I’m Juan Bartolomei, MD and I’m a spine neurosurgeon at Yale who believes that surgery should be absolute last resort and have founded a comprehensive spine program in Texas. AMA!

Do you believe chiropractors are actually helpful and generally well-trained, or do you believe the field is poorly regulated and risky?

Thanks for your question! My personal opinion is that I do believe chiropractors can be helpful.  My understanding is that the field is well regulated by state and national boards.  I have seen excellent results in some of my patients after other treatments have not helped.

With the prevalence of scoliosis (6+ million in the US), why has there not been a better treatment developed yet? I grew up in Boston, one of the best healthcare systems in the country, and still received outdated treatments like rigid bracing. Do you foresee new/more effective treatments becoming available in the future?

Thanks for your question! The field of scoliosis has certainly changed over the past 20 years.  We are able to understand better who needs to be treated and what stage in their lives.  For children, there is new technology that allows the metal rods to expand as the spine develops.  For surgery today we have specialized navigational systems and robotics that allow the surgeon to accurately place the screws with incredible precision, less trauma to the muscles, and less blood loss.  This has allowed for faster recovery and less time in the hospital. I hope that over time, we'll see even more improvements to treatments.

What are your thoughts on Stuart McGill and his approach to healing an injured back?

Also seeing that your in south lake, what are your thoughts on Dr. Riroden’s stem cell approach to disc injuries and Regenokine for disc injuries which is offered by Life Span Medicine. Both clinics are located in Dallas.

Thanks for your questions. I have not read his book. My advice to my patients is that it does not hurt to learn different techniques from different approaches. However, I also advise my patients to be careful and listen to their bodies. In regards to your 2nd question, I left South Lakes several years ago and I am not familiar with the other treatment options that you alluded to.

"believes that surgery should be absolute last resort"

Why?

Thanks for your question! After 20 years in practice, I have learned that there are certain conditions on which surgery can be avoided.  Clearly, this depends on the patient's neurological examination and whether there are any deficits that could be irreversible if surgery is not performed early. Conditions such as neck pain or back pain can sometimes be alleviated without requiring surgical intervention with the help of a good team.

I have a bulging disc between C5 and C6 that my doctor said I should get surgery to fix. It pinches a nerve causing extreme pain and making my left arm numb at times.

What possible alternatives are there to surgery as a permanent fix are there?

Thanks for your question! There are conservative measures available involving a combination of physical therapy and/or an evaluation by a pain specialist or a specialty physiatrist that can provide you with injections to help controlled inflammation. Hope that gives you some options to think about.

What could happen when you slouche every day for 20 years?

Thanks for your question! One of the problems with having a bad posture is the potential development of permanent changes in your spine that can lead to further problems.  I would certainly recommend consideration for an evaluation by a therapist to help you develop a strengthening program and correction of your posture.

About 4 years ago I started having severe leg pain. I was mis-diagnosed with sciatica and given pain killers (which i didn't/couldn't take). I went to a different doctor who actually ordered tests (xray/mri) and was told I needed surgery immediately. By this time, I could barely walk (had a cane and could only handle about 10 steps without needing a break). I went for a second opinion with a recommended surgeon who was absolutely phenomenal (both pre/post surgery) he agreed I needed immediate surgery. I was wheel-chaired into the hospital on a friday and walked out of the hospital later that night. I had a double laminectomy. I've since recovered 100% of the muscle loss since my leg atrophied and have been fine until a couple weeks ago. I'm starting to get the same symptoms that I had pre surgery (although not as severe yet). Is there anything that can be done to avoid having to go through the surgery again if what is going on now is a relapse?

Sorry to hear about your experiences! I would certainly recommend that you are evaluated by a therapist to help you guide based on your needs, strength, and weakness in a program to strengthen your core that you can perform on a daily basis for the rest of your life.  Also, stretching exercises can make a big difference to prevent scar tissue from tethering your nerve.  I would certainly recommend that avoid impact type exercises that could lead to further loading of your discs and joints.

For scoliosis and spinal fusion corrective surgery, could you expand on your meaning of “necessary”? Would you consider pain the driving factor or something such as symmetry or the curve(s) being >50 degrees?

Thanks for your question. There are multiple things that we look for in regard to corrective surgery.  Things that take high importance on our list is the neurological condition of the patient. There are certain conditions in which the patient can have lower extremity weakness or significant stenosis that can lead to bowel bladder dysfunction. Pain clearly also is a factor as well as the degree of curvature. 

