Q: I am 25 years old. I used to be an athlete (100mts. sprinter). Since last four year I have been suffering from slip disc, in the lumber region (pain in left side) The MRI that i got done on 6thJanuary2003 , the report says that: MR finding are disc degenerative change at L4-L5 and L5-S1 levels with mild radiculopathy. I went through physiotherapy,in Delhi itself wich included: Dythermy,Traction,Ultrasound,and IFT. with complet bed rest for a month, but there was no imporvement. Than after few months I came to pune and again I got the same treatment with curvical traction, as I also started having pain in my neck, shoulder and arms on left side. According to doctor I also have developed curvical spondylosis because of prolong working on computer but still no improvement. Than I got admited in the hospital for the 24 hour traction for 12 days. But still the pain continued in the same manner. Again I got my MRI done after the treatment on 8August2003 and the report is as: Thecal sac cross section area in mm sq are: L1/2- 162, L2/3-146,L3/4-98,L4/5-88,L5/S1-39 Spinal canal diameter in mm are: L1-16.0,L2-14.9,L3-13.6,L4-14.0,L5-14.9 IMPRESSION: .Degenerated L5/S1 disc with diffuse disc bulge and small postero-central protrusion seen contacting bilateral traversing S1 nerve roots with likely irritation. There is mild canal stenosis at this level[9.9mm]. Small peripheral annular tear seen in L5/S1 disc posteriorly. Mild L4/L5 disc bulge with no nerve root compression. Mild ligamentum flavum hypertrophy at L4/L5 and L5/S1 levels. Now doctor suggested me to go throug surgery for wich I could not make up my mind. And I am now with severe pain from my neck to legs. My pain in my back aggravates while walking, and after driving and working on computer I have a very sever pain in my shoulder. And the whole day my legs dont want to work, my legs feel weak, I feel relax when I am on bed. But I cant always be on bed. My friends my relative think I am just making an excuse to be on bed. They say that they understand that I have pain in my back, but why pain in legs, why pain in hands and shoulder. They think I am psychologicaly ill. I have stoped visiting doctors. But my pain is geting worse day by day. Some time I too aske my self am I psychologically ill, I dont no what it is, but I do feel the pain. I whant to know Am I really psychologically ill, and if not than is there in way to get rid of this pain but with out surgery.

A:From your letter it is quite apparent that you have gone through a painful period and you are still in pain. The current MRI report indicates that there is mild canal stenosis L5 and S1 and degenerative disc bulge at that level. The trouble with looking into such reports is you tend to jump to conclusions regarding surgery. The MR findings must be correlated with clinical examination. The indications for surgery are: 1. Severe persistent pain not getting relieved with the conservative treatment. 2. pain in the back which gets relieved but comes again and again to cut into the normal economic activity of the patient. 3. The objective criteria are: a. paralysis of the limbs or a massive paralysis b. paralysis with involvement of urine and bowel movement, c. if you are not sure of the diagnosis In your case, clinical symptoms are present and seems to correlate with the MRI findings. Technically, if the findings are correct, there is an indication for surgery. However, I would suggest that you get yourself examined by a competent orthopaedic surgeon and then decide.