Do you have low back pain with possible buttock pain or leg pain and an MRI scan that shows you’ve got a bulging disc? Is surgery the first and best option?
“The reputation of surgery rests on the observation, after treatment, that some patients sometimes do well, with some procedures.”
Persistent low back, buttock or leg pain is debilitating. It can become a disruptive soundtrack to your life that you can’t turn off, and it’s easy to understand that people will do whatever it takes to get their life back.
If you then have an MRI or CT scan with some obvious findings of a prolapse disc – that must be it! That must be the cause of the pain!
It can’t be any simpler – back pain and a scan showing a damaged disc. Just remove the damaged tissue and the back pain will go. Or will it?
The first thing to consider is that a scan does not tell the whole story. The scan provides you a visual perspective of the anatomy of the area, but it gives you no details about the function or more particularly the loss of function.
A clinical assessment is the by far the best way to accurately assess someone’s low back pain. You find out the critical details about the pain. how did it happen, where is the pain, what type of pain it is, what aggravates it, etc plus more importantly what impact it is having on your body – what function is and is not affected.
Don’t get me wrong, the scan can be a very important additional piece of information. But it is just that an adjunct tool that a practitioner will use to help confirm their diagnosis.
A diagnosis can never made based solely on a scan.
The presence of a disc bulge on an MRI is not a definite cause of the back, buttock or leg pain and definitely not categorical to determine that surgery is required.
I’ve seen many cases where people have bought in MRI’s with an incidental finding of a disc bulge or bulges but have no low back, buttock or leg pain. But I’ve also seen a large number of patients that have intense low back, buttock or leg pain and have no MRI disc bulge findings.
There are several different areas where nerves can be irritated that have little to do with the disc and there are numerous structures in the low back area that if dysfunctional and inflamed can create similar pain in the low back, buttock and leg areas.
Saying that, there are obvious emergency cases where nerves are being directly and severely impinged and surgical help is required.
Outside of obvious emergency cases, where possible conservative treatment should be the first port of call before considering irreversible surgery. Most low back pain can be managed and resolved with conservative care or can form part of surgery prehab if surgery is still required.
Unresolving low back pain is not something to be taken lightly, but either is surgery. Never allow any practitioner to diagnose your low back pain based on a scan alone.
Here are my top tips to help get the best outcomes from your low back pain:
- Clinical Assessment– Always ensure that you undergo a comprehensive functional and neurological assessment. This is a not a corner that can be cut.
- Conservative care– Unless you are one of the very rare cases, the majority of low back pain can be managed and resolved with conservative care. Find a good practitioner and start a care plan with clear goals for your care.
- Care Plan – Ensure that any practitioner that you work with has a detailed care plan to resolve your low back pain. It needs to include the detailed treatment steps that they will go through, how long it should take and what your prognosis would be at the end of the care plan. It should never be an open-ended program
- Second opinion – Don’t ever be afraid to get a second opinion – it’s your health. Surgery is irreversible and not without risks, so seek second opinions with any practitioner where you don’t feel comfortable or not happy with your progress.
If you are thinking about surgery to resolve your back, buttock or leg pain and you’re unsure of whether it is the right approach for you, give us a call on 9318 7758 and let’s quickly assess you to see whether conservative care might be an option for you.
