“My father has a disc problem. Should we go for physiotherapy or surgery?”

I agree. A second opinion is the best way to proceed.

I would definitely suggest a second opinion and physical therapy.

I would try therapy first ...

I would suggest a non aggressive approach first. Try Chiropractic first as they are specialists in spinal conditions for a 6-8 week period.

If he is in good health then this is one condition that should favor surgery. However, the specific diagnosis should be stated to verify if surgery is the treatment of choice! If there is a herniated or protruding disc pressing on a nerve then discectomy is the treatment of choice. By no means should this be accompanied by instrumentation or fusion. If this is just a narrowed disc space then lumbar epidural steroidal injection or facet joint injection should be done. Have a nice day.

I would suggest a trial of conservative physiotherapy. Chiropractors learn a technique called flexion-distraction that has been shown to significantly improve painful disc conditions. Also, physiotherapists utilize a technique called McKenzie that has been shown to assist with alleviating disc pain. Finally, chiropractors, osteopaths, and physical medicine doctors also can learn a therapy called spinal decompression (intermittent traction). If these techniques do not work then I surgery is most likely necessary. Also, surgery should only be an option after failed physiotherapy and the person as an abnormal nerve conduction velocity testing and/or a study called an EMG. Thes two tests show if there is nerve damage due to the disc compression and if the the muscles are losing strength due to nerve damage. Again, conservative first and then if that does not work surgery. Also, always get a second opinion. This time around go to a neurosurgeon. Neurosurgeons specialize in preserving nerves and surrounding tissue and are less likely to recommend complex spinal surgery. They tend to favor nerve/tissue sparing procedures that have better surgical outcomes in the long run. One final thought, your dad's age may play a role in whether he is a good candidate for surgery. What is most important is what are his other health issues? Is he obese? Diabetic? Hypertensive? Does he have a heart condition? These all affect how well a person does during the surgery and with recovery. If he does not have other health issues then the surgeon may want your dad to get the surgery; because he is healthy enough and in good enough shape to have a positive recovery. I wish you and your father all the best.

As a Chiropractor for 35 yrs and over 100k patients, I see moderate to severe disc problems daily. We reduce them daily. Surgery is disturbing. I lost my 1st disc patient to surgery this week in 4 years. He was severe, was brought to normal and work again but reinjured it. The diagnosis was overwhelming: nearly 20mm. Any surgeon will operate on any disc over 6mm. I have helped up to 9mm, but 20mm is off the charts. The Dex II hip inversion is an awesome, safe home decompression tool that will prevent surgery.

For myself, being a "dual-doctorate" physician (M.D. and D.C.), I'm am not biased in answering this question. The reason being is because it depends on who you ask. If you ask a medical doctor, he will say absolutely, a surgical consult is warranted. If you ask a chiropractor, he will answer absolutely not.

So with my background and training, I can answer this question without any preconceived notions and/or biases.

How would I personally approach this case? Well for one, I would ask your father how long has he been experiencing this back and hip pain. With his pain, what has it limited him from doing? Is he bedridden? Is he able to perform his normal activities of daily living without any issues or problems. Has he attempted to explore any alternative form of therapies such as chiropractic, physiotherapy or acupuncture? Would he like to entertain the possibility of giving one of these form of alternative form of therapy a try?

If he is all in with chiropractic, then, I would perform a thorough history, a complete physical examination and an x-ray of the Lumbosacral region to determine the extent of structural damage and also ascertain if he need a more detailed examination such as an MRI of the same region.

Depending on those results, I would prepare a "Review of Findings" with the patient. A typical R.O.F consist of 4 important aspects:
1) What is the nature of the condition and extent the extent of the damage.
2) What are your father's options? Both with traditional and alternative treatment. What are the pro's and con's of each?
3) The length of the treatment plan? Including the realistic timeline goals.
4) The cost of therapy from the initial consult to the final examination.

Then, I would leave it up to the patient to make an informed, educated decision as to what would be best for him,

Consider a Chiropractic exam with possible decompression. Most of my patients have "disc problems." Surgery may be required, but often a more conservative approach can be helpful.

I hope for the best for you.

Neither, go see a Chiropractor. Many Chiropractors are very well educated on handling disc problems.

Unless there is profound weakness associated with a pinched nerve or severe unrelenting pain, it would be rare to advocate surgery without a trial of physical therapy and possible interventional pain management, e.g. epidural injections or nerve root blocks.

Age is really not a factor, but some medical problems may be. Physical therapy is an option. Injections are also an option. Surgery is an option if those are not successful or he is having significant neurological problems.

What does “the scan reveals a problem with the L5S1 disc mean” what is the scan? An MRI? A CT scan? A myelogram? And what is the “problem”? A herniated disc? A degenerated disc? Compression on a nerve or the whole spinal canal? That is Spinal stenosis? You need to be a little less vague so I can give you a good answer. Otherwise, I would be guessing and it might not have anything to do with your father's problem. You also didn’t say what conservative treatment he had. Physical therapy, chiropractic? Epidural injections? All of this is extremely important before deciding whether surgery is a good and final option

Sincerely,
Mitchell Cohen MD

While there are many variables that would push one toward surgery for a disc issue, the best course of treatment is decided as a team with the physician and the patient as equal partners. A second opinion is always a good idea. In general, physical therapy, epidural steroids, oral medications and time can help and should be tried before surgery; but, there are cases where a patient has a particular problem that will not improve with these modalities and is only responsive to surgical intervention. Surgery as a primary course of treatment may also be indicated to stop ongoing nerve damage and dysfunction. In these cases therapy will only delay definitive treatment and cast the patient more money.

I would recommend a pain management consult for an epidural steroid, followed by PT.

Dr. Bartley

Hello,

Depends on how bad the bulge is. A mild bulge can resolve with conservative care but a more severe bulge with other degenerative factors could need surgery. A second opinion is never a bad thing.

Alternative approach first with physical therapy, physiotherapy, Chiropractic, inversion table etc.