Quote:
Originally Posted by Vicki_in_Florida
Depends on what is wrong with your disc.
A degenerated disc isn't going to heal itself.
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You asked if a wait and see approach hurts.
I agree with both on the above:
a. depends
b. healing is short of full function
There are "red flags" where surgery is indicated. I am not a physician, but ...
Foot Drop is a
red flag and surgery is needed within 7-14 days, get it done (L4/L5). There is a quality of life consideration mentioned in the below video.
Conservative treatment (waiting) is the standard practice. Many symptoms resolve in the short to medium term. You have cervical and lumbar MRI's so your symptoms passed a threshhold and you possibly have a surgeon's writing saying "surgical candidate".
The surgical timing is debated & researched by professionals in the field. The best reference is
SPORT (spine patients outcomes research trial). Dr. Weinstein/Dartmouth is often noted as an author, see pubmed.
LINK. There may have been more than one journal article on the clinical trial regarding timing of surgery.
Look for:
Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT).
Rihn JA, Hilibrand AS, Radcliff K, Kurd M, Lurie J, Blood E, Albert TJ,
Weinstein JN.
J Bone Joint Surg Am. 2011 Oct 19;93(20):1906-14. doi: 10.2106/JBJS.J.00878.
Predominant leg pain is associated with better surgical outcomes in degenerative spondylolisthesis and spinal stenosis: results from the Spine Patient Outcomes Research Trial (SPORT).
Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial.
Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT).
Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J.
Spine (Phila Pa 1976). 2008 Dec 1;33(25):2789-800. doi: 10.1097/BRS.0b013e31818ed8f4.
Spine surgery may be considered "elective". Surgeons will give you options, alternatives, or differing opinons. Someone wrote get more than one surgical opinon (options?).
Healing occurs to a limited extent wit the disc. The disc (intervertebral disc, or IVD) will scar after a discectomy, to the extent that is healing. The IVD is avascular. There are no IVD blood vessels. Blood vessels supply the normal healing mechanisms and nutrients. The IVD will not heal like our skin or our bones. The IVD will respond after injury. The response may include blood vessel ingrowth to a limited extent or nerve ingrowth (angiogenesis, neurogenesis). New nerves are thought to possibly cause some "discogenic" pain, but I will save you the citations (TMI).
Identifying a pain source is big. Leg pain indicates a type of surgery that has a bit better results than just back pain. I think leg pain means it is easier to identify what is going on, like nerve compression (stenosis) in the foramen or lateral recess, or ... Stenosis is part of the normal aging process in my limited view, like any joint with cartilage, with added biologic variability, exacerbated by toxins (industrial, smoking), injury, trauma (horse/car accidents) etc.
The UCSF medical school television site video is OK+ to watch if you have the time. Two (2) spine surgeons give a 90 minute talk to people in the community, not doctors/surgeons. The surgeons in the video speak to the lumbar region. The injury, trauma and aging issues are similar between the spine and IVD in cervical and lumbar regions.
The treatment options for cervical are also briefly mentioned in the video by Dr. Praveen Mummameni. He is a co-author several papers on cervical and lumbar surgery (
pubmed.link). Dr. Dean Chou authors multiple papers, but his name is less unique to give quick references on pubmed.
Low Back Pain:
Causes, Conservative Treatment & Surgical Intervention
Causes and treatment of low back pain.
Date: 2/20/2012
Views: 190,247
Time: 89 minutes
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slackwater_sf