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Q. Will you recommend fusion surgery for disc extrusion?

Answered by
Dr. Palanikumar Chellamuthu
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 30, 2016 and last reviewed on: May 19, 2020

Hi doctor,

Four years before, I met with a car accident with no external injury. After a week, I started getting pain in my right buttock and calf area. Later, I was recommended for an MRI and found it was L4-L5 disc extrusion. I underwent the microscopic discectomy the same year. Now, for the past one month, I am having severe pain in the same area. I consulted my surgeon and took another MRI as recommended. This time as well, I have the disc extrusion in the same disc. This time he is recommending for fusