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Do I need surgery for my backache?

Q: I was recently diagnosed with the following: At L5-S1 there is loss of disc height and signal intensity with mild disc bulge asymmetric to the left with slight contact of the left S1 nerve root. There is a mild to moderate, left greater than right, L5 foraminal narrowing, as well as my uterus is antiverted. Will this condition worsen with pregnancy? Who would be the best type of doctor to see for this sort of condition? Will this eventually lead to back surgery? Will I be crippled when I get older?

A:Though you have not mentioned it, your description is of MRI done for backache. Let me reassure you that you can never predict anything on backache purely on the basis of MRI findings. You always need to correlate with clinical findings. You can never predict which patient will deteriorate or which one will improve. As far as pregnancy is concerned you can go through normal pregnancy. Towards the last trimester of pregnancy you may have some increase in backache which can be controlled with posture and care during lying down. More than 80% of cases of backache do not need surgery. Most of them settle with conservative measures of restricted activity, pain killers and exercises. Disc prolapse patients are treated by orthopaedic surgeons as well as neurosurgeons. I would recommend either would suffice provided they deal with backache patients on a routine basis. As far as age related changes are concerned, in patients of disc prolapse degenerative changes appear faster at the level of lesion. However, there is no need to worry about the fact that you become a dependant cripple.

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