Disc Herniation: Seeking Effective Treatment Options

Annoying pain?

Hello Dr.
Chen,
Last June, I noticed a tingling sensation in my feet and difficulty straightening my back, so I visited an orthopedic clinic.
I was diagnosed with a herniated disc, and the doctor only recommended physical therapy, including lumbar traction, heat therapy, and electrical stimulation.
After several months, there was no significant improvement.
Later, I went to the neurosurgery department at Tainan Hospital for neurological conduction tests and a CT scan, where I learned that I have herniated discs at the L4 and L5 levels compressing the nerves.
The doctor advised me to avoid lifting heavy objects, to place a pillow under my knees while sleeping, and prescribed some muscle relaxants, but did not indicate whether surgery was necessary or how serious my condition was.
Unfortunately, my condition has not improved.
Recently, the symptoms have worsened.
When I lie flat, I feel tingling in my right leg, and I also experience sharp pain in my buttocks while sitting or standing, which is painful to the touch.
I want to see a doctor again, but I feel that just taking medication may not resolve the issue.
If I need to undergo an MRI, will it be out-of-pocket? When I visit the doctor, how can I effectively communicate my condition and discuss treatment options for recovery? Additionally, could you recommend a specialist in this field in the Tainan area? I am eager to get treatment as I want to become pregnant soon and avoid additional strain on my spine during pregnancy.
Thank you for your assistance.

jane, 20~29 year old female. Ask Date: 2004/04/17

Dr. Chen Changmu reply Neurosurgery

Your condition sounds quite serious and indeed requires further intervention.
For a herniated lumbar disc, the initial treatment, as you mentioned, involves medication and being mindful of lifestyle habits to avoid exacerbating the condition.
If symptoms do not improve, rehabilitation should be pursued.
Surgery is typically considered when rehabilitation is ineffective (after 2-3 months), symptoms worsen, or there is rapid deterioration; of course, the patient's willingness is also very important.
May I ask when your last MRI was performed? I recommend that you schedule an appointment at a medical center (such as National Cheng Kung University Hospital or Chi Mei Medical Center) in the neurosurgery outpatient department, where you should be able to receive satisfactory care!

Reply Date: 2004/04/17

More Info

Understanding disc herniation and its treatment options is crucial, especially when symptoms like leg numbness and pain persist. Based on your description, it seems you have been experiencing significant discomfort due to a herniated disc at the L4-L5 level, which is compressing the nerve roots. This condition can lead to symptoms such as pain, numbness, and weakness in the legs, and it can severely impact your quality of life.

Diagnosis and Current Treatment
From your previous evaluations, it appears that conservative management has been the primary approach. Physical therapy, including traction, heat therapy, and electrical stimulation, is often the first line of treatment for disc herniation. However, if these methods do not yield significant improvement after several months, it may be time to consider more advanced diagnostic imaging, such as an MRI, which provides a detailed view of the spinal structures and can confirm the extent of the herniation and any nerve compression.

When to Consider Surgery
Surgery is typically considered when conservative treatments fail, and symptoms worsen or significantly impair daily activities. Indications for surgical intervention may include:
1. Severe Pain: If the pain is debilitating and not relieved by medication or physical therapy.

2. Progressive Neurological Deficits: If you experience worsening numbness, weakness, or loss of bladder/bowel control.

3. Quality of Life: If your ability to perform daily activities is severely affected.

The most common surgical procedure for a herniated disc is a discectomy, where the portion of the disc that is pressing on the nerve is removed. In some cases, spinal fusion may be necessary if there is instability in the spine.

Communicating with Your Doctor
When you visit your doctor again, it’s essential to communicate clearly about your symptoms and concerns. Here are some points you might consider discussing:
- Symptom Progression: Explain how your symptoms have worsened, including the new onset of pain and numbness in your right leg and buttock.

- Impact on Daily Life: Describe how these symptoms affect your daily activities, work, and plans for pregnancy.

- Desire for Further Evaluation: Express your interest in obtaining an MRI to better understand the condition of your spine and discuss the potential need for surgical options if conservative treatments continue to fail.

Seeking Specialized Care
In terms of finding a specialist in Tainan, you might want to look for a neurosurgeon or an orthopedic spine surgeon who has experience with disc herniations. You can ask for referrals from your primary care physician or consult local hospital directories. It’s also beneficial to check online reviews or patient testimonials to find a doctor who is well-regarded in treating spinal conditions.

Conclusion
In summary, while conservative treatment is often effective for many patients with disc herniation, your ongoing symptoms suggest that further evaluation and possibly surgical intervention may be warranted. Be proactive in your discussions with your healthcare provider, and don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your health and comfort are paramount, especially with your plans for pregnancy in mind.

Similar Q&A

Understanding Spinal Disc Herniation: Treatment Options and Recovery Tips

Hello, doctor! I have been experiencing persistent pain in my left lower back for a long time. It worsens after even slight physical activity or poor posture, lasting for several days. Today, I visited Kaohsiung Municipal United Hospital for an X-ray, and the doctor informed me t...

Dr. Su Hongci reply Rehabilitation
Hello: I believe your issue is "lumbar disc herniation." Between the vertebrae, there are intervertebral discs that serve as cushioning support. When these discs are subjected to excessive force or undergo degeneration due to aging, they can herniate, potentially compre...

Alternative Treatments for Herniated Discs Beyond Surgery

After being diagnosed with a herniated disc through X-rays and electromyography at the hospital, are there any alternatives to surgery?

Dr. Shi Guozheng reply Orthopedics
The first occurrence of a herniated disc can typically be managed with conservative treatment, which includes medication or rehabilitation traction, along with bed rest, most cases can improve. If there is no improvement after six weeks of treatment, then invasive methods, such a...

Understanding Herniated Discs: Rehabilitation vs. Surgery Options

Hello Dr. Lai, I went to see an orthopedic doctor due to lower back pain and found out that I have a herniated disc. I would like to ask if rehabilitation can improve my condition, or if surgery is the only option. I'm not sure how to upload images.

Dr. Lai Zhaokang reply Neurosurgery
Hello: A lumbar disc herniation may not necessarily present with discomfort. If you are already experiencing back pain or nerve pain symptoms, it is advisable to proceed step by step: first, protect your back by avoiding bending and heavy lifting. Use anti-inflammatory and analge...

Understanding Disc Herniation: Surgical Options and Recovery Insights

Hello Doctor, last month I went to the hospital for an examination due to lower back pain and found out that I have multiple herniated discs, with the first, second, fourth, and fifth discs being the most severe (the fourth and fifth discs are completely herniated on the MRI, whi...

Dr. Lai Zhaokang reply Neurosurgery
1. Over 90% improvement is achievable, with a safety rate of over 99% (unless there are specific underlying conditions) (##but this depends on the surgical method you ultimately choose##). 2. It is essential to review your imaging and symptoms. The benefits of the product come ...