Thank you for your response. My 13 y/o son has an S curve with a 49 degree thoracic curve and a 53 degree lumbar curve. He has no pain but after getting several opinions from different orthopedics, we are scheduled for spinal fusion surgery. Based on his curvature, I understand surgery may be the best option, but it’s difficult to make the decision knowing that he will have lifelong discomfort/pain when there isn’t any now. Appreciate your time and decision to answer questions!

I understand your dilemma. Younger patients tend to do much better following scoliosis surgery. It is also great that you seek several opinions.

Which is more primarily the cause of scoliosis, genetic predisposition or trauma/other environmental factors?

Thanks for your question. We do know that there is a potential genetic predisposition for developing scoliosis. As we fight time and gravity there is a lateral loading against our spine and disc that can contribute over time to degenerative changes that are commonly seen.  Somebody with underlying scoliosis has increased loading at certain points in the curvature that can further advance the curvature later on.

What do you think about ASC surgery for scoliosis ? In my opinion it’s the most advanced surgery for scoliosis to date , and has fewer disadvantages compared to traditional fusion. Also do you believe that curves can be reversed somewhat if the right treatment is applied ?

Great questions. Scoliosis surgery performed at an Ambulatory Surgical Center (ASC)  depends on how many levels are being fused. The longer the scoliosis segment the most likely that the patient will need several days of recovery and perhaps an ASC might not be the best place to perform this type of surgery. I believe that the future will give us advanced technology where we will be able to perform these surgeries on a more routine basis at an ASC.  Regarding your 2nd question, there are instances in which scoliosis can be detected early on in childhood and bracing can help.

I believe he was referring to anterior scoliosis correction, not ambulatory surgery centers.

Apologies for the misunderstanding. There is actually a movement to move these types of surgeries into Ambulatory Surgical Center. In regard to your question, depending upon the location of the curvature and whether there is anatomical access to the spine, anterior surgical correction can be beneficial without having to provide posterior support.   This approach is also helpful when scoliosis is more mobile, particularly in younger patients.

Hi Doc! I have a few questions. What are the common long term outcomes of spinal fusion in scoliosis patients? What are the reasons you feel it should be utilized as a last resort? What are some ways to keep pain to a minimum if one has had a spinal fusion? Also, when a corrective surgery IS performed on a scoliosis patient, why are they not corrected to a higher degree? (Mine was corrected to 22*, I’ve seen many others who have have corrective surgery and it never seems to be corrected so that the spine is straight or nearly so) Lastly, as a top specialist in your field, do you feel that research supports the use of bracing? What other tools are utilized to avoid surgery?

Thanks for your questions! I may not be able to get to all of them, but I'll try.

What are the common long term outcomes of spinal fusion in scoliosis patients?

Some of the things that we tend to consider when we do surgery for scoliosis and fusions are what happens to the adjacent segments above and below the fusion. it is known that any alterations of the spine can lead to potential increase loads at the level above and below the fusion that perhaps might require an extension of the fusion over time.

What are the reasons you feel it should be utilized as a last resort?

What we cannot predict after any type of surgery is the ability to control pain 100%.  I usually recommend to my patients is that all conservative options are exhausted.  Also, depending upon the patient's medical condition there are associated risks that have to be taken into account.

What are some ways to keep pain to a minimum if one has had a spinal fusion? 

I believe in the importance of having a strong muscular core with the help of a physical therapist.  I also will try to avoid impact exercises such as jumping or running or lifting heavy weights.

Also, when a corrective surgery IS performed on a scoliosis patient, why are they not corrected to a higher degree? (Mine was corrected to 22*, I’ve seen many others who have have corrective surgery and it never seems to be corrected so that the spine is straight or nearly so). 

Scoliosis surgery requires a significant amount of leverage and force. In some instances, the patient's anatomy (significant arthritis) does not allow the surgeon to provide a complete correction. Some patients' spines are more mobile and require less force to be corrected.

Lastly, as a top specialist in your field, do you feel that research supports the use of bracing? What other tools are utilized to avoid surgery?

Bracing can be used on younger spines that tend to be more mobile and malleable.  As we age, unfortunately, the arthritis that we develop makes our spine stiffer and in my opinion, bracing might not be of benefit. Having a good weight and a strong core can sometimes help alleviate some of the musculoskeletal pain that patients may developed with scoliosis.

