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Does S1 veterbra,dessicated L4/5 disc and sagittal bulge at D11/12 require a surgery?

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Practicing since : 2002
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I have transitional S1 veterbra, L4/5 disc is dessicated, sagittal bulge at D11/12, will I require surgery? Not cancer related or so I hope, had MRI scan of lower spine following lower back pain and sciatica. Findings were : transitional vertebra incompletely demonstrated on the coronals. On the axial image, illolumbar ligament meaning there is a lumbarisation of S1. At L5/S1 there is a right paracentral disc hernia extending into the right foramen. The L4/5 disc is dessicated and narrowed with a broadbased bulge with disc material extruded superiorly by about 6mm with erosion of the posterior inferior corner of the vertebral body consistent with this being longstanding. There is a small sagittal bulge at D11/12 but there is no effect on the chord. I am in so much pain, these results were from may 2012 and i was told to keep taking the pain killers, 18 months later i am still struggling, do i need surgery to resolve this?
Posted Sun, 26 Jan 2014 in Cancer
Answered by Dr. Robert Galamaga 36 hours later
Brief Answer: Considerations Detailed Answer: Thank you for submitting your question. I can appreciate that you must be in a great deal of pain and discomfort, and I am sorry to hear about this. Generally speaking, disc herniation can be managed with rest, with medication (pain relief and anti-inflammatories), with physical therapy, and in some instances with surgery. In your particular case, there are multiple foci of herniation and a multi-modal approach would likely be optimal. In order to most accurately determine if you are a candidate for surgery or strictly medical management, a thorough physical examination and review of your imaging is needed by a neurosurgeon who can also take into consideration your past medical history. It is unfortunately impossible to definitively predict the need for or outcome of back surgery in any patient without the physical examination and considerations of the above factors. If you believe that your condition is not being managed properly or that your concerns are not being addressed, I encourage you to seek another opinion from a neurosurgeon in person. I wish you all the best and hope the new year begins a journey to relief of these symptoms. Sincerely, Dr G
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