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Suffering from back pain. MRI shows disc protrusion at L3 - L4. Meaning?

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My mother (47 years old) school teacher, with 3 kids

- She suffers from pain in the 2nd half region of her back, mostly concentrated in her Lower back (pain's strongest point is the lumber area), also she feels the pain extends through the

sides of her back not just the back bone/spinal cord area.

- That back pain extends to both right and left hips, she can feel the pain passing down to the center of both left and right hips.

- She feels also strong pain in her left leg starting from her back going through hips, leg, back part of the knee, down to the foot, till her feet and fingers down there.

- In her right leg she feels also pain but its quiet insignificant compared to what she feels in her left leg.

- She doesnt feel any pain when urinating, and she doesnt complain about any pain in her bladder
- She doesnt feel any pain in her knee, except that back part area of her left knee where she feels its the same pain extending from her hips down to her feet.
- She doesnt have any menstrual abnormalities/pain, or any sexual organs pain.

- Occasionaly when waking up from bed after sleep or after walking a lot, she feels that she isnt able to control both her legs, that they almost cant carry her body and she is about to fall

, feeling both legs almost numb.

- About once per week, it happens that her left leg makes an involuntarily move that she didnt mean to do, which disorients her and some times causes her to fall.

- Recently she started also feeling some pain in her left shoulder, and numbness in her left arm also started feeling some pain her whole left body region that turns into numbness after


We checked several doctors and the problem is each one come up with a different diagnosis, and requiring a different surgerical operation to be done, what is confusing them as they say

is that the MRI shows disc protrusion at L3 - L4, but the symptoms and pain she is complaining about is more about L5-S1 issues.

One of the doctors suggested having a some sort of a pain killer injection (a mixture of DIPROFOS/Betamethasone and 2 other things that i do not remember) at L5-S1 disc, and in case
that the pain went away, they would know for sure that its the disc causing all that pain, after that my mother kept feeling strong pain from the injection itself for 12 hours after the injection operation, and after that all the usual pain came back as it used to be, if not worse.

MRI Report:

MRI Images:

We need your opinion about her illness, what exactly is she suffering from is it spinal stenosis , or foraminal stenosis, is it a protrusion or what ?
Also what kind of surgery she would need, we fear that after doing a surgery her pain remains as is, before the surgery.

Please advise

Posted Thu, 6 Jun 2013 in Brain and Spine
Answered by Dr. Gopal Krishna Dash 4 hours later
Thanks for the query
I understand your concern
I see 5-6 such cases per day. Please note that the management of these problems largely depends upon the clinical data rather than the MRI data. MRI generally overestimates these findings somehow and people are worried based upon the MRI data alone. You need a detailed clinical neurological examination. If the examination findings show that there are clinical signs of nerve root compression and conservative treatment has failed for 6-8 weeks, the options are surgical removal of that particular disc. If there are pains alone without any signs of nerve root compression or neurological deficits, you need medications like gabapentine, pregabaline and regular physiotherapy along with measure to avoid further disc herniation. You do not worry and just get her neurologically evaluated by a neurologist initially.
Hope this clarifies your query
Please get back to me in case you have any other concern
Best wishes
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