90% of these patients get better over four to six weeks. They may have recurring episodes, they may have deterioration. As I talked, patients with spondylolisthesis, instability, 33% will worsen overtime, 33 will stay stable, 33 will get better.
So patients who are presenting with pure axial back pain and no leg pain, usually have to be treated non-operatively. These patients are not good candidate for surgeries. If they don’t have any radiculopathy, even if they have a combination of both. The radiculopathy will be more substantially treated with a surgery rather than a back pain. And they may have persist to have back pain, despite all measures.
So if the patient who has presented with axial back pain and an MRI shows one level of disc desiccation, a black disc, single disc or maybe two sometimes. And then we put them on a very rigorous physical therapy program and they have to fail that program for three to six months.
Then we have a counseling with them that this can be treated surgically, which is a fusion surgery for them because it’s just a black disc that is causing it. But there’s no guarantee on this because many of these patients will not get better, despite doing any surgeries. So we tend to stay away from these surgeries, unless there’s a very compulsive reason to do that.
