Q. What does abutment of the nerve root mean?

Answered by
Dr. J Mariano Anto Bruno Mascarenhas
and medically reviewed by iCliniq medical review team.
Published on Dec 07, 2017 and last reviewed on: Sep 09, 2019

Hi doctor,

I am just wondering what is abutting and abutment of the nerve root means in a back issue. Please explain. What treatment is required for annular bulging and tear?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome to icliniq.com.

I have gone through your query with diligence and would like you to know that I am here to help you.

  • Abutment of nerve root means that the disc is touching the nerve root.
  • Treatment of disc bulge alone is mostly non-surgical means. If there is annular tear, then you will need surgery sooner or later and sooner the better.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

I have had lower back pain and left leg pain for over two months. I had two MRI scans and have been diagnosed with a broad annular tear and bulging disc into my nerve roots. What is your take on the photos of my L5/S1 disc? Is the tear a big one? What is your recommendation on the treatment options?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

I have gone through the images (attachment removed to protect patient identity).

  • The tear does not appear big, but there is compression of the left nerve root at this level.
  • In my opinion, based on these images, I would advice surgery. My choice would be discectomy and foraminotomy on the left side.
  • As of now, you are having only pain. This is a very good time to operate.
  • You are also having osteophytes (bony projection) and canal stenosis. In due course, you may develop weakness of your great toe. It is better to operate before further complications develop.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

Are sure that there is an annular tear?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

  • In axial view, there is an irregular shape. The smooth curve is altered and we see an out pouching in the left side.
  • In sagittal view, there is a black line in the posterior part and there are osteophytes. These findings are suggestive of tear in the annulus in the left side.

For further doubts consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

I have just seen a neurosurgeon today regarding the injury, we have talked about. He stated that I have an annular tear and disc bulge, but the bulge is not big enough to cause my left leg pain. He suggested surgery is not needed and the tear should repair itself with a strong physiotherapy program. I have been told opposite from another doctor that physiotherapy could cause more damage to the tear. What is your take on this?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

  • As per the images, you have sent to me, there was an annular tear and prolapse of the disc.
  • If there is a generalized disc bulge (without an annular tear), the bulge can go in with physiotherapy. But, when there is an annular tear with herniation of nucleus, there is no chance for it to heal by itself.
  • The second doctor is correct. You have pain for two months. You have annular tear and prolapse as per MRI. All three of these say that surgery is needed.
  • Physiotherapy is not useful now and maybe even harmful at the current stage.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

If I did not get surgery, then what is my future with this tear? How long does it take to recover from the surgery? Is there a possibility of recurrence of tear as I did work in a heavy lifting job?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

  • Spinal canal is a small space and the foramen through which nerve roots exist is an even smaller space. Now, there is an annular tear in the disc. Through this tear, the nucleus of the disc has protruded out.
  • The protrusion of the nucleus creates two problems. Chemical irritation of the root and mechanical compression of the root.
  • Your pain for the past two months is because of this and so the treatment would be removing the prolapse part of the disc.
  • This surgery is very much needed. Without this surgery, the root will be continued to be mechanically compressed and chemically irritated.
  • Right now you have only pain. After some time, with continuous irritation and compression, you may have weakness of the toes or foot. So, please undergo the surgery as soon as possible.
  • Once you do a surgery, you may need bedrest for two weeks and light work for six months. After that, you can return back to your work.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

I have attached a photo from my MRI showing something pressing on a nerve. Can you explain what it is? I have not visited my doctor yet. Also, I have developed a sharp pain in my toes for the last five days and redness on the top of my left foot. I never had this before. Is this something related to nerve issue?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

  • I am not sure about the sequence of this (attachment removed to protect patient identity). If this is myelogram, then it is prolapsed disc pressing the nerve root.
  • Your pain is likely to be due to the disc prolapse, which is irritating the nerve root.

