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How can broad-based protrusion be treated?

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Orthopaedic Surgeon
Practicing since : 2005
Answered : 43 Questions
Hi I have a broad-based protrusion L4-L5 causing slight deformity of the ventral thecal sac and just contacting the L5 nerve roots bilaterally. I went to 1 surgeon and he said fusion. Went to another and he said I did not need surgery. I have hip , leg and feet pain. My legs and hips ache and back. I have to take baby steps when i first gert up. I have no numbness or tingling. i have also been told i have fibromyalgia and also a small hip labral tear. I have tried injections , they stopped working. i go back to the first surgeon thurs. dont know what to do. I am 50 and 128 lbs 5'3"
Sat, 21 Apr 2012 in Back Pain
Answered by Dr. Sangeet 1 hour later
Hello Darlemorg,

Thanks for the query.

Don't worry, there's a solution for everything. Your's is similar to the scenario with most of the patients with backache. There's no one i know who hasn't had backache in their lifetime.

Before jumping into the treatment aspect, i would like to know some more details.
- Is your hip and leg pain shooting from the back downwards?
- Do you have any weakness in the legs/ decreased sensation?
- Any bowel/bladder problem?
- Did you try bed rest/ back exercises?
- Is your pain relieved on bending forwards or does it aggravate on doing so?
- When did you check your Bone Mineral Density (a test for Osteoporosis)?

Get back to me with your answers and I will be available for your follow up queries.
If feasible, do send me all the recent investigations you've got to " YYYY@YYYY " with subject as "ATTN : Dr.Sangeet"

Above answer was peer-reviewed by
Follow-up: How can broad-based protrusion be treated? 1 hour later
Att Dr Sangeet
I have had bone density test nd I have osteopenia. The shooting pains yes are on side and back and legs. I have had injections before, but have side affects and they basically stopped working. my husband is a physical therapist and I have done XXXXXXX which does not help
Answered by Dr. Sangeet 52 minutes later
Dear Darlemorg,

The cause of shooting pain is the prolapsed disc compressing on your nerve. Osteopenia adds to back pain.

You need to follow these before opting for surgery:

1. Ask your Family doc for nerve protective drugs (multivitamin) for 6-8 weeks.

2. Continue the XXXXXXX as rightly suggested by your hubby. Do it only when your back is pain-free. But you need to carry on for at least 6 weeks.

3. Visit a Geriatrician/ Endocrinologist for management of Osteoporosis. You will need bone protective drugs, Calcium and Vitamin D supplements.

4. When the pain is severe:
-get bed rest till the pain subsides and use a pillow under each knee.
-Use counter irritant creams/ spray and analgesics as prescribed.

5. You need to see a doctor as soon as possible if any of these occur:
-unbearable pain
-sudden weakness in your legs
-bowel/ bladder incontinence

6. Avoid lifting heavy weights. If you are lifting something, lift with your knees bent.

7. If comfortable, sleep with a pillow under your knees as this would prevent stretch on your nerves.

Kindly follow this regime strictly for a month and let me know the difference.

Wishing you good health. Smile, its just a backache and will resolve soon.

I will be available for your follow up queries.
Above answer was peer-reviewed by
Follow-up: How can broad-based protrusion be treated? 7 hours later
Thank you for your information. I do have to say that this is chronic not acute. It has just got worse over the last yr. I am confused about the 2 different opinons of the neurosurgeon. I have appointment with the one that wants to do surgery Thurs. I guess I can ask him about the nerve drugs. I have tried Savella but it made my heart race. I guess I could possibly try neurontin. I just feel like I am going to become crippled with the pain I have walking. I would appreciate any more feedback
Answered by Dr. Sangeet 3 hours later
Hi again Darlemorg,

Thanks for writing back.

This regime works with chronic as well as acute backaches. Once your back muscles are strengthened, the pain should be considerably less.
The shooting pain should wane off following surgery, however I am not sure about the backache as it could be due to the disc/ osteopenia/ spinal instability.
Yes, you could try drugs containing Vitamin B12 and B6 preparation; it helps. You wont be crippled with pain, don't worry. Be patient and try the measures i asked you to.
I advise you to stick to one Neurosurgeon or spine surgeon instead of getting different opinions. Backache can be managed in a number of ways. Some go for the non operative line while some prefer otherwise. So, no one's wrong about their opinion; its only their experience that speaks.
If you get time, before or after surgery, I advise you to do some Yoga for the back. It will alleviate your trouble and calm your mind too. Try this only if there's a certified yoga trainer around.

Hope i have solved your query. Get back to me anytime with your follow up queries. I'll be available.

Thank you Darlemorg.
Above answer was peer-reviewed by
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