This is the final in a three-part piece looking at sciatica, the pain affecting the back, hip and outer side of the leg, which is caused by compression of a spinal nerve root in the lower back.

IF an MRI scan does not distinguish between a favourable and unfavourable outcome, how should a doctor and patient make the decision on whether to have surgery? Here are five guidelines that have served me well over the years.

You have persistent pain that you can no longer tolerate, and it is unresponsive to medication, physical therapy and a prolonged period of conservative therapy, such as chiropractic. Still, give it a little more time. You cannot reverse the effects of a botched surgery and there is no guarantee that surgery will correct your problem.

If you have a true, referred surgical case, then the planned surgery must correlate with the end anatomic location of your symptoms. Far too often I have seen patients have surgery on an area that is unrelated to the location of their radiating complaints. Surgery that is performed for low back pain without leg pain that goes all the way to the feet or toes is fraught with difficulties.

If you have “progressive” weakness or atrophy, this may suggest that there is increasing pressure on the nerves that needs more immediate attention. Weakness in and of itself is not an absolute indication for surgery, however.

Many people have numbness, tingling or some loss of sensation in their leg. This does not automatically require surgery and frequently does not resolve with surgery. The key here is whether you have a progressive loss of sensation or a sudden neurological change that needs immediate attention.

The rapid onset of bladder or bowel symptoms may be a neurological emergency that needs immediate surgery. If you have chronic back or leg symptoms and then develop problems urinating, for example, then this may need immediate attention.

The next time your are lying on your back, encased in an MRI machine making clanging and banging sounds from another world, keep in mind that the amazing pictures your doctor will show you of your back are only part of the story. Remember that there is no such thing as “good as new”. We each only receive one brain, spinal cord and spine. It is our responsibility to take care of it and to maintain it. The simplest way to do so is preventative maintenance using chiropractic care; however, if you do have these more serious symptoms develop, try the more conservative methods first. A competent chiropractor will make the connection and the professional referral if you are a true surgical candidate. A chiropractor, or chiropractic physician/neurologist, who refers you to an orthopaedic surgeon (such as on the first or second visit) without ever touching your spine, or without giving it an honest go with a conservative treatment plan, should be avoided even more than the surgeon who is ready to put you under his knife at the drop of a hat. Keep in mind, if you go to a plumber, he will recommend and sell new plumbing. If you go to someone who has a financial interest in the plumber, he will also recommend new plumbing. And, if you go to a surgeon or someone who has a vested interest or relationship with a surgeon, well, you get the idea.

So, finally, what is an MRI good for if it does not definitively indicate the need for surgery? Well, it is good for evaluating soft tissues that do not show up on X-rays, and it is mostly good for about $80,000 to the imaging company (for a full scan), as well as the doctor referral reward and the radiologist’s pay to read the films and produce a report. A doctor usually makes the call for surgery based on the MRI report and the insurance coverage almost solely, along with general subjective back pain complaints. There is huge financial incentive in obtaining a positive report, coupled with a patient who is desperate and happens to have good insurance coverage.

Want to know if you have a disc herniation, for free? Did you hear a pop when you bent down to pick up that heavy object? Did you have instant debilitating pain? Did it bring you to your knees? Did the pain radiate down your legs to your feet? Is the pain and radiation increased or reproduced when you bend forward to touch your toes, when you cough, sneeze or have a bowel movement? If you answered yes to all of those questions, then you almost certainly have a disc herniation that is putting pressure on your spinal cord, nerve roots or sciatic nerve. If not, then you probably do not have a true sciatica from a disc herniation whether a herniation is present or not.

I once had a patron who presented to my office that said he was prescribed a fancy Doppler Echo Sonography (sounds impressive — and expensive) to assess the patency of his vertebrobasilar arteries. I believe at the time, this test cost around US$1,000. Today, at a large hospital it can cost over US$2,000. I sat him down and performed a simple vertebral artery insufficiency test that took less than two minutes and was able to inform him with near certainty that he most likely did not have an insufficiency. Then I asked him for half of the money he was prepared to spend on the expensive diagnostic test. We had a good laugh and proceeded to begin his chiropractic care regimen, which in total was far less than that one diagnostic test his doctor was prescribing.

At the very least, if you are being pressured into invasive procedures or costly diagnostic testing, get a second, or even third opinion. You will probably be pleased and assured you did.

Whether you have a disc herniation or not, your best bet for overall wellness and decreased symptoms, including sciatica, is to ensure that the intervertebral foramen are aligned properly and have the most space and symmetry for the nerve roots to exit the spine. This is anatomical common sense. Only your chiropractor can assist your body with this effectively and safely. Make your appointment today and you could very possibly avoid expensive, horrifying, invasive, and even unnecessary surgical procedures and change your life for good.

Don’t forget to “Ask Your Chiropractor” every week where your questions may be published and answered in subsequent articles. Address questions to: Dr Chris Davis, the Spinal Mechanic at movethebone@gmail.com; or, Dr Michael Harvey, director, at dr.michael_harvey@yahoo.com