Athletic 40 yo man with low back pain, MRI shows an old injury. What's next? Injection? Surgery?

0:00 Herniated disc with sciatica
01:23 Low back pain on the left with radiation to the side of the thigh without weakness or numbness
02:52 Low back pain caused by a facet joint is typically worse in the low back than the leg.
04:02 The alignment of the spine is shown on magnetic resonance imaging along with the bones and discs.
04:37 A herniated or protruded disc bulges into the spinal canal and is visible on MRI.
04:58 A Tarlov cyst is noted in the sacrum, this is of no significant int he current problem.
05:37 The crossed straight leg raise test is a very accurate sign of disc herniation and nerve root problems (radiculopathy)
06:20 MRI does not show how you feel! Even after you get better your MRI may still show an abnormality which can be misleading.
06:50 Nerve root pain is mostly in the leg, electrical or lightning like, and often is associated with numbness, tingling or weakness in the leg.
06:58 Facet joint pain has a typical pattern as it is mostly int he legs, goes to the butt, feels like the hip and burns on the outer thigh.
07:32 It can be hard to tell if you are looking at a horse or a zebra.
07:54 There are 3 Treatment options for herniated discs: wait it out, epidural injection, and microdiscectomy surgery.
08:00 There are 2 treatment options for facet pain: wait it out, or diagnostic medial branch block followed by RFA.
08:15 Microdiscectomy surgery is notoriously bad for central disc herniation without radiculopathy.
08:42 A diagnostic block is a good way to clarify the cause of pain.
09:17 Medial branch block is a diagnostic block for low back pain done by a pain management doctor.
09:42 Radiofrequency ablation relieved 80% of the pain in most patients for an average of 10 months.
10:04 If medial branch relieves 80% of your usual pain most pain management doctors see that as the correct criteria to go ahead with radiofrequency ablation.
10:18 RFA is a temporary treatment and lasts an average of 10 months in those who get relief.
10:35 Is there a long-term solution to low back pain? Usually not.
12:07 Without treatment you are not likely to improve.
13:00 Spondylosis is the long-term changes to the spine associated with degeneration (not trauma).
13:28 Look for a pain management doctor who is board certified in anesthesia or PM&R, and who specializes in pain management.
15:02 Prior MRI when available is helpful to determine how long a problem has been present.
15:34 You can always request a comparison of your current MRI to a prior one just by requesting it.
16:52 You've got this!
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