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Suffering from back pain. MRI showed L5/S1disc narrowed S1/2disc partly formed but narrowed. What is the remedy?

Nov 2013
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Practicing since : 1994
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HI Had previous surgery for large para-centraland lateral disc herniationL5/S1 impinging on both L5 and S1roots 6 years ago and it leftme either permanent nerve damage in my right leg. Recently I had 2 episodes of urinary incontinence and severe lower back pain with extension of nerve damage into big toe on right foot.Admitted to hospital MRI without contrast dhowedL5/S1disc narrowed S1/2disc partly formed but narrowed suggestion of previous surgeryinvolving posterior elements between the L5/S1 disc end the lower border of S2. No evidence of tendering of the nerve root at this site but the course of the nerve root is postereriorly in the sacral canal. significance un certain but suspect is related to residual post operative changes. Medical review of neurological status recommended.Mild diffuse heterogeneity of the marrow fat, non specific feature but suggest evaluation of pharmacological parameters and bence XXXXXXX protein/paraproteinaemia. Bloods urine Nad I have severe back pain and generally feel unwell. I am seeing spins team in 2 weeks but am using crutches to help me walk. What could they do to help?.Iam a female age 44.thank you.
Posted Fri, 20 Dec 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 10 hours later
Brief Answer: Thank you for posting your query. Detailed Answer: Hi, I have gone through your recent MRI findings and medical history. These are suggestive of nerve compression at operated site and the pain is likely to be occurring because of that. The best treatment option at this stage is nerve pain medications such as pregabalin and gabapentin capsules, along with physiotherapy (such as IFT/ultrasound/traction). In case the pain does not resolve with these, epidural injection is another option. I hope my answer helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: My BLOG:
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Follow-up: Suffering from back pain. MRI showed L5/S1disc narrowed S1/2disc partly formed but narrowed. What is the remedy? 18 hours later
Thank you for your help. I have had severe pain now for over 15 weeks and have had 6 weeks of physio accupuncture. I have tried Gabepentin and pregabalin after my last surgery and had quite severe side effects. I had an epidural prior to my last surgery with no affect but at that time went on to develop both bladder and bowel dysfunction and ended up with emergency surgery. I have had loss of sensation on the outer aspect of my lower right limb and foot which has never improved also now weakness in my big toe and loss of sensation which started 8 weeks ago. Physio etc has not helped the pain but has helped my core strength as whilst pregnant with my third child 4 years ago I developed a dyastasis recti it has never improved and you can fit about 4-5 fingers between the muscles. Would spinal fusion ever be considered and would it help?fingersfingersbbetween the musclesiabout4-5 Sorry it was submitted before I had finished. I am a Nurse Endoscopist and am off sick at present due to the pain and immobility I am using crutches as because of the pain J am leaning very heavily to the left and the Physio is not happy with the way I am walking. The pain is affecting every part of my daily living and I am getting very depressed as J want to get back to work. I have a demanding job and 3 children and I am worried about what the future holds re my back and possible restricted mobility. I trip up at times and have had 3 falls.Is fusion a possibility or is it best avoided? Thank you for your time.
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer: Thank you for getting back. Detailed Answer: Thank you for providing more information and writing in detail about the severity of your symptoms, your job, past treatments, etc. Yes, I agree that at this stage, spinal surgery including fusion should be considered. In most cases, it is safe. However, since you have had previous surgery, it would be demanding, however, an experienced neurosurgeon could do this surgery well. In the meanwhile, if you have not tried duloxetine capsules, you could use it for nerve pain relief. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: Suffering from back pain. MRI showed L5/S1disc narrowed S1/2disc partly formed but narrowed. What is the remedy? 12 hours later
Thank you so much I feel I can go to the Consultation well prepared. I have been taking amitriptyline now for 8 weeks and having some side effects very drowsy horrible taste in my mouth dizzy and nauseous it has however helped my mood and aided sleep Im now getting about 4 hours before waking with pain.I have a detailed questionnaire to complete before I see the team at Salford Hope Hospital.I want to be sure I have choices and feel a spinal fusion would bring permanent pain relief. I am trying to exercise within my limitations and keep positive. How long is recovery following spinal fusion? You have been so helpful think you for your support.
Answered by Dr. Sudhir Kumar 7 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: I am glad to note that you are getting some relief with amitriptyline. The side effects you mentioned are common with this drug. The usual recovery time after spinal fusion is 4-6 weeks, by when you would expect to be near normal and be able to do all your chores. I would be pleased to answer any follow up queries later on, if you have any. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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