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do i need surgery - specifically microdiscectomy (doctors have advised against nucleoplasty as the bulge/protrusion is large and it wont help)?

I have a L4 L5 level slip disc, and had it for 2-3 years now and we've been trying to treat it non surgically, there is always temporary relief but nothing long term. My work requires me to be on my desk 8 hours a day so there's a lot of sitting in my day. The pain / discomfort usually starts every evening around 8-9pm, and every morning more often than not i'm absolutely fine and pain free ( provided i've had 7-8 hours of sleep that night)

On some long days ( if ive walked a lot or not slept enough either/or, my back pain extends to the legs, it's like a nerve pain, some doctors have told us its risky when the pain extends to the calf muscles or hamstrings, as it can lead to completely loosing sensation in the leg ( paralysis?) 

my lifestyle requires me to be out at nights or even giving up sports completely for the last 4 years has been difficult. In addition I travel a lot and any day where I slightly exert myself or have to walk more than 10k steps or have a late night, I get a tilted posture and my back really hurts.

I have had a slip disc for the last 4 years and the days i exert myself there is shooting pain down my leg. The days i completely rest (bed rest), i could play extreme sports (not that i've tried). I havent been to the gym or played a sport in the fear that things might get worse. Most doctors after looking at my mri have said the disc is out but its not that big a problem, lets try conservative methods. I've tried every possible thing, yoga, physio, accupuncture, chiro etc. I havent been very regular to be honest but i have tried giving each a shot for atleast a month or more. I have finally mentally made up my mind to go for surgery but a lot of people who have had surgery have told me this should be a last resort. Now, i'm not in major pain that i need surgery but my lifestyle is such that we go out alot and my dearest wife has to suffer more than me due to this (we have traveled to over 50 new cities in the last 4 years, we both love traveling and taking holidays and i have the luxury to do so).

Here begins my list of questions, anyone with prior similar experience who can comment on any of them, would be much much appreciated:

1. the pain in the leg will go away 100% and the pain in the back will be reduced tremendously (90-100% less pain than existing) with microdiscectomy?

2. Best case scenario with microdiscectomy - i can go back to play extreme sports, diving etc and may not require any exercises etc to keep the back in correct posture or for relapse.
Worst case scenario there will be 90% less back pain than what i am at right now and i will need to keep strengthening the back? Am i correct?

3. I have been very lazy with exercises and knowing my lifestyle I doubt I will ever get to regular exercises - I just want to make sure post surgery things will not deteriorate because of that.

4. Will the degenerative disc get worse, better or stay same with surgery?

5. someone recommended i take an epidural and try strengthening my back (going to the gym daily for 2 hours) first before going to surgery. if the epi doesnt work then surgery would be the best option - do you agree?

6. If yes to above, currently i am generally in pain (3 or 4 on 10 amount of pain) which reduces my initiative and also doesnt allow me to push for more. not sure if not surgery what else can be done to strengthen the back in this pain.

7. I am generally lazy about exercises - will post care be an issue if this is taken lightly? I have heard the chances of a relapse are high if i dont strengthen the back?

8. if yes to above, is it better to leave it untreated and the chance of a relapse reduces (considering the back is natural and no surgery is done) or is the probability of a relapse the same with or without surgery?

9. I have always had a tight hamstring since high school - i used to play a lot of sports and my instructors always told me about it. even now i have very strong calfs but my hamstrings are very tight - will surgery loosen them? will i need to anyway fix this issue with or without surgery?

10. is there any breakthrough in technology that will specifically help someone as such in my case? Looking for an alternate to microdiscectomy that may be worth considering?

As i mentioned above, any help/feedback/suggestion from someone whose been through something similar will be much appreciated. Age: 30. No kids yet. Weight 150 pounds (not overweight yet). Work - business owner but a technology firm (which means im behind a desk atleast 10 hours a day).

Category: Spine Surgeon

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Category: Spine Surgeon
Dr. Goutham Cugati is online now

Expert:  Dr. Goutham Cugati replied 4 Days.

Hello. Thank you for posting your query at
I understand your concern.
Surgery will be offered to you only if it is indicated. If there is no significant compression of nerve roots and you undergo surgery then you might not get the expected results.
1. If surgery is indicated and performed appropriately then both your back pain and shooting pain should completely vanish in few weeks after the surgery
2. Extreme sports should be avoided for few months after surgery. I would recommend you to do regular exercises for rest of your life to prevent relapse if you are continuing extreme sports. a new disc prolapse may be seen in an adjacent level.
3. I always advise my patient to exercise after the surgery. If not, then change in lifestyle is required so that your back does not get stressed.
4. The degenerated disc will not change with surgery. Only the prolapse/ extruded fragment will be removed in surgery
5. I agree with them - if the MRI is suggestive of mild or no compression of nerve roots and there should not be any extruded fragments of the disc.
6. Please try epidural steroids or transforaminal injections.
7. You are right. Spine strengthening exercises are mandatory.
8. If surgery is not performed for a patient who has large disc then he may eventually have weakness of the foot(footdrop) and numbness which may at times become permanent.
9. Tight hamstrings have nothing to do with your degenerative disc prolapse. Your spine surgeon shall examine and let you know anything is required or not.
10. Coblation technology is one such breakthrough. But its indication is limited. Please consult your spine surgon who will let you know whether you will benefit with Coblation or not.
Feel free to discuss further,
With regards,

Dr Goutham Cugati

Patient replied :

So after looking at my MRI and my symptoms, would you recommend I am a candidate for surgery or I try non-invasive methods such as chiro/back strengthning first and then surgery?

Expert:  Dr. Goutham Cugati replied 3 Days.


Kindly attach your MRI scan report or films so that I can reply / advise you suitably.


Dr Goutham Cugati

Consultant Neurosurgeon

Patient replied :


Expert:  Dr. Goutham Cugati replied 2 Days.

Hello. Thank you for posting the follow up.

The MRI images which you have sent are very limited.
I would specifically require L4-5 level T2 axial images, to comment.
Or you can send the complete radiological report


Dr Goutham Cugati

Consultant Neurosurgeon

Patient replied :

you can download it from here -

I tried viewing it myself first and it works - it includes all the files that can be viewed with any DICOM viewer - a free viewer is available at and takes less than 30 seconds to install. Please do let me know if this works or if you are still having any issues with this.

Expert:  Dr. Goutham Cugati replied 1 Day.

Please scroll down for the answer to your last query that was mailed to
Hello. Thank you for the follow up.

I have gone through the MRI images.
If you have neurological deficits or if your neurosurgeon has told you that there is any motor or sensory deficits then you are a candidate for surgery. Or If you have intolerable pain despite all measures like physical therapy, exercises and Spinal epidural then you may be benefited by surgery.
The answer for your last query :
If you are not having neurological deficits, and your symptoms are tolerable then I dont advice surgery. You can try epidural steroids.
If you still dont see results then go for surgery.

Dr Goutham Cugati

Consultant Neurosurgeon

Dr. Goutham Cugati
Category: Spine Surgeon
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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