Jock Doc

Patient in severe pain from extruded disc. Is surgery the only treatment?

Q: I had lower back soreness and pain in my right buttock for about six weeks. It came on gradually and just persisted despite rest and anti inflammatories. I was able to function with most things till four days ago when my back pain improved but I started to have severe pain going down my buttock, thigh and calf. The pain became so bad that I had to go to the emergency room. They gave me a shot for pain and I got an MRI which showed an extruded disc in my lower back. I was referred to a spine specialist and I am waiting to get in. I am still in severe pain and wonder what an extruded disc is and is there any treatment besides surgery to get better?

A: The disc is a gelatinous shock absorber between the bony vertebra of the spine. The disc can be injured by trauma, repetitive stresses, or just by aging. The disc can bulge outward, herniate(rupture), or rupture and split away(extrude). If the disc material pushes on the nerve it can produce severe pain, numbness, or weakness where that nerve runs. There are many non-surgical options that can be tried such as medications, physical therapy, neuromuscular therapy and epidural steroid injections. I agree that you should see a spine specialist or neurologist as soon as possible. The physician will determine which nerve is involved and what treatments options are safe and effective. In some patients, the injured disc does not get better without surgery.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to