Brief Answer: Lower impact therapy less risky, but may not work Detailed Answer: Hello Mr. XXXXXXX My name is Dr. Vinay Bhardwaj. Thanks for coming to HealthCare Magic. I see that you have back pain that may or may not be radicular in nature in your lower back. The pain seems to spread into your thighs or legs on occasion as well. I have seen your reports as well as the doctors recommendations. Firstly, you must forgive me because i am unable to examine you and cannot confirm the neurologic findings that seem to be shown here. That having been said, let me ask a few questions. This will help me have a more informed conversation with you and help you arrive at a well informed decision. Q1) I see that you have been prescribed tablet Pregabalin. Has this helped since you started taking it? Has the pain come down in any way. Q2) You have described back pain that radiates to the leg. But how does the pain behave when you lie down? Or bend over? Does the pain get better or worse. Q3) Could you also give me an idea of your height and weight so that I can factor that in to the decision making process? Q4) do you have any medical issues for which you are receiving medication? If you are can you list them and tell me what medication? Now, to the 4 options you mentioned in your question: 1) Epidural steroid injection, I am aware that the injections are not FDA approved, but that is not to say that they are not effective. I saw on your lumbar MRI, that you have osteophytes in the lower spine. These osteophytes are signs that the bones in this region are highly inflamed and hence you have 'Arthritis' of the spine. A steroid injection into this region by a good pain specialist would be a minimally invasive way of seeing if the pain is from the arthritis, if the injection works, they tend to work for a long time and in combination with Physical therapy can be very effective. 2) Nucleoplasty is minimally invasic surgery where the surgeon is sucking out part of the disc to reduce the bulging, it seemms to work well in younger people. If injections didn't work for me I would look hard at this option. 3) Discectomy: As the name suggests, the surgeon will remove the disk and fuse the two bones together. It's permanent and has a good track record. 4)MicroDiscectomy is the same as above. Just done with minimally invasive instruments. Not much change to outcome, but you can recover from surgery more quickly. There are very few circumstances where the Microdisc technique cannot reach a particular segment and instead your doctor might do the more traditional surgery, but overall, if done by a good surgeon, both techniques are safe. I hope this helps. I look forward to your reply. Vinay

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Brief Answer: I would opt for Injections Detailed Answer: Thank you for following-up. Given your build and your lack of history. I do not believe that the discs in this case would be the cause of pain. I think that it is better you have a steroid injection into the area of the osteophytes noted on the MRI. A good pain management specialist or a good anaesthesiologist would be able to do this for you. If this therapy does not work. You have not risked much and lost even less. It is fairly safe and no permanent surgical changes are being made. I think it would bring down your pain significantly without very invasive procedures, but if it fails to do that, you can explore you options with surgery at THAT point. Again if it were me. I would try the injection first. Even though it is not FDA approved, the medications have been around for a long time and with a skilled pain management specialist you will be safe. I hope this helps. Feel free to follow-up. Vinay

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