My approach to spinal disorders in adults is quite different than children. It needs to be approached first by the cause of the problem. Back pain versus leg or arm pain versus spinal deformities like scoliosis and kyphosis (round back).
It is essential, particularly in adult spinal disorders, to understand the cause of the problem. Most x-rays and MRIs of adults have abnormalities such as bulging discs and arthritis. The crucial part is to understand which, if any, of these abnormalities seen is causing the pain.
Surgical intervention is always the last resort with exercises/physical therapy and injections being the first line of treatment. This is not the case when one has an acute neurologic deterioration such as severe weakness. In those cases, surgery is often urgently needed.
Most herniated discs can be treated with medications both a steroid for a short period of time and anti-inflammatories. As well, physical therapeutic exercises can often shorten the duration and lessen the pain. If the pain is unremitting for more than approximately 6 weeks or if the herniated disc is associated with muscle weakness then a microdiscectomy may be indicated. This is performed usually as an outpatient procedure with a one inch incision and under a microscope I remove the loose disc that is pressing on the nerve.