Spine Health & Slipped Disc Treatment

An L4-5 disc bulge in your MRI, assuming your MRI radiologist meant a small disc protrusion in his report, represents an ageing disc that has naturally lost its water content and its cushion and height with time, resulting in a bulge, like a bulging "worn out" car tyre. Because this is a natural ageing process, it cannot be reversed or “cured” and disc bulges can also be seen in MRI even if you have no back pain as you age.

In principle, low or non-impact "horizontal" exercises (swimming, yoga, etc) are safer for your lower back. You don't want high impact "vertical" exercises (running, racket games, etc) to stress your worn out L4-5 disc further ! Heavy weight lifting stresses your back too if done upright "vertically" better to do them lying down "horizontally" or without bending your back.

Depending on the severity/size (or Stage) of your disc herniation in both your clinical signs and in your MRI, Stage 3 (large, severe) slipped disc must undergo surgery to improve no other choice ! Early Stage 1 (small, mild) and Mid Stage 2 (moderate disc bulge) can be "managed" by physical therapy whenever it "acts up" but without surgery cannot be permanently "cured".

According to Ministry of Health guidelines, laser treatment is currently NOT a recommended treatment for spinal disorders in Singapore (unlike in USA). In fact, laser spine surgery is NOT even included in the Ministry of Health list of Table for Surgical Procedures for purposes of fee benchmark/insurance/medisave claims ! Please be aware of this and double check with your specialist again if you are recommended to undergo laser spine treatment as you may be charged under another different spine procedure instead (e. g. radiofrequency discoplasty "injection" which is NOT laser treatment !)

Microdiscectomy is the standard surgical procedure commonly performed when a disc needs to be removed usually because it is endangering a nearby spinal cord or nerve (e. g. if patient has worsening sciatica pain in his leg unable to walk). It combines both the advantages of physical removal of the herniated disc out of the spine (unlike radiofrequency discoplasty "injection") with minimally invasive approach reducing risk of collateral damage, pain, bleeding and infection because of a smaller incision wound, enabling patient rapid recovery (early return to home and work) after microdiscectomy.

Surgery is not commonly needed for all natural aging disc protrusions (like a bulging old worn out car tyre) - only 10% require surgery ultimately either due to intractable or worsening pain/disability. The majority 90% can be managed conservatively successfully and repeatedly with medications, physical therapy (physio, chiro, osteo, tcm), injections (including steroid, radiofrequency or "laser" disc-plasty) as long as the conditions do not worsen rapidly as they are being slowly and gradually managed.

It is very common to be told we have a "slipped" disc whenever an MRI scan is done for our back or neck pain. However its a "misnomer" layman's term as only a minority (less than 10%) of discs actually ruptured or "slipped out". This can cause dire consequences of compressing the adjacent spinal nerves or spinal cord, which usually necessitates open spinal surgery (not injections or disc-plasty "laser") to remove the offending EXTRUSION disc fragment. This helps to decompress and "free" the nerve or cord (like removing a "burst" car tyre in a car workshop).

Without knowing the details of your uncle's surgeon nor surgery, in general, recovery after disc surgery depends on: 1. neck or back surgery (longer for neck) 2. fusion or non-fusion surgery (longer if fusion implants are used) 3. more than one disc or just single level (longer if multi-level surgery) 4. standard open surgery or minimally invasive approach (longer if larger incision wound e. g. minimal invasive single level lumbar disc surgery can be discharged the next day) 5.