Getting an accurate clinical diagnosis for the underlying cause can be a difficult process, but it is important in order to guide optimal treatment decisions.
To help navigate the diagnostic and treatment process, here are 3 pieces of advice that are helpful to know:
1. Having a Disc Disorder Does Not Equate to Having Pain
While this is contrary to common sense, a damaged or diseased disc does not always cause pain or any symptoms at all. In fact, a relatively high percentage of the population over the age of 40 has some sort of disc problem that is evident on an MRI scan. This is similar to other disorders that often cause no symptoms, such as a heart murmur, which is a heart defect that often causes no symptoms.
In addition, the severity of the disc problem that is on an MRI scan does not correlate to the amount of pain or symptoms the patient experiences. For example:
- One person with a large herniated disc can have no symptoms
- Another individual with a small, almost insignificant disc herniation can suffer burning, searing pain that radiates down the leg.
This distinction is important because if a disc problem shows up on an imaging test but is not the cause of the patient’s pain, then it will not be helpful to treat the disc problem. In the worst case scenario, a patient might undergo surgery to treat a herniated disc or degenerated disc, only to find that after the surgery the pain is the same and has not improved at all.
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2. Diagnostic Testing Does Not Usually Identify the Source of Pain
The spine specialist’s interview with the patient about his or her medical history, combined with an assessment of the patient's symptoms, will usually result in a clinical diagnosis determining the cause of the patient’s pain.
A radiographic test, such as an MRI scan, X-ray or CT scan, may then be used to confirm the diagnosis and gain more information for treatment options. This type of test can be helpful in planning a surgery. However, the radiographic test is rarely used as a basis for a diagnosis – it is mainly used confirm or rule out possibilities.
3. Deciding on Disc Surgery is a Complicated Process
When deciding on a treatment option for pain caused by a disc problem, it is important to consider the type of surgery before deciding whether or not to have surgery. For example:
- The typical surgery to address radiating leg pain for a herniated disc is a microdiscectomy, a surgery with a high success rate in immediately relieving the leg pain with a relatively short recovery time.
- The typical surgery to address lumbar degenerative disc disease is a lumbar spinal fusion, which has less reliable outcomes and a longer recovery time.
Moreover, within types of surgery, there are many considerations. For example, a multilevel fusion of any type will take longer to heal and will cause more stress to be relayed to the other non-fused spinal segments than a one level fusion. Multilevel fusions (such as L4 – S1) therefore deserve more cautious consideration than a one-level fusion (such as an L5-S1 or an L4-L5 fusion).
Given the many considerations involved, patients are well served to become as educated as possible about their surgical options before making any decisions.
Above all, it is important for patients to educate themselves on their specific condition to help ensure an accurate diagnosis and selection of the best possible treatment options.