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Dr. Andrew Rynne

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Suggest treatment for back pain due to disc bulge

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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6531 Questions

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Posted on Tue, 26 Aug 2014 in Brain and Spine
Question: Recent MRI reveals L4L5 - where there is slight loss of height of the disc and reduction in disc signal there is substantial right paracentral and posterolateral disc extrusion adjacent to a posterior annular tear and compression on the descending right fifth lumbar nerve root. The Central spinal canal dimensions are reduced at this level as a consequence. At L5-S1 there is a central and left paracentral posterior annular tear and a shallow central and paracentral disc bulge but no evidence of nerve root compression. Clinical correlation advised... Symptoms .. for the past six weeks -suffering back pain amounting to affecting my gait and daily routine moving around..can not stand for more than five minutes... lying down and sitting down are ok but walking is a big problem.. will this need surgery
doctor
Answered by Dr. Vivek Chail 3 hours later
Brief Answer:
No pain relief for a year may need surgery

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read through your query in detail and feel sorry for the pain and discomfort you are going through.

The condition you are having is relatively common at your age and I see that you have taken physiotherapy and epidural injections in February this year.

The initial treatment is always physiotherapy, restricted heavy physical activity and medications for pain reduction including neurogenic pain relievers. The pain intensity is monitored with a wide range of medications for about 6 months to a year before deciding on a surgical treatment to relieve the pain due to disc degeneration.

In your case it looks like the following disc at L4 -L5 is most bothersome and may need surgical attention. Presently newer surgical methods are available with minimum invasive techniques.

Wishing you good health.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Vivek Chail 3 hours later
Thanks for the reply...what type of surgery. .decompression. .would spinal fusions be required
doctor
Answered by Dr. Vivek Chail 10 hours later
Brief Answer:
Decompression is common surgical procedure

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

Decompression is the commonest surgical procedures done to release the pressure on nerve roots. Spinal fusion is done when there is significant loss in disc height. As your report clearly mentions mild reduction in disc height, I don't think that you need spinal fusion surgery.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Vivek Chail 8 hours later
can you explain from this information if i have spinal stenosis and is this is what is causing my problem. Thanks

I would like my questions to be answered by XXXXXXX XXXXXXX . how can I get hold f him... he has been dealing with me all the time so I think it would be best to stick to the same consultant.. please revert back asap
doctor
Answered by Dr. Vivek Chail 12 hours later
Brief Answer:
Answered in detail below

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

There definitely is spinal canal stenosis at level L 4 - L 5. However since the spinal cord ends at lower border of L1 vertebra therefore there is no risk to spinal cord injury but the pinching of nerve roots is significant at that level.

I am sorry that getting your query answered by Dr XXXXXXX is possible only by contacting YYYY@YYYY

Hope your query is answered.
Please do write to customer care with your request for a specific doctor.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 13 minutes later
thank you.. this is an excellent answer..do you think it would be advisable to have another epidural.. I am really concerned as I have a feeling my orthopaedic consultant contemplates doing surgery.. what type of surgery.. lamantomey? I am really concerned about my gait for the future.. I am not working at the moment.. is this spinal stenosis.. this is a dreadful condition
doctor
Answered by Dr. Vivek Chail 13 hours later
Brief Answer:
Epidural may be advised for immediate pain relief

Detailed Answer:
Hi XXXXXXX
You are welcome and thanks for accepting my reply.

You may get another epidural for immediate pain relief till such time your surgeon decides on your further treatment.

Laminectomy is a commonly done procedure to release pressure on the spinal canal and nerve roots. In this procedure, the small portions of a vertebra are cut away at the back to make way for the nerves to pass. Complete relief from symptoms may not occur in all patients. However further deterioration in condition is prevented.

Your surgeon knows exactly how your condition is worsening over last 6 months and may like to wait a short while before taking a decision and this is a regular practice among surgeons.

I hope you have been clinically assessed recently to evaluate your gait and mobility. Newer forms of minimally invasive treatments including laser assisted procedures are being done in many clinics.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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