Hope this helps! :)

What are some exercises or good habits we can start now to either avoid or help fix neck/back problems from sitting in front of a computer all day?

Great question! Always try to take a break between 30 to 45 minutes. Make sure you are always sitting up straight with good support in your neck and try not to slouch.

What is the best way to treat nerve pain while its healing without pain meds. I understand nerves heal about 1mm per day. When there is a lot of nerve healing to do, what do you do in the meantime?

Thanks for your question. The concept of a nerve growing 1 millimeter per day is applicable when you have transection or cutting of the nerve itself.  In most instances whenever we deal with nerve pain is usually from nerve irritation rather than transection of the nerve. There are medications such as steroids that can bring the inflammation down in some instances a can help with the pain. However, steroids over a prolonged period of time can be deleterious to your health. there are other medications such as gabapentin that can help with nerve pain.  Please refer to your doctor regarding which medication can help you the most.

I've had lower back pain for years now, pain will flare up if I'm sitting for a long while or bent over/ stooping for an extended time, it will flare up really really bad twice a year at most with extreme pain where I cannot move, because any movement will cause extreme pain, I does have to rest until it subsides. I'm at a point now where I always have to be aware of my posture, do you have any idea what is causing this? And can this problem be solved without surgery?

Thanks for your question! Your pain could be related to musculoskeletal dysfunction. Musculoskeletal conditions can be related to a malfunctioning or irritated joint, tendon, ligament, or muscle.  My best advice would be to consider a daily exercise program guided by a therapist that you can perform and condition your core. Another important point that I try to make to my patients is to do these exercises even when you are not in pain.  We tend to perform these exercises only when we have pain. Good luck!

Thank you Dr Bartolomei for doing the AMA!

What's your take on the current fad of standing desk. Is sitting down while working really the smoking of our generation?

Thanks for your question! It is important to take intermittent breaks after periods of sitting down. I think that the flexibility that the new desks provide could be advantageous to some patients. As one patient told me once, "If you rest, you rust."

What are your thoughts on alignment-based yoga therapy for the long-term treatment of low back issues (eg bulging discs)?

Hi there, I highly support and recommend yoga for patients (as long as they can tolerate it without pain).  I believe that the benefit is mostly to create a strong core as well as the flexibility of the joints that can lead to a stronger spine.

What would be your top tip(s) to avoid spinal issues as much as possible?

Great question. My advice is to not smoke, control your weight, maintain a healthy lifestyle (with good nutrition and exercise), avoid impact exercises that load her spine such as heavy lifting or excessive running. Always maintain a strong lumbar and cervical musculature core.

Do you think surgical outcomes for fusion will improve? Or will we see any alternative methods any time in the near future?

For context I'm a 25yo male with spondy. I've been avoiding surgery for two years but the pain permeates every aspect of my life and I'm wondering if I can hold off for 5-10 more years, will I see better outcomes

Thanks for sharing your experience. In the past 20 years, I have seen significant changes on the way that we treat patients who undergo a fusion. One thing that we have learned is who to operate on. Every condition is different and is difficult to generalize with significant precision who will do better. Patients with instability as well as narrowing of the canal and with significant leg pain tend to do much better after surgery involving a fusion.  In my opinion, the longer you can wait the better, but we can't predict a patient's outcome based on future analysis and outcomes research.

In your experience, what is the best way to control pain following spine surgery?

I'm a PACU nurse and our spine patients almost always come out rolling in pain. I feel like something in our management of these cases is very inadequate.

This is a great question.  In my personal experience working with different hospitals, I believe that anesthesia and the agents used during surgery can make a significant difference.

I've had multiple posterior fossa decompressions, cervical laminectomies, fused occiput to C5, and detethering L2-5 with Tarlov removal. I have been unable to bend at all for several months due to severe lumbar pain in the area that was detethered. I moved 1700 miles this year and don't have another doctor yet. There is right leg weakness and bladder issues (previous mesh surgery). Is it possible for this to just be scarring causing issues? Is it possible to retether?? I have Ehlers-Danlos and am afraid of yet another surgery, as complications are such a problem with EDS.

Thank you.

I am sorry you are going through this.  I would recommend that you obtain an MRI with and without contrast of the lumbar to assess whether not you have retethered your spinal cord and seek a spine specialist for further recommendations

What about scoliosis curves >50-60 degrees in young adults as they will slowly progress over time? Is there any real alternative to fusion given they could end up >100 degrees in older age?

