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On tramal and epidural vaccination. Have several disc extrusion. Should I go for surgery?

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Spine Surgeon
Practicing since : 2002
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Will disc extrusion of 0.4 anterior posterior and 0.6 in transverse dimension and 0.5 in craniocaudal dimension
Require sugery?
Impingement of intrathecal left nerve root

The neurosurgeon i have seen here has asked me to have an epidural injection into L3 and L4 and he said that might ease the pain.
He also told me that there is an 50/50% chance that if surgery is performed then it might not even be benificial for me?

BUT I dont understand why I have to endure this pain everyday, I am taking Tramal 50 mg 2 times a day and Gabapentin 3 times a day of 300mg and Durotram at night 200mg
i have had a facet joint injection and a nerve sleeve root injection on S1
I am also attending physio treatments 2 times a week where I have a slight massage an acupuncture.

This nerve root impingement happen during work due to heavy lifting and I have been told that I have several disc extrusion's

Is it true that disc extrusion is worse that protrusion as the fluid is now leaking pass the barrier?

Am I at risk of worsening my condition?


And I also have a small lump on my back that I have had for serveral years but I have noticed since my injury it hurts allot more and even by slight touch!

Should I seek a 2nd opinion with another Neurosurgeon?

Look forward to your response

Regards, XXXXXXX
Posted Sun, 17 Mar 2013 in Osteoporosis
Answered by Dr. Rahul D Chaudhari 2 hours later
Welcome to XXXXXXX
It seems you have multiple level problem. At which level you have this disc extrusion? In spine when you have multiple level issues It becomes important to identify the symptomatic level. It is important to correlate the clinical findings with MRI findings.

The disc extrusion need to consider dimension of the canal. The measurement of extruded fragment may not be of significance unless it is pressing on your nerve. Disc protrusion and extrusions are the stages of the herniation. Extrusion means the disc fragment has come out of the disc and lying in the spinal canal compromising the space for the nerve root.

Please get back with more details about the symptoms such as pain scale, location, any radiation, how frequently it comes? do you get night pain also? can you perform your daily routine without medicine? any tingling or numbness in legs? any weakness? since how long you have this pain? is it worsening or static?

If possible please upload your MRI images or at least the MRI report.
At this point It is difficult to comment on the neurosurgeon's opinion.

A hemangioma is a buildup of blood vessels in the vertebral body and usually it is incidental finding on the MRI and may not have clinical significance.

Please get back with above information which will help me understand more about your spine and symptoms. Thanks.
Above answer was peer-reviewed by
Follow-up: On tramal and epidural vaccination. Have several disc extrusion. Should I go for surgery? 12 hours later
Hello again and thank you for your answer and time.
I have night pain in my legs, mostly left leg, I have tingling and less feeling in the left leg and also some of my toes.
The pain is sometimes so bad that I have to stay in bed!
There is a shooting pain starting from lower lumbar area down over left buttocks and all the way down to the left foot!
I have been on sickleave since October 18th 2012 and are unable to work due to the pain. I have to take the Tramal and Durotram every day at the same time incl the Gabapentin.
I can only sit for 20-30 min then I have to stand. I get pains in my legs if I stand up too long. I am mostly comfortable when lying in my bed with a pillow under my legs/knee area.
I sleep with the pillow for support.
I no longer drive my car - due to numbness in my left leg and im unable to sit in the car too long as the pain then starts.
I sometimes have very bad pain even though I take these painkillers and I sometimes have to take an extra 50mg Tramal or 200 mg Durotram.
Its clear that I have nerve impingement but why would surgery not help or possibly relieve the pain?

I have had an injection of Facet joint
i have had a nerve-sleeve-root injection
And now im scheduled for a EPIDURAL in the L3 & L4 area.......BUT can I rely on this to relieve the pain?

I did take a photo of the MRI report, are you able to read that?

I look forward to your answer

Kind regards, XXXXXXX
Answered by Dr. Rahul D Chaudhari 48 minutes later
Thanks for the information.
Definitely you are quite disabled due to pain. I looked at the MRI report and it mentioned significant stenosis with nerve root compression at L3-4 level. If we consider a step by step approach then epidural injection can be tried. It has therapeutic and diagnostic value. Therapeutic means it will relieve your pain and diagnostic means if it relieves the pain significantly then it gives more confidence to surgeon about the results after surgery.
I would suggest to go ahead with epidural and if the pain relief does not last long then I would definitely consider doing surgical intervention and decompressing the nerves.Thanks.
Above answer was peer-reviewed by
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