I hope that your fiance was seeing a neurosurgeon and not a neurologist as you stated in you post.

A neurologist is not the kind of doctor that he should be seeing for spinal problems.

I would not assume that the PCP is correct with what he said. He is only reading a radiology report about the MRI.

The reading is only 1 opinion on the results and many times you can have more than one radiologist or spine specialist read the report, look at the MRI pics and have a different diagnosis.

Basically, a herniated disc is just a larger bulge in a disc. the larger the bulge the better chance that some of the disc material is coming out of or has come out of the disc and can be irritating the nerves.

Your fiance's symptoms sound more like the herniated disc at the L5 is pressing on the nerves in the area and causing his pain.

That doesn't mean that he isn't having problems from the L3 and L4 as well though.

Only a spine surgeon can tell you if or when he will need surgery.

The rule of thumb though, is to start with conservative measures to treat him, unless there is a serious concern or evidence of severe nerve involvement, serious weakness and impending paralysis or partial paralyis, or bowel and/or bladder issues such as any loss of control.

Many insurance companies will not authorize any type of surgery without conservative treatment first unless the above issues are present.

Conservative treatment would include anti inflammatory medications including steroid given orally, ibuprofen, also a course of physical therapy to strengthen the core muscles and learning proper body mechanics and posture, and a round of Epidural steroid injections. Also ice and heat treatment, message and maybe ultra sound treatment, and several other possibilities.

Surgery would be discussed if he has no relief with conservative measures.

The type of surgery would depend on a full evaluation and diagnosis from a spinal surgeon.

It could be that only one level really needs something done and it could be more.

Fusion should be the last choice for surgery and the latest information now show, that instead of the gold standard of laminectomy being done, that laminotomy is the choice of surgery.
Unfortunately there are still many doctors that still perform the full laminectomy and that is not a good idea. It leaves the spine with a high risk for becoming unstable.

Either way, if surgery is the choice suggested by a spinal surgeon, it is very important to get at least one other opinion and I would get several of them before opting for the surgical route.

I would also search out for a spine surgeon that is open to and experienced in doing laminotomy instead of laminectomy.

No doubt, you will find that the suggested treatment will be the conservative route first and then go from there.

Good luck and keep us posted on how the doc appt turned out.

Fran