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Hip pain down leg, took epidural injection, done discogram, CT scan showed annulus tear and annular bulging. Surgery?

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Neurologist, Surgical
Practicing since : 1997
Answered : 65 Questions
Hi , I have bad pain in my left hip going down my leg , I had epudural injection done and it didn't help , I went to a spine surgeon and he sent me to get discogram , it was very painfull to the point that I almost jump out the table and almost take the needles out my back , I did cat scan after that and the result shows
L4-L5 contrast extended to the inner third of the annulus margins centered at the 8 o'clock position reflecting grade I annulus tear . There is posterolateral annular bulging bordering the thecal sac

At L5-S1 contrast extends to the posterior annulus margins eccentric to the right posterior aspect near the 8 o'clock position and extending from the 7 o'clock to 9 o'clock position ( grade IV annulus tear) . There is prominent posterolateral annular bulging at L5-S1 adjacent to the ventral margin of the thecal sac more to the right

1- L5-S1 shows grade IV annulus tear and prominent annular bulging .
2- L4-L5 shows grade I annulus tear and mild annular bulging .

My pain management doctor looked at the film and he said its grade 5 not 4 because it's completely ruptured and the XXXXXXX is going out
So my question is what kinds of surgery is done for this kind of problem thank you very much

Posted Sat, 21 Jul 2012 in Brain and Spine
Answered by Dr. Shivakumar S. Kupanur 7 hours later

Thanks for posting your query.

With your history and discogram finding, it appears that you have prolapsed disc compressing the nerve root at that level. I am surprised that MRI Lumbosacral spine was not performed. I would like to know the reason for not doing MRI. Was there any contraindication?

Probably, you require Microdiscectomy at that level to get complete relief of pain. However, MRI and detailed clinical evaluation is necessary before planning further treatment.

Kindly consult Neurosurgeon for further management.

I hope, I have answered your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
Follow-up: Hip pain down leg, took epidural injection, done discogram, CT scan showed annulus tear and annular bulging. Surgery? 1 hour later
Hi thank you for your answer , yes I had 2 MRI done and emg and idid 8 month of chiro and PT , I also had epudural injection done I did every step required , the discogram was the last recent thing I just did , the past MRI shows herniated disc at L5-S1 with no compression and EMG shows nerve damage at L4-L5 and L5-S1 that's why my doctor recommended the discogram to make sure which disc need surgery but he didn't mention to me what kind of surgery , I see pain manegment doctor and I asked him he said the surgeon will tell me what kind of surgery I need , but my surgeon never answer the phone he is always busy and my next appointment with him is on July 9 , that's why I'm trying to get an answer to what kind of surgery need to be done to help me with my pain because when I look online I see a lot of different surgery and I see people go for disc replacement surgery that have same problems ,
Thank you very much

Answered by Dr. Shivakumar S. Kupanur 18 hours later
Hello again,

Thanks for sharing your previous reports with me.

With your Symptoms and radio-logical findings, it appears that you have prolapsed disc which is symptomatic and not relived by conservative treatment.

Ideal surgery would be Lumbar MICRODISCECTOMY, considering your age and pathology.

Disc replacement is other option but it is not that ideal for lumbar disc. It may not be necessary for you.

Any way, it is difficult to advice without seeing MRI and clinical evaluation.

Microdiscectomy is very common surgery and you should get relief.

I hope this helps to solve your query. I wish you speedy recovery.

Above answer was peer-reviewed by
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