Patient: About 9 weeks ago, I had an episode of sciatica (herniated discs at L3-L5). I still have significant loss of strength in the left quadricep (especially vastus lateralis) and very minimal patellar reflex. I’m experiencing some gains via osteo-therapy, but the progress is slow. The neurologist I visited says that I need to have a discectomy right away. How long should I try conservative treatments before considering surgery?
Doctor: The problem is that the bulging part of the disk that is coming out from the annular tear may be compressing the nerve that is very close and exits by the intervertebral space. The back pain with or without radiation to the legs, the loss of strength and decreased patellar reflex are being caused by the herniated disk compressing the nerve and producing an inflammatory process: neuritis, that if it is kept for long time may cause irreversible damage to the nerve. The bulging may or may not be clinically significant. Some patients with bulges are symptomatic and have a lot of pain, while others remain totally asymptomatic. Basically the conservative treatment of the Lumbar Radiculopathy is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-educating and teaching you a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: sleeping with a pillow between your knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above with the objective to keep you as far as possible from episodes of acute low back pain, and also to preserve your quality of life. But if the pain and the neurological symptoms worsen, the surgical treatment option might be considered to decompress and avoid more damage to the affected nerve.