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Dr. Andrew Rynne

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Hi Dr Taka, One more question from my conversation with

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3608 Questions

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Posted on Mon, 4 Feb 2019 in General Health
Question: Hi Dr Taka,
One more question from my conversation with you few days back. My MRI showed small broad central disc herniation at L4 L5 and also moderate stenosis at that level. I have pain from my right butt and down the leg upto calf. I had two epidural steroid injections: one at L4 L5 and one split between L4 L5 and L5 S1. There was no relief. I have scheduled an EMG/NCV test on March 6. In the mean time I am planning to take a cortisone shot soon in the right butt in case there is piriformis syndrome plus to get some relief.
1) Do you think it is ok to do so or should I wait for the EMG/NCV test results.

2)They say no more than 3 cortisone shots in one year. Is that per location? So if someone has problem in both knees, he can take 3 shots per knee per year or a total of six in one year.
Thanks again.
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Follow up: Dr. Olsi Taka 0 minute later
Hi Dr Taka,
One more question from my conversation with you few days back. My MRI showed small broad central disc herniation at L4 L5 and also moderate stenosis at that level. I have pain from my right butt and down the leg upto calf. I had two epidural steroid injections: one at L4 L5 and one split between L4 L5 and L5 S1. There was no relief. I have scheduled an EMG/NCV test on March 6. In the mean time I am planning to take a cortisone shot soon in the right butt in case there is piriformis syndrome plus to get some relief.
1) Do you think it is ok to do so or should I wait for the EMG/NCV test results.

2)They say no more than 3 cortisone shots in one year. Is that per location? So if someone has problem in both knees, he can take 3 shots per knee per year or a total of six in one year.
Thanks again.
doctor
Answered by Dr. Olsi Taka 8 hours later
Brief Answer:
Would wait unless intense pain, 3 per location.

Detailed Answer:
Hello again!

The answer to your first question depends a little on your condition. If the pain is manageable through medication I would postpone the injection for a while till the EMG/NCV, especially since there is no guarantee that it will work this time around. Generally I advise cortisone shots when other alternatives have all been exhausted and the patient is still under intense pain affecting his quality of life. From our previous exchange the pain seemed bearable and you weren't taking all potential pain medications (NSAIDs, medication for chronic and neuropathic pain). Physical therapy, TENS, acupuncture are other alternatives as well.

As for the second question, yes, the number refers to the location. The limit is because of potential damage to the tendons, ligaments or cartilage from repeat local injections, so it applies to the injection location, in your example 3 shot per each knee a year (for a total of 6).

Hope you'll feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
Would wait unless intense pain, 3 per location.

Detailed Answer:
Hello again!

The answer to your first question depends a little on your condition. If the pain is manageable through medication I would postpone the injection for a while till the EMG/NCV, especially since there is no guarantee that it will work this time around. Generally I advise cortisone shots when other alternatives have all been exhausted and the patient is still under intense pain affecting his quality of life. From our previous exchange the pain seemed bearable and you weren't taking all potential pain medications (NSAIDs, medication for chronic and neuropathic pain). Physical therapy, TENS, acupuncture are other alternatives as well.

As for the second question, yes, the number refers to the location. The limit is because of potential damage to the tendons, ligaments or cartilage from repeat local injections, so it applies to the injection location, in your example 3 shot per each knee a year (for a total of 6).

Hope you'll feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 4 hours later
Thanks for your advice. I have cancelled the cortisone injection and have the EMG first.

My MRI showed small broad central disc protrusion at L4 L5. One doctor said this:

Also, be aware that the party line on "broad central disc protrusion" that actually results in XXXXXXX symptoms of PAIN, weakness, etc. is that they really don't have much to do with those problems since anatomically they cannot easily come anywhere close to nerve roots to irritate them since the disk is bulging OUTWARD and toward the BACK of your spine whereas nerve roots that would likely be responsible for pain are located to the SIDES of your spinal column and the nerves themselves are traveling more inwardly and in the opposite direction to where the central disc protrusion would be going if were centrally located.

Do you agree with this? Your thoughts will be very helpful. Thanks.
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Follow up: Dr. Olsi Taka 0 minute later
Thanks for your advice. I have cancelled the cortisone injection and have the EMG first.

My MRI showed small broad central disc protrusion at L4 L5. One doctor said this:

Also, be aware that the party line on "broad central disc protrusion" that actually results in XXXXXXX symptoms of PAIN, weakness, etc. is that they really don't have much to do with those problems since anatomically they cannot easily come anywhere close to nerve roots to irritate them since the disk is bulging OUTWARD and toward the BACK of your spine whereas nerve roots that would likely be responsible for pain are located to the SIDES of your spinal column and the nerves themselves are traveling more inwardly and in the opposite direction to where the central disc protrusion would be going if were centrally located.

Do you agree with this? Your thoughts will be very helpful. Thanks.
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
I agree.

Detailed Answer:
Yes, I agree with that. While perhaps I wasn't able to put it as eloquently as my colleague, if you go back to our previous exchange when I precised that I wouldn't go for the surgical procedures, I said that such central disc bulges are commonly found but they do not necessarily need surgery, not when the imaging report doesn't mention it causing a nerve root compression. The nerve roots exit on the sides so it would be a lateral disc herniation which would cause a nerve root compression with symptoms on that side. Central herniations may in some rare cases be very pronounced and compress the nerve bundle descending to lower levels, but again there is no mentioning of such a compression on the MRI report.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
I agree.

Detailed Answer:
Yes, I agree with that. While perhaps I wasn't able to put it as eloquently as my colleague, if you go back to our previous exchange when I precised that I wouldn't go for the surgical procedures, I said that such central disc bulges are commonly found but they do not necessarily need surgery, not when the imaging report doesn't mention it causing a nerve root compression. The nerve roots exit on the sides so it would be a lateral disc herniation which would cause a nerve root compression with symptoms on that side. Central herniations may in some rare cases be very pronounced and compress the nerve bundle descending to lower levels, but again there is no mentioning of such a compression on the MRI report.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 1 hour later
So you are saying that if the disc protrusion was touching the nerves, it will be mentioned in the MRI report. Also one will be able to see it in the MRI DVD. Is my understanding correct? Thanks.
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Follow up: Dr. Olsi Taka 0 minute later
So you are saying that if the disc protrusion was touching the nerves, it will be mentioned in the MRI report. Also one will be able to see it in the MRI DVD. Is my understanding correct? Thanks.
doctor
Answered by Dr. Olsi Taka 4 minutes later
Brief Answer:
Yes it would be mentioned and be seen in the DVD.

Detailed Answer:
Yes, it would certainly be mentioned in the MRI, clarifying whether there is compression ofthe nerve structures is the main purpose for ordering a spine MRI, you understand correctly. It would also be visible on the DVD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Olsi Taka 0 minute later
Brief Answer:
Yes it would be mentioned and be seen in the DVD.

Detailed Answer:
Yes, it would certainly be mentioned in the MRI, clarifying whether there is compression ofthe nerve structures is the main purpose for ordering a spine MRI, you understand correctly. It would also be visible on the DVD.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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