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Dr. Andrew Rynne

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Report shows diffuse annular intervertebral disc bulge with extension into bilateral neural foramen. Meaning?

Answered by
Dr. Saurabh Gupta

Orthopaedic Surgeon, Joint Replacement

Practicing since :2004

Answered : 5930 Questions

Posted on Tue, 12 Feb 2013 in Back Pain
Question: diffuse annular intervertebral disc bulge with extension into bilateral neural foramen at l4-5 & l5-si levels causing moderate impression on thecal sac and bilateral traversing nerve roots
Answered by Dr. Saurabh Gupta 3 hours later
Welcome to XXXXXXX and Thanks for posting your query.

There is possible mild nerve root compression of L4-L5 fibers due to the bulging disc. These are progressive age related degenerative changes.

The treatment is done according to the severity of symptoms. Medicines are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life of the patient.

Muscle relaxants can help with your symptoms if used in appropriate dosage in combination with a potent analgesic. You can get these prescribed from your orthopedician.

Local analgesic gels and hot fomentation may provide a short term relief. You can use analgesic gels like Volini gel. Exercise is not advisable in the times of acute pain.
Using an LS contour belt of appropriate size might be helpful in providing support to back muscles.

Physiotherapy also plays a major role in treating such conditions. Epidural steroid injections have been used if oral pain killers are not very effective and surgical treatment is not considered. Discuss with your orthopedician and an appropriate treatment can be planned depending on the response to medical drugs.

I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.

Please accept my answer in case you do not have further queries.
Wishing you good health.

Dr Saurabh Gupta.
Orthopaedic Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Saurabh Gupta 41 minutes later
Thanks Dr.,i would like to ask you if surgery is my option,is it time to do it and what are the post surgery complications and the success rate.
Answered by Dr. Saurabh Gupta 6 hours later
Thanks for posting your query again.

If the pain and other symptoms continue after six weeks of conservative treatment, and if the pain is severe, it is reasonable to consider microdiscectomy surgery as an option.

As with any form of spine surgery, there are several risks and complications that are associated with a microdiscectomy, including:
•Dural tear (cerebrospinal fluid leak) -- this occurs in 1% to 2% of these surgeries, does not change the results of surgery, but post-operatively the patient may be asked to lay recumbent for one to two days to allow the leak to seal.
Nerve root damage
•Bowel/bladder incontinence
However, the above complications for microdiscectomy spine surgery are quite rare

The success rate for microdiscectomy spine surgery is approximately 90% to 95%, although 5% to 10% of patients will develop a recurrent disc herniation at some point in the future.

Hope this information helps you. Please do write back if you have any additional concerns.
If you have no further query,please close the discussion,rate the answer and give your review

Wishing you good health...

Dr Saurabh Gupta.
Orthopaedic Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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