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Is surgery necessary for back pain?

Q: I am a 65 years old man. I had sudden pain in my back and on the upper side of my left legs a few days back. I consulted a few orthopaedic surgeons and all gave different opinions. One doctor said that I will have to go for surgery. Another said it will be cured by physiotherapy. The third doctor only advised bed rest for a few days. I had a CT Scan of L-S spine. The examination report is as follows:- Examination of L-S spine: A dual spiral sequence of lumbo-sacral spine was obtained using 2.5 mm. slice collimation and 3.0 mm. slice width. Mild central and bilateral postero-lateral disc bulging is seen at L4-L5 level with loss of posterior concavity. Mild posterior central and right postero-lateral disc bulging is seen at L5-S1 level. No evident vertebral compression fracture, spondylolysis or listhesis can be seen. Spinal canal diameters (AP) are normal and are as follows: L-1: 1.55 cm; L-2: 1.55 cm; L-3: 1.31 cm; L-4: 1.17 cm; L-5: 1.69 cm. Impression: CT findings are suggestive of mild central and bilateral postero-lateral disc bulging is seen at L4-L5 level. Mild posterior antral and right posterolateral disc building noted at L5-S1 level. The above was the CT Scan report. At present I am only taking bed rest and continuing pain killer valto 40 mg once a day and dolo 650 mg thrice a day. Please advise.

A:Surgery is not the first line of treatment for back pain. You should try conservative treatment which includes rest, exercises, medications and if required spinal injections. If conservative treatment fails, you should be evaluated for surgery. At least 6 to 12 weeks of conservative treatment should be tried, unless there is worsening of symptoms. MRI would also give more details and could be performed preoperatively.

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