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MRI report says Dessicated diffuse disc bulge with focal central disc protrusion at L4-L5 level. Advise

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
I have undergone an MRI and report says that "Dessicated diffuse disc bulge with focal central disc protrusion at L4-L5 level causing compression of thecal sac." I get severe pain at the lower spine and the pain radiated to the left leg totally and the left leg stays numb most of the time. I was advised to undergo a Micro-surgery. Can you advice em the implication of the same.?
Posted Sun, 15 Dec 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 21 minutes later
Brief Answer: Initial management is always conservative. Detailed Answer: Hi, thanks for writing to XXXXXXX Your MRI findings suggests that you have Lumbar disc disease and you symptoms of radiating pain down the leg along with numbness suggests radiculopathy (the protruded disc causing pressure over the nerve root). The initial management for this condition is always by conservative management (unless you have urinary bladder and bowel disturbances, in which case, emergency microdiscectomy has to be done). The general guidelines for managing this condition includes - - Avoid lifting heavy weights as it imparts more strain on your back - Avoid excessive forward bending activities as it will worsen the disc protrusion. if you want to bend forwards, do it with your hips and knees flexed. - Use a lumbosacral back support to stabilize your spinal muscles - Intermittent pelvic traction might be helpful to cause a regression of the protruded disc - Maintain optimum body weight,if you are obese - Physiotherapy is needed to strengthen your back muscles. Physiotherapy has to be done only after the acute pain has subsided. - Use analgesics like advil or aleve and muscle relaxants as needed. Vitamin B12 supplements & Pregabalin may be helpful. If your fail to improve with the above measures being followed for 4-6 weeks, an Epidural steroid injection may provide good symptom relief for a few months. If all these measures fail to provide you relief, then surgical decompression may be an option. Hope I have addressed your query. Happy to guide further Regards
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Follow-up: MRI report says Dessicated diffuse disc bulge with focal central disc protrusion at L4-L5 level. Advise 11 minutes later
I am Facing this problem frm last 6 months.... I have been trying physiotherapy bt of no relief... Is there any permanent solution fr this as am a software employee and its becomin highly difficult to be sitting or standing daily...
Answered by Dr. K. Naga Ravi Prasad 7 minutes later
Brief Answer: Only Physiotherapy won't help. Detailed Answer: Hi, Nice to hear from you. This is just to inform you that only physiotherapy is of no help in improving your condition. You have to follow the other recommended measures also. Mainly neurotropic medicines like Gabapentin/Methycobalamine/Pregabalin have to be taken to see if the symptoms improve. As I already stated, if your symptoms are not improving with the given recommendations being followed for 4-6 weeks, then surgery is indicated. Surgical decompression offers a permanent solution. Hope I have justified your query. Good day
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Follow-up: MRI report says Dessicated diffuse disc bulge with focal central disc protrusion at L4-L5 level. Advise 8 minutes later
Thanks for the reply... Wanted to know the root cause behind this... Also is gym suggestable?? Apart frm surgery aren't there any other solution??
Answered by Dr. K. Naga Ravi Prasad 11 hours later
Brief Answer: Might be due to uneven loading. Detailed Answer: Hi, I suspect that the root cause behind the problem (at your age) would be due to sudden lifting/bending strain of the lumbar spine (lower back) during activities of daily living, that might have gone unnoticed. Any sort of an activity that puts additional load or strain over the lower lumbar spine is going to make your condition worse. So, keep this in your mind while working out at the Gym. Yeah, there is one more option (via media solution) which is worth trying in case of MILD DISC PROTRUSION, and that is OZONOLYSIS or OZONE DISCECTOMY. This procedure involves the injection of ozone inside the affected intervertebral disc. When injected, Ozone (O3) breaks down into O2 and O (single oxygen) and rapidly dissolves the water in the disc. It causes shrinkage of the disc, thus reducing its volume and lessening pressure on the nerves. The treatment relieves pain substantially and, after two sittings, people 'can go back to work under medical guidance'. A reduction in herniated disk volume is one of the therapeutic aims of intradiscal administration of medical ozone, as disk shrinkage may reduce nerve root compression . Another reason for using medical ozone to treat disk herniation is its analgesic and antiinflammatory effects. So, its worth trying Ozone therapy. Good day
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Follow-up: MRI report says Dessicated diffuse disc bulge with focal central disc protrusion at L4-L5 level. Advise 37 hours later
Thanks for the reply. I am just 22 years and I heard such issues come to people above 40 years. Y is this that I have this issue now? And will this problem have any future impact in the long run as spinal cord is the most essential part.
Answered by Dr. K. Naga Ravi Prasad 29 minutes later
Brief Answer: Please find the answers below. Detailed Answer: Hi, there is no hard and fast rule that this condition should occur over 40 years of age. Infact, I personally operated a patient aged 17 years who presenting to me with lumbar disc disease and severe symptoms. So, it can happen to any one or at any age, when the vertebral column is subjected to severe bending forces. No, this problem will not cause any harm to the spinal cord but (if left untreated) will cause severe radiculopathy symptoms in the legs and ultimately leads to weakness of the involved muscles in the legs. At times, severe compression of the spinal cord will cause urinary and bowel disturbances. Good day
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