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MRI showed broad based central disc protrusion with moderate neural form and hypertrophy. Suggest?

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
My MRI shows that at the L3L4 level, there is a small broad based central disc protrusion with moderate neural foraminal narrowing on the right and mild on the left. At the L4L5 level, there is a large central disc protrusion with moderate facet joint and ligamentum flavum hypertrophy on the left and mild on the right. Right neural foramen is markedly narrowed and the left moderately narrowed. At the L5S1 level, there is a moderate sized central disc protrusion. Moderate facet joint hypertrophy is noted on the left and mild on the right. Left neural foramen is momoderately narrowed, the right mildly narrowed. Can you tell me what my options are and am I a candidate for radio frequency? My transaction reference # is: 7TL0000RC0000R
Posted Sun, 18 Aug 2013 in Back Pain
Answered by Dr. K. Naga Ravi Prasad 4 days later
Hi, thanks for writing to XXXXXXX

All the MRI findings suggest that you have LUMBAR DISC DISEASE with DEGENERATIVE CHANGES. Based upon the MRI findings, I expect that you should be having symptoms of Back pain along with radicular pain in the right leg (shooting pain along with tingling and numbness).

The initial management of your problem will be as follows -

* avoid lifting heavy weights
* avoid forward bending activities
* Use a lumbosacral back support
* Intermittent pelvic traction
* Maintain optimum body weight,if you are obese
* Physiotherapy to strengthen your back muscles. Physiotherapy has to be done only after the acute pain has subsided.
* Judicious use of analgesics and muscle relaxants.

Majority of the patients (around 80%) respond well to the above measures.

If the symptoms are not resolving within 8 weeks, then an EPIDURAL INJECTION of steroid can be tried which will give fairly good results.

If everything fails (conservative line of management) along with worsening back pain and leg pain, then surgical decompression may be necessary with or without fusion based on the levels of decompression (disc removal).

RFA (Radio frequency ablation) is a procedure used to reduce pain and is especially helpful in patients with CHRONIC (long lasting pain) LOW BACK ACHE.
*It should be remembered that the degree of pain relief after RFA varies from person to person.
*The duration of pain relief is also variable ranging from 6 months to 2 years.
* It is a relatively safe procedure with inherent complications
* RFA is not suitable for everyone and is not recommended who have active infecions , bleeding problems.
* More than 70% of patients treated with RFA experience pain relief.
* Also RFA is said to be effective and provide good pain relief when one or two levels are involved. (in your case its 3 levels - L3 to S1). So think about it.

So I suggest you to consult an orthopedic / spine surgeon and follow his advice.

Hope I have addressed your issues. Happy to help for any more clarifications.

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