Question
Dear Dr. steve

I appreciate your virtual social responsibility from the core of my heart, which enable me to believe that there are some human in the today's materialistic world.

My question is that, on the basis of given below details of my L4-L5 and L5-SI disc, what can i do with it? either to use pain killers or surgery may be effective?

The consultant advised me that there is no alternative treatment but surgery is. Seeing surgery result in the country of such cases, its completely useless as the patients comment that we have not been recovering for the last year after surgery.

Now, your owner is requested to suggest what kind of medicines should be taken? or which therapy/exercise should be worked out?? or you too recommend surgery??


Findings:
?  Loss of normal Lumber Lordosis, this could be due to muscle spasm.
?  Disc desiccation seen at L4-L5 and L-5-SI.
?  At the L5-SI level there is a left paracentral and central diffuse extruded disc herniation causing anterior thecal compression with impingement of the left SI nerve root within the spinal canal.
?  Diffuse disc protrusion seen at L4-L5 causing thecal compression with a bilateral foraminal stenosis.
?  The caudae equina and filum terminal are normal.
?  The paravertebral soft tissues are normal. No facet joint abnormality is seen. The vertebral bodies show no abnormal signal to indicate bone marrow replacement.

Conclusion:
1.   Loss of normal Lumber Lordosis, this could be due to muscle spasm.
2.   Disc desiccation seen at L4-L5 and L-5-SI.
3.   At the L5-SI level there is a left paracentral and central diffuse extruded disc herniation causing anterior thecal  compression with impingement of the left SI nerve root within the spinal canal.
4.   Diffuse disc protrusion seen at L4-L5 causing thecal compression with a bilateral foraminal stenosis.


Looking for your expert opinion Mr. Steve
God bless you and your family,

Yours truly

Khair Nawaz

Answer
Hi Khair,

The disc desiccation is part of a normal process that occurs with aging or degeneration. This can be painful, but from what I see in the report, that would not be the major problem. It appears that it is not related to a pathological form of degeneration as no Modic or endplate changes were noted, no marrow changes, and the facet joints are not involved.

The L5-S1 level finding that could be a problem would be the extruded disc. This can cause pain, and if the nerve root is involved, pain down the back of the left thigh, possibly into the lower part of the side of the leg.

There is also a disc protrusion at L4-L5 which could be causing pain and this could effect both sides of the back and legs.

What is necessary is to correlate the findings with the symptoms you have to determine exactly where the problem is. The only signs for surgery are pain that is severe and does not respond to therapies, and emergency signs like loss of bladder or bowel function and/or numbness between the legs and inner thighs.

Surgery may or may not help. Exercises should be based on the McKenzie method and you can see an example of it here http://www.necksolutions.com/back-pain-exercises.html or you can ask a physical therapist if they are familiar with McKenzie or centralization.

The disc may be able to be hydrated with exercise and/or traction therapy.

Before surgery, it is common to try a round of spinal injections. This could help with pain and inflammation. They would inject a steroid and possibly an anesthetic into the spinal canal that would help with any inflammation from the extrusion and protrusion. Usually, 3 of these can be done over a period of time, and I would not have surgery until this was tried. A surgeon or person who does anesthesia can do this.

Medications can be prescribed. It is always best to stay away from narcotics. Something like Tramadol can be helpful. It is possible that a doctor could prescribe a steroid medicine to take if you can not have injections and if you do not have any stomach problems. This would be something like a Medrol Dose Pack. It is a steroid that is taken for about a week that can do something similar to the injection.

I understand how painful this can be and how it can upset you since it makes it difficult to do normal activities. I have a similar problem. Stretch your hamstring muscles - the back of the leg if you can. A physical therapist can help with this and with exercises that might help. Medications, as stated may help. I am waiting to have a spinal injection. It takes time to set up and to get evaluated, but it is worth a try. If you can not, see if your doctor will prescribe a short trial of oral steroids.

I hope this helps Khair, and I hope you will get relief that will make a big difference in your life and those who care about you.

My best regards and wishes.

Dr. Steve