For further doubts consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

The sequence is from an MRI it is a T2 coronal. I have attached two photos of the MRI. Can you do a pointing like you did with the other ones for my reference?

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Hi,

Welcome back to icliniq.com.

Thanks for uploading the images (attachment removed to protect patient identity).

  • The compression is due to the same disc, which we have already seen.
  • In this image, you are seeing the compression from the front and in the earlier images, you had seen that from the side and from above.

For further doubts consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hi there, Still having issues with my injury, I had a huge bolt of back pain 4 days ago and now I have a indent in my lower back that was not there before (photo attached) can you advised what this or has happened as my back pain is uncontrollable now and My symptoms have got worse. Also got a follow up mri can you explain what you see and is the tear getting worse? I attached this too. My specialist has recommended a fusion or a disc replacement what is the best option? Thanks.

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Dear Sir Welcome Back Question 1 : Hi there, Still having issues with my injury, I had a huge bolt of back pain 4 days ago and now I have a indent in my lower back that was not there before (photo attached) can you advised what this or has happened as my back pain is uncontrollable now and My symptoms have got worse. Answer 1 : As I had earlier told, Protrusion of the nucleus creates two problems 1. Chemical Irritation of the root. 2. Mechanical Compression of the root. The Huge Bolt of Pain is due to Nerve Root Irritation and compression. The indent is because of muscle spasm due to pain So The treatment would be removing the prolapse part of the disc so that there is no mechanical compression and no chemical irritation on the root This surgery is very much needed Without this surgery, the root will be continued to be mechanically compressed and chemically irritated. Right now you have only pain. After some time, with continuous irritation and compression, you may have weakness of the toes or foot So Please undergo the surgery as soon as possible Question 2 : Also got a follow up mri can you explain what you see and is the tear getting worse? I attached this too. Answer 2 : I am not able to appreaciate much in this image, but the fact that you had an episode of bolt of pain along with muscle spasm categorically says that it is time for Surgery Question 3 : My specialist has recommended a fusion or a disc replacement what is the best option? Answer 3 : My First Preference would be Laminectomy and discectomy. Disc Replacement would not be in my choice. If Needed, PEEK cage can be used. The Most Important step to be done is to remove the prolapsed disc. Others can be decided as per the treating surgeon's decision. Feel Free to ask further doubts Take Care

Thanks for your answers they are great. Im regards to that muscle spasim and indent why does it create a indent and does it cause any issues to my spine or existing injury because my back pain has doubled. Also the last two days I had a a couple bad episodes where my whole left foot and leg has gone red and swollen and my toes curling up, this lasted for 2 hours and the pain is horrible what and how is this caused? I have attached a photo.

Dr. J Mariano Anto Bruno Mascarenhas

Neuro Surgery Neurology Spine Health Spine Surgery
#

Dear Sir Question 1 : Im regards to that muscle spasim and indent why does it create a indent and does it cause any issues to my spine or existing injury because my back pain has doubled. Answer 1 : There is mechanical compression and Chemical irritation to the nerve roots. This is aggravated during movement. So the body's innate mechanism wants to avoid movements. So there is muscle Spasm Indent can be due to two reasons a. Muscle Spasm b. The Signals to the muscle in the site of indent are obstructed since they travel via the nerve root which is compressed. Question 2 : Also the last two days I had a a couple bad episodes where my whole left foot and leg has gone red and swollen and my toes curling up, this lasted for 2 hours and the pain is horrible what and how is this caused? I have attached a photo. Answer 2 : This is again caused by the Chemical irritation and Mechanical Compression of the nerve roots. This causes Spasm of the Muscles supplying your toes I am afraid that you have reached a stage where you are having all classical signs of radiculopathy or compression and irritation of nerve root 1. Back Pain 2. Back Muscle Spasm 3. Spasm of Toes 4. Shooting Pains You need to undergo Surgery at the earliest Delay may damage the nerve root even more Take Care Please feel to ask further doubts

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