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MRI shows focal left foraminal disc protrusion with annular fissures, mild arthropathy. Effective remedy?

I had MRI and the impression is a focal left foraminal disk protrusion at l4-5, with annular fissuring, contributing to moderate left foraminal narrowing. L5-s1, there is mild arthropathy without significant canal stenosis . With that said, I have been a lot of lower back pain for over a year. I had physical therapy and didn t help. I had 3 epidurals they didn t help. I am currently on 2 -30 mg pills of oxycodone daily for pain. Neurologist recommended laser procedure but concerned bc experimental. I am now trying accupuncture. Willing to do anything. No one including neuro surgeon thinks requires surgery but can t keep taking pills and dealing with pain. Thoughts please? Bob
Asked On : Sat, 15 Dec 2012
Answers:  4 Views:  188
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Orthopaedic Surgeon, Joint Replacement 's  Response
Jul 2013
Hi, thanks for writing to HCM.

As you have tried all other methods of conservative management without much improvement in your pain, I suggest you to try RADIO FREQUENCY ABLATION which is said to offer substantial amount of pain relief in chronic low backache cases. The pain relief obtained by RFA will last from 6 months to few years.

Hope this information is helpful. Good day

Answered: Thu, 22 Aug 2013
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Spine Surgeon Dr. Niranjan Kavadi's  Response
Dear Bob
Thank you for your question.

I feel sorry for what you are going through. Is it the back pain that you are troubled with or do you have leg pain as well?
The annular tears can be very painful but usually the pain does not last that long as they are painful acutely. The foraminal narrowing is usually the culprit for leg pain. Arthropathy is common in middle to old age group and results of surgery are very unpredictable and are in fact controversial. Physical therapy includes ground therapy, aquatherapy, TENS and other pain modalities. It is recommended to discuss these options with your therapist. If there is instability at L4-5 and L5-S1 surgery is indicated to stabilize these segments of spine and achieve fusion. Of course, I would recommend trying all nonoperative means of pain control first to find out whichever works best for you.

Please let me know if I can be of further assistance.
Answered: Thu, 22 Aug 2013
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