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Is surgery necessary for disc herniation?

Q: I have been diagnosed with a disc herniation of L5-S1. I have little pain in the left leg and lower back pain. It occurs mostly during the night. My doctor has advised microdiscectomy surgery in London, since I will be there for studies. Is it safe to undergo this surgery? I also experience erection disorder, is this because of the back problem? Please advise.

A:Your MRI findings show a disc herniation at L5-S1. Treatment is not based on MRI findings alone but a combination of clinical evidence along with MRI findings. The mere presence of a large disc on MRI cannot help you decide on treatment. If the large disc is associated with clinical signs and symptoms, then surgery could be an option. The decision to operate is based on the following criteria: 1. Severe pain that does not get relieved even with medications and rest. 2. Pain that gets relieved but comes back again and again; such recurrent attacks of pain that cut into the normal life activity of a patient. 3. Increasing neurological deficit or paralysis in a patient. 4. Presence of a massive paralysis with difficulty in urination or bowel movements (this needs emergency surgery). You are worried about safety of surgery. I do not think you need to worry about that as with modern technique most of the things are reasonably safe, barring unforeseen episodes. You could get a second opinion on the need for surgery based on your symptoms and see if you need any surgery. You have also mentioned about erectile dysfunction. This may have nothing to do with disc prolapse. Rarely, this may be a cause but it is unlikely to occur in isolation without causing other symptoms especially of problems in urine and bowel movements. I suggest you consult your urologist regarding this.

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