovial cyst in the lumbar spine [2].
For the last two months I have been experiencing severe lower centralized back pain. The pain sometimes radiates to the lower right buttock and upper right leg. My MRI shows mild circumferential bulging at L4-5 segment with a right disk herniation. In 1994, I also had an MRI that showed the same results.
I met with an orthopedic surgeon who stated that the only treatment is to conduct bone fusion surgery! He explained that the microdiscectomy surgery is not appropriate since most of the pain is in the lower back only. Based on the above, what are my options?
If the scan only shows a disc bulge and there have otherwise been no other changes in the last 8 years, I would agree that you should be very leery of any fusion procedures. A disc herniation at L4-L5 can give you only buttock pain (vs. pain all the way down the leg). Sometimes a microdiscectomy can be helpful to relieve this pain, and a fusion procedure is not always necessary. See Microdiscectomy (microdecompression) spine surgery [3].
Typically, I do not recommend a fusion procedure to my patients unless they have failed 6 months of conservative treatment. Also, I do not consider a fusion unless there are extensive changes on the MRI scan at one level (e.g. disc space collapse, erosion into the endplates, edema in the vertebral bodies).
A more reasonable course at this time would be to pursue non-surgical treatment, such as epidural injections, medications, physical therapy (with a spine therapist), and chiropractics. A physiatrist would be well suited to guide your treatment. If this does not help, I would suggest getting an opinion from a fellowship-trained spine surgeon who specializes in spine surgery. If you are absolutely miserable, you may want to do this before 6 months is up. See also When to see a surgeon for lower back pain [4].
We encourage you to continue to educate yourself about your condition and treatment options - through reading reliable sites, such as Spine-health.com, thoughtfully preparing for your physician appointments, and complying with your physical therapy or other rehabilitation program. Serious pain can seriously impair your quality of life, but there is still a lot you can do to help manage your recovery and/or pain management process.
Best wishes,
Peter F. Ullrich, Jr., M.D., Medical Director
Stephanie Burke, President
Spine-health.com
About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board. The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.
Links:
[1] http://www.spine-health.com/treatment/chiropractic/chiropractic-treatments-back-pain
[2] http://www.spine-health.com/conditions/pain/pain-a-synovial-cyst-lumbar-spine
[3] http://www.spine-health.com/treatment/back-surgery/microdiscectomy-microdecompression-spine-surgery
[4] http://www.spine-health.com/treatment/back-surgery/when-see-a-surgeon-low-back-pain
[5] http://www.spine-health.com/