Q: I am a 29 years old male suffering from L5-S1 spine degenerative disc disease for the last five years. I am afraid of getting married due to this problem. I have L5-S1 bulge also. What is the best treatment for this?

A:From your description you only have degenerative disc disease of lumbar spine. You are unnecessarily worried over this issue as you can get back to active life with proper treatment. You started your symptoms five years back (you were 24 years then), an age when you are unlikely to be having degeneration of the spine. You possibly had a disc bulge or prolapse which over the year has resulted in degeneration of the disc space. 80% of patients with this problem settle with conservative treatment and are able to get back to work. 10-20% may require surgery depending on severity of symptoms of pain and neurological paralysis. You obviously do not have any sensory or motor power paralysis. Your symptom is essentially that of pain. You will have to be assessed clinically to see if you have muscle spasm, stiffness of back or any evidence of nerve root irritation. You could be started with a regime of analgesics and muscle relaxants followed by exercises.

The indications for surgery are very few with two subjective and two objective criteria. The subjective criteria are:

1. Intractable pain not getting relieved with medicines.
2. Recurrent attacks of pain that cut into the patient’s economic activity.

The objective criteria:

1. Obvious paralysis of muscles from pressure on roots.
2. Massive paralysis involving bladder and bowel sensations.

The surgery that is done in a single level disc is removal of the disc. In multiple level discs there may be a need for spinal fusion. But this has to be assessed clinically and radiologically. Disc replacement surgery is not routinely done but it has specific indications. Stem cells at present have no role in this.

I would recommend that get a good clinical examination done and follow a regime of medicines / exercises.