Conversation: The conversation between human and AI assistant.
[|Human|] Mri shows broad base disc buldge at L3 L4 with a annular tare that indents the the al sac. L4 L 5 broad base disc buldge with thickening of the ligamentum flavum causing mild narrowing of the spinal canal with facet arthropathy the same at level L5 S1. Do i need surgery I have pins and needles in both feet and pain in back
[|AI|]  Hello. Thanks for asking from Chat Doctor. I can understand your concern. In case of disc disease, surgery or conservative treatment decision is made based upon multiple factors. MRI findings are correlated with clinical profile of patient, patients dedication to follow precautions before and after surgery, physiotherapy. Now in your case, I will give you some knowledge and insight of disc disease. Based on that you may be benefited regarding management of your disc problem. As you have disc bulge at three level, it might be due to your age (if it is more than 60 years, chances of disc bulge is unto 35-40%), your occupation (heavy weight lifting or keeping spine in flexed position for long duration). Now if you are less than 60 years, active, having no other illness, then you should consult doctor and get your neurological examination done. The doctor will examine your pain site, any radiation of pain from back to posterior part of lower limb. It is due to nerve compression from disc. Doctor will evaluate your urine, bowel and sexual function for any deficit. He/she will examine you for sensory loss in L4/L5/S1 territory which is your front aspect of leg and plantar aspect of your foot. After that, your lower limb power will be checked. If there is any deficit, then it will be correlated with MRI findings. It is known as Clincio-radiological correlation. Based on it, you will be advised painkillers like pregabalin/Gabapentin, nerve vitamins like B12, folic acid and/or surgery. If you are >60 years, bedridden, having morbid illness like heart disease and not active, then you will be advised medical management most probably. Usually, disc surgery is advised in case of focal deficit caused by nerve compression from disc, acute disc with focal deficit, no relief in articular pain even after full dose of painkillers after 6 weeks of therapy, disc herniation with unstable spine and patient is fit to undergo surgery and follow post-operative advise. You are having diffuse disc bulge at L3-4, L4-5 and L5-S1 which is usually not treated by surgery. Mostly, disc extrusion or migration are managed by surgery. But final decision can only be made after complete clinical evaluation. Meanwhile, you should avoid weight lifting, avoid forward flexion, travelling long distance, prolonged sitting. Thanks. Hope it will help you. Take care.