Question
QUESTION: I suffered with lower back pain and sciatica for 7 weeks, i tried ibuprofen and 5mg valium some mornings to try to manage this however the pain worsened and first thing in the morning it was extreme and i found it difficult to move, the pain radiated all the way from the lower back down the right leg even feeling pins and needled in my feet.  I attended a doctor then had an mri scan, these are the results. Findings, Good alignment, Decreased T2 signal of lumber discs, L1-L2 posterior and right posterolateral disc protrusion, indenting the theca, normal conus, no abnormal para spinal soft tissue abnormality noted. I was given the scan results to take back to the doctor, he seemed slightly unconcerned about the problem as he said it was high up level 1- level 2 and not herniated.
The doctor has prescribed a cortisone injection, I asked for this to be administered into muscle rather than spine, mobitil 15mg after dinner each day. He told me that the L1-L2 protrusion should not be a cause for sciatica all down the right leg,only L4-L5 would cause this?? He also said this problem can be managed with treatment as described, i mentioned visiting a chiropractor and he advised even the orthopaedic surgeons don't recommend this here as it worsens the condition and can be dangerous if they try to manipulate back into place, it can press on the nerve more??. He said if i still have problems after 2 weeks he has suggested physio. I am British living in Egypt and i know that there is different thinking in the UK.  Please can you advise me on mri scan results and if this is anything i should be concerned about also recommended treatments and any long term prognosis.  I asked the doctor if this will correct itself, he said the disc will never go back only fragment and i am not sure what this means?
I would really appreciate your expert opinion.

ANSWER:

Hi Catherine,

Find another Ortho, this guy is so far out of convention wisdom and standard practices that his license should be under review!



"L1-L2 posterior and right posterolateral disc protrusion, indenting the theca,"

"I was given the scan results to take back to the doctor, he seemed slightly unconcerned about the problem as he said it was high up level 1- level 2 and not herniated."


Fist off, you do have a herniation causing thecal sac compression, is this doctor blind"

"He told me that the L1-L2 protrusion should not be a cause for sciatica all down the right leg,only L4-L5 would cause this??"

Wrong! L5/S1 causes sciatica and contributory nerve roots as high as L1 can refer to the lower extremities from mechanical swelling migrating into inferior nerve roots.

 "He also said this problem can be managed with treatment as described, i mentioned visiting a chiropractor and he advised even the orthopaedic surgeons don't recommend this here as it worsens the condition and can be dangerous if they try to manipulate back into place, it can press on the nerve more??."

This is absolutely absurd, Spinal decompression and Flexion distraction has been the Gold Standard for disc decompression for 30 yrs, it has been well researched, documented and published in countless medical journals as the treatment of choice. There is no question as to its efficacy and should be the treatment of choice for disc lesions of all sorts. True, spinal manipulation isn't as effective but epidurals do nothing but destroy connective tissue while masking symptoms which further the disease necessitating surgery which renders the patient on permanent disability in most cases, that's if you live through it and don't mind being dependent on heavy narcotics the rest of your life.

"He said if i still have problems after 2 weeks he has suggested physio."

Only if you want the disc to further migrate against the thecal sac is PT indicated do to the increased pressures caused by the PT activities themselves.

Find a Chiropractor that has a F/D (flexion/distraction) table ASAP and you should have significant relief in 2 weeks!

Sincerely,

Dr. Timothy Durnin


---------- FOLLOW-UP ----------

QUESTION: Hi Dr Durnin
Thanks so much for your previous reply however i wonder if you could help me further,
I searched to find a chiropractor here in Egypt and i have had 5 treatments now, unfortunately the clinic does not have a flexion/distraction table and i haven't been able to find anyone here who has. I am not really feeling any improvement and still suffering at times tremendous pain,  sciatica and tingling all the way to my right foot despite taking the prescribed meds, without the meds i have serious difficulties getting around. I was given an exercise dvd by the clinic, although i am trying to do the exercises i am afraid incase this may make things worse.  Last vist to the chiropractor he said i will have problems until the spine is stable. I have booked and paid for another 5 treatments. At the moment the treatment has ceased as the doctor is on vacation for 10 days. Can you advise me if i can expect any relief from this pain with the current treatment and how long should i give this?  At times i even feel my condition has worsened from when i had the mri???  
Many thanks for your help.

Answer
Hi Cathrine,

Unfortunately, the only fix to your problem is flexion/distraction. The Chiro has no business treating this unless he has the table. I can't imagine a chiropractor without one. This is exactly the reason why there is trepidation referring to a DC, because the Ortho doesn't know what the DC is going to do. Do not continue with any doctor unless they have a F/D table or other spinal decompression device. You may have to go back to the UK, but in a week or two, you will be significantly improved. You should notice marked improvement after two treatments.

Please keep me informed of your search, I will put my email below for addition questions.


Good luck,

Dr. Timothy Durnin
[email protected]