Should I Expect My Primary Care Physician to Recommend Surgery for My Disc Issue?
I am a 27-year-old woman, measuring 5'4" and weighing 185 pounds. My recent MRI results reveal the source of my intense lower back discomfort: a 6mm extrusion of the L4-L5 disc, accompanied by mild central canal stenosis and constriction in the right subarticular recess. Additionally, there is a slight bulge in the discs at L2-3 and L3-4. For the last month, I have been enduring excruciating pain on my right side, extending to my hip, leg, and pelvis. This situation has significantly impacted my mobility, necessitating the use of a cane for support. Transitioning from sitting to standing or bending over to lift objects has become particularly challenging. Prior to the MRI, my primary care physician prescribed Flexeril and a brief course of oral steroids. The steroids provided the most relief, and while physical therapy has been suggested, the clinic is currently overwhelmed with patients. I am leaning towards opting for surgery. My mother underwent her first spinal surgery at just 15 for a herniated disc and had another procedure at the age of 20. Though the only diagnosis I’ve received so far is hypermobility, I have a strong suspicion that both my mother and I may have hypermobile Ehlers-Danlos syndrome. Unfortunately, numerous visits to rheumatologists have not yielded any helpful insights. My primary concern is whether my PCP would be inclined to issue a referral to a neurosurgeon, or if I would be required to endure conservative treatments for an extended period first. Additionally, could this situation serve as another sign pointing towards hEDS?
Answers (1)
9/5/2025, 4:20:40 AM
OpenHealth AI
It’s understandable to feel anxious about your back pain and the possibility of requiring surgery. Let’s break down your situation to help clarify what you might expect from your primary care physician (PCP) and your next steps.
Main Points:
- Surgery is typically a last resort for disc issues after conservative treatments have been tried.
- Your current symptoms and MRI findings suggest significant pain and mobility impairment, which may prompt a referral for further evaluation.
- Based on your family history and symptoms, consider exploring the possibility of hypermobile Ehlers-Danlos syndrome (hEDS) more thoroughly.
Explanation:
Your MRI shows a 6mm extrusion of the L4-L5 disc, which can cause nerve compression leading to pain down your leg. The fact that you have intense pain, reduced mobility, and the need for a cane indicates that this is affecting your daily life significantly. While surgical options can be effective, they are often considered only after other treatments have failed.
Your PCP might first want you to try physical therapy, even though access may be delayed; this is typically part of the management plan unless your condition is very severe. However, given your debilitating symptoms and your past experience with steroids providing relief, your PCP may indeed consider a referral to a neurosurgeon sooner than usual.
Next Steps:
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Communicate Your Concerns Clearly: Schedule a follow-up with your PCP and express your ongoing pain, functional limitations, and desire for possible surgical consultation. Make sure to highlight how this affects your quality of life.
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Discuss the Referral: Ask your PCP specifically about a referral to a neurosurgeon. Emphasizing the impact of your condition on your daily activities may expedite this process.
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Explore Symptoms of hEDS: Since you suspect hypermobile Ehlers-Danlos syndrome, prepare to discuss your family history and any related symptoms you may have with your doctor. This may help you receive a more comprehensive evaluation that addresses the connective tissue aspects of your pain.
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Focus on Pain Management: In the meantime, continue with pain management strategies. Over-the-counter medications like ibuprofen or acetaminophen may help, if permissible for you, and consider light exercises that do not aggravate your pain, if possible.
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Seek Support: Connect with support groups or online communities for people with similar conditions, which may provide you with valuable insights and coping strategies.
Taking these steps can help you engage proactively with your healthcare team, ensuring that your concerns are addressed effectively.
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