Severe and persistent Lumbar pain radiated to left leg

Dear Ask The Doctor: 1st mri finding: l4 l5 large central extrusion is seen which impresses on the exiting right l4 nerve root and the descending right l5 nerve root 2nd mri finding: l4 l5 posterior soft tissue post surgical changes. a small 2mm midline protrusion inferior extrusion with inferior annular high signal area either from postoperative change or annular fissure mild disc desiccation and facet degeneration bilaterally. mild associated canal stenosis. no significant foraminal stenosis question: i'm still experiencing l4 l5 lumbar pain and radiating to the buttocks and left leg i want to know what kind of treatment do i need and does a discectomy help lower back pain or do it just help radiating to the buttocks and left leg.

Dear Lawrence: A herniated disc may produce a root nerve compression at a given level of the spine that causes an inflammation of the nerves and radiated pain to the arms or legs depending on the level of compression. If this compression progresses, meaning, gets worse over the time, it can produce irreversible damage of the nerve root, then the discectomy is performed to decompress the nerve root involved so the neurological symptoms (numbness, tingling and pain local and radiated to the legs) improve and also avoid further damage to the nerve. The first treatment for a herniated disk is a short period of rest with pain and anti-inflammatory medications, followed by physical therapy. Most people who follow these treatments will recover and return to their normal activities. A small number of people need to have further treatment, which may include steroid injections or surgery. Changes in your lifestyle are a must, like diet and exercise are crucial to improving back pain by controlling weight .Physical therapy is important for nearly everyone with disk disease. Therapists will tell you how to properly lift, dress, walk, and perform other activities. They will work on strengthening the muscles that help support the spine. You will also learn flexibility of the spine and legs. Steroid injections  into the back in the area of the herniated disk may help control pain for several months. Such injections reduce swelling around the disk and relieve many symptoms. Spinal injections (ESI)are usually done on an outpatient basis. Surgery may be an option for the few patients whose symptoms do not go away despite other treatments and time.