Do I need an MRI? An MRI is necessary to image the intervertebral discs, because these do not show on a plain x-ray. Imaging of the disc allows your physician to diagnose disc herniation, disc protrusion, disc bulging, as well as other related conditions, such as spinal or foraminal stenosis.

Do I need X-Rays of my back? Plain x-rays are helpful to examine the bony structures. These can be abnormal in case of fracture or metastatic disease.

What are the risks of surgery? Back surgery is less risky now because less invasive procedures are used for the majority of patients with disc disease. Nevertheless, surgery is invasive and requires anesthesia, which also poses a risk by itself. For a more detailed discussion, please click here.

What do I need to know about epidural steroid injections? Epidural steroid injections involve the placement of cortisone solution adjacent to the inflamed nerve root through the use of a long needle which is passed through the skin of the back. Bruising is common, and discomfort is minimized through the use of anesthesia. This procedure is much less invasive than surgery, and can result in symptom relief for those patients with radiculopathy (e.g. sciatica due to disk herniation).

Is chiropractic effective for sciatica? The summary of the AHCPR panel was as follows: "The evidence for effectiveness of manipulation varies depending on the duration and nature of the patient's presenting symptoms. For patients with acute low back symptoms without radiculopathy, the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms. For patients whose low back problems persist beyond 1 month, the scientific evidence on effectiveness of manipulation was found to be inconclusive. For patients with radiculopathy, the scientific evidence was also inconclusive about either the effectiveness or the potential harms of manipulation. Finally, the panel offered the opinion that, for patients with acute low back problems and findings of possible progressive or severe neurologic deficits, assessment to rule out serious neurologic conditions is indicated before initiating manipulation therapy."

Is acupuncture effective for treatment of sciatica? The AHCPR study did not find acupuncture to be useful for patients with acute sciatica. The following quote is from the AHCPR report: "Invasive needle acupuncture and other dry needling techniques are not recommended for treating patients with acute low back problems."

Is my back pain mechanical or inflammatory? Patients with disk herniation can have both components contributing to their pain and neurologic dysfunction. Mechanical malfunction may require surgical correction. Inflammatory components may fail to resolve even after successful surgery.

Are there special risks to fusion surgery? Patients can experience additional disk herniations above and below the area of fusion following fusion surgery.

Should I choose an orthopedic surgeon or a neurosurgeon to do my surgery? There are many qualified spinal surgeons in either category. Your choice depends more on the individual surgeon's training, experience, and expertise.

Questions to ask your doctor before you have surgery