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Leg pain, disc bulging, stenosis, disc protrusion. MRI done, discectomy done. Do I need level three spinal fusion?

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Spine Surgeon
Practicing since : 2002
Answered : 102 Questions
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I had previous L4/5 and L5/S1 discectomy about a year ago. But I have very bad leg pains n numbess. My doctor suggested another MRI and below the results; which he suggested a lumbar fusion may solve my agony. First of all may I know what it means by:
(1) At L3/4 - diffuse disc bulging associated with central disc protrusion is seen indenting the thecal sac. Mild lateral recess stenosis.
(2) At L4/5 Diffuse disc bulging associated with an annular tear. There is moderate narrowing of both lateral recess and mild narrowing of both neural foraminal.
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots.

I had been through many conservative ways & methods and all not helping. Do I really need another surgery & will it be advisable to do all 3 level fusion? Thank you very much & really hope to get some advises soon.
Posted Thu, 12 Apr 2012 in Brain and Spine
 
 
Answered by Dr. Krishna Kumar 12 hours later
Hi,

Thank you for sharing your thought with me

(1) At L3/4 - diffuse disc bulging- means jelly like material inside the disc had spread out which can cause pain
(2) At L4/5 Diffuse disc bulging associated with an annular tear- means the outer covering of the disc has a tear, which can cause severe pain
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots- means the disc has bulged out towards left side pressing onto the left nerve root resulting in more of left leg pain and numbness

I think you should try epidural steroid injection or left L5-S1 root block injections before surgery, as some patients get good relief after these injections

If still no relief you may undergo surgery, I think you may benefit from revision microdiscectomy at l5-s1 and l4-l5 levels. I do not feel l3-l4 disc bulge is significant.

So to conclude, try injections, if not better revision discectomy ; that would be my line of management

Hope I have answered your query. Please accept my answer in case you do not have further queries.
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