The current information that we have today suggests that perhaps scoliosis could progress over time.  Clearly, close follow-up is important, and if there is ongoing progression perhaps surgical intervention would be of benefit.  Young spines are much more prone to be corrected with current scoliosis instrumentation.

Any chance stem cell treatment will be approved by the FDA any time soon?

From what I have followed over time,  I am not aware of any good clinical trials that are presently being done to promote the use of stem cells for regenerating degenerative discs. I'm hoping that this will change. I am not aware of any current big industry focusing on this line of research

Wish I had seen this earlier. Hopefully I'm not too late.

What would you recommend for someone with a thoracic herniation that's already two minimally invasive surgeries? I know it's not common but maybe you have some ideas.

Unfortunately, I cannot provide any conclusive recommendations since the treatment really depends upon your clinical symptoms.  In other words, do you have shooting pain along the nerve being compressed or is it mostly thoracic spine pain?

My father has degenerative disk disease or something like that. He has had multiple fusions in his lower back. The first or second worked really well and relieving the nerve pain in his legs. It was somewhere around a year or so after that he began to experience the same pains that gradually ended up leading to worse pain. Apparently he scars up really bad which caused more pressure on nerves or something like that. The last fusion surgery on the next vertebrae up from the previous fusion did not help at all. If anything he says he is worse.

He has told me he regrets ever having surgery and won't ever have another. He swears that the scarring is one of the biggest issues.

He had a knee replacement after his last fusion and days it worked great for 6 montha before his range of motion went away. Again he swears it the scarring.

Is excessive scarring a common issue in spinal (or any type) of surgery?

Unfortunately, scar tissue around the nerve is one of the consequences of any form of spine surgery. In regards to his back condition, it might be appropriate to be evaluated by a pain specialist or physiatrist who perform spinal cord stimulator implantation to see if this can help with his condition. The technology of spinal cord stimulators has significantly changed over the past 10 years and it might be something worth exploring.  

I'm an internal medicine physician. Apart from obvious red flags like incontinence, saddle anesthesia, etc what are times when recommend I should think about referring a patient with chronic radicular back pain to a surgeon?

Any signs or symptoms that are suggestive of a pinched nerve, in other words, radiculitis that is causing focal neurological deficits such as a foot drop (weakness lifting foot), deltoid weakness (inability to raise the elbows above shoulders). In the elderly a potential axial loading fall that can cause a compression fracture, signs of myelopathy (compression against spinal cord) that could manifest with gait instability, abnormal hyperactive reflexes, and a Hoffmann sign.  Also, patients with a known history of malignancy that complain of increasing axial spine pain should raise concerns for obtaining an MRI to rule out metastatic disease.

Have you seem Jennifer Brea's case (from the Unrest documentary on Netflix)? And her Medium posts about her subsequent recovery after she was finally heard by a doctor? It took 8 years of her life.

Why is there so much malpractice, so much pride and arrogance in such field?

I am afraid I have not seen the documentary, I will put on my list to watch. Thank you for the recommendation.

What are your thoughts on microlaminectomy? I have scoliosis and developed stenosis at L4/5. I have tried PT for years, incl Schroth. It has not helped my pain. I don’t have leg pain but an epidural eased my pain so we are fairly certain nerve compression is the cause. I’m 38F, avid dancer and athlete.

In my opinion, when I see patients with your condition, we have to take into consideration the curvature and where most of the fulcrum of the curvature lies. If most of the forces are placed at the (in your case) L4/5 junction then a microdiscectomy can change the dynamics of the curvature that can exacerbate your nerve compression.  Based on your question it seems that your symptoms are mostly back pain and in my experience, a microdiscectomy might not be a solution to your back pain.

I’m sure I’m too late for this but my friend has two compressed disks in his lower spine causing excruciating sciatic nerve pain. He’s on heavy duty pain killers and they are suggesting surgery. Is it likely he could address this any other way? He wants to avoid surgery but is completely debilitated and has a young son to take care of.

Unfortunately not being able to fully assess the imaging findings with a clinical exam I cannot provide an appropriate treatment plan. In the absence of any significant neurological deficits which has to be determined by the primary treating physician, I would certainly recommend consideration for conservative measures first.  But again, it is difficult for me to assess with the current information.

Ever forgotten a sponge inside a patient?

No. There are very strict protocols and processes to avoid these types of situations in the operating room to ensure that these types of mistakes do not occur.

Hi Dr. Bartolomei. Thank you for doing this AMA.

I've recently been diagnosed with scar tissue around my nerve root after my second surgery for my L5S1 herniated disc. The scar tissue is what's causing me pain and numbness. What would you advise I do in my situation? Is there an effective treatment for this?

Secondary: do you know of any helpful scientific articles or specific keywords I could search for about this? I want to educate myself more on what's happening inside my body.

Thanks in advance.

I am sorry you are in pain. Unfortunately, scar tissue is one of the complications that could be severely disabling and is hard to predict or prevent.  Not being able to examine you or review your imaging makes it difficult for me to provide you with accurate guidance.  I certainly would recommend that you research spinal cord stimulation. This is a procedure where a pain specialist places a very thin wire behind the spinal cord and stimulates the spinal cord with electrical impulses that can sometimes help alleviate leg pain caused by scar tissue after surgery.

Have you seen anything promising in regards to stem cells for treatment of degenerative conditions of the spine?

In the early 2000s there were some technological advancements and studies that were being performed to regenerate the disc with stem cells.  Although there was a lot of hope, unfortunately, some of these did not reach clinical trials or approval and moreover, the insurances did not cover them.

Assuming conservative treatment fails what are your indications for stabilisation surgery based on clinical picture aswell as MRI imaging?

In my personal experience as well as what the medical literature has revealed, if the patient has a slip or evidence of instability between 2 vertebrae in conjunction with leg pain and back pain, fusion seems to be a better option when conservative measures are exhausted.

What's your opinion on a pars repair (pedicle screw & lamina hook) for spondylolysis instead of a spinal fusion? Do you feel this is a good long term solution?

It depends on whether the fracture is acute (recent)  or chronic. If the pars fracture is acute within a month or so, then perhaps surgical repair as you describe could be beneficial.  

What do you believe should be the protocol in treating a ruptured disc prior to making a decision about surgery? What do you think at PRP therapies?

The decision is based on clinical presentation. If the ruptured disc is compressing against the nerve and there is weakness and significant pain as a result of the compression then the surgery could be considered. In regards to PRP therapies,  I cannot provide you with an accurate personal account since we do not perform these in our center.  

How long do you wait to see if conservative therapies help with pain and nerve compression? I have heard that people wait until there symptoms are greatly affecting quality of life where others wait 1 year to decide if they have significant improvement. Additionally, I have read that disc rupture size will determine outcome for both surgeries and conservative methods, could you elaborate based on your experience? If there is improvement in leg weakness and back pain to 85% functionality, do you recommended waiting to see when improvement plateaus before making a decision on surgery.

In my practice, I follow the patient very closely as they go through conservative measures.  If there are any neurological deficits such as weakness in the lower or upper extremities that are refractory to the conservative measures, I tend to offer surgical intervention. The important thing to recognize is that everybody's condition is different, and care has to be tailored individually.

Do you have recommendations for neurosurgeons that practice this way in the Philadelphia or New Jersey area?

Dr. Ali Ozturk at University of Pennsylvania and Dr. Michael G Kaiser in New Jersey are excellent doctors.

What conditions/complications have you encountered as a patient ages with a congenital non segmentation anomaly at c2/c3?

Can you specify exactly what you mean by nonsegmental anomaly?  Are you referring to a congenital fusion between C2 and C3?

Yes.

I know some studies discuss mental health issues and others describe physical symptoms.

A congenital fusion of vertebrae can potentially lead to accelerated degeneration at the adjacent levels due to the loads now being disproportionately shared among the levels above or below the fusion. Dependent upon the levels fused, symptoms might manifest by shooting pain down the arms from the narrowing of the canal.

As a physical therapist, I am always curious about a surgeon's take on the PT profession. The goal of PT is sometimes to help patients avoid surgery. In some areas of the country, it seems that surgeons are quick to offer surgical interventions without exhausting conservative treatments first.

What criteria do you use to determine if a patient needs surgery versus continuing on conservative treatments like exercise and postural correction techniques?

I personally consider myself extremely conservative.  Unless there are obvious signs of severe compression of the spinal cord with rapidly evolving paralysis, or excruciating pain in which the patient cannot participate in physical therapy, I tend to encourage all my patients to do physical therapy. My personal philosophy is that the better shape you are in before surgery the better shape you will be to bounce off surgery.  I also encourage all my patients to do the exercises that they learned during physical therapy for the rest of their life at home.

Do you know anything about metallosis from implants? Is it a real thing? How common is it?

Hi there, metallosisis is usually seen on implants where there is metal rubbing on metal such as in total hip replacement implants. In the spine, these are very rare since the implants tend to be rigid and nonmobile.

Hello, doctor. Thanks for stopping by the sub.

Question: for a patient that re-herniated within the 3 months post-microdisc L5/S1 when would you recommend a revision procedure? Would it be sooner rather than later so that scar tissue doesn’t complicate the issue or is it 100% dependent on symptoms?

In my case my MRI prior to surgery and post re-hern are identical. Yet symptoms are extremely different.

Thank you for your time and expertise.

Thanks for your question! I definitely would treat the symptoms.  I have situations in which a reherniation occurs after surgery and as long as the patient is able to tolerate conservative measures I would tend to hold off on surgery.  I have cases in which a reherniation with a disc fragment can reabsorbed on its own without requiring surgery.

Hi, I had a whiplash accident where my neck rolled over the seat rest. C5-C6 disc was crushed leading to referred nerve pain and cramping muscles.

I did ten years of "hard time" going to chiropractors, physical therapists, a physiatrist, pain management, opiate addiction, and I finally got disc replacement surgery last year. It had been 12 years of hell.

Hard time cost me my mental health in my 20s. Can you tell me why you think that surgery should be the last option when in cases like mine, it may have saved a decade of suffering?

I am very sorry for what you went through. It appears that you tried every conservative measure available. Sometimes neck pain from whiplash injuries can be very difficult to treat since the source can be from different generators other than the disc and that can be difficult to predict. I am glad that in your case surgery was successful.

Hello doctor, thank you for opening this AMA post. My question is, what cases would be that last resort to consider a surgery? I have spinal stenosis due to L4-L5 disc hernations.

Spinal stenosis has different degrees of severity.  In my practice, I tend to follow the patient closely through conservative measures. If the stenosis is such that it causes refractory leg pain despite conservative measures, I tend to offer surgery.

I've had sciatica from a bulged disc going on 9 months now and have had no success from PT, max gabapentin or acupuncture. I'm worried that my back will never heal and that I'm doing permanent damage to me nerve. Can my disc still heal after 9 months? How long does it take to permanently damage your sciatic nerve?

Sorry to hear you're going through so much pain. If you are suffering from leg pain due to the bulging disc compressing against the nerve, a potential option for consideration is injections before surgery.  Permanent nerve damage is variable among individuals and it depends on the severity of the compression as well as clinical symptoms. Sorry I don't have a more specific answer, but do speak to a doctor about your specific circumstance.

What's the best thing we can do to look after our spines? What should we encourage in children to ensure the best possible outcomes for their spines while they grow?

Healthy habits including body weight control, good nutrition, avoid excessive loading exercises, no smoking and avoidance of heavy extensive labor in the future. 

What are some of the most common injuries/problems you see in your field?

The most common problems that we tend to see in our field are issues related to chronic low back pain as well as neck pain.

What are your thoughts on Robin McKenzie?

In our prior practice, our physical therapists were Mckenzie certified.  We had very good success with the techniques that he developed.  However, I would say that everybody is different and not everybody can benefit from a particular modality.  It is always best to be evaluated by a therapist who can design a specialized program for each individual.

Hi doc, Could c-spine disc herniation (c4-c5,c5-c6) cause severe flatus all day long? what is the treatment?

Herniations between C4-5 and C5-6 usually cause discomfort in the shoulder or the hand if there is compression against the nerve root.  If there is significant compression against the spinal cord, some patients can develop problems losing control of the bladder and/or bowels. in my personal experience, I have not encountered the condition you describe. 

Does sciatica always have to be accompanied with bulging disc? Is bulging disc visible without x ray or MRI? What’s the best way to recover? Thanks so much in advance !

The technical definition of sciatica is irritation of the S1 nerve. Some people describe sciatica as shooting pain down the legs. To your question, sciatica does not need to be accompanied by a bulging disc. Sometimes there can be an inflammation of the nerve without compression. The best test to be able to visualize the nerves and disc is an MRI.  Depending upon the severity of your symptoms and imaging findings, there are conservative options involving physical therapy and/or evaluation with a pain specialist or physiatrist to discuss possible injections.