I have chronic low back pain. The MRI has shown herniations in L4-L5 and L5-S1 intervertebral discs. Do I have to be operated?

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 19 June, 2011

If pain is localised low in the back, with potential radiation to the buttocks and posterior or/and lateral surface of thighs down to the knees and in some rare cases even lower, then three are the most probable causes of chronic lumbar pain:
1. Facet Joint Syndrome
2. Sacroiliac Joint Pain
3. Intradiscal Degenerative Disease (not necessarily with herniation)

After taking the patient’s medical history and clinical examination, the specialist physician can suspect the probable aetiology based on the findings.
A safe diagnosis is set by applying minimally invasive techniques, such as diagnostic facet joint block, intra-articular sacroiliac injection of local anaesthetic and discography. Firstly, the physician has to examine whether pain is due to the facet joint syndrome  or sacroiliac joint and lastly investigate whether there is potential intradiscal degenerative disease.

As a conclusion, it is not herniations shown in the MRI that actually cause the patient’s pain and, therefore, their surgical removal will not solve the problem but, on the contrary, may even aggravate it.

In any case, you should always discuss with your physician in order to take together the proper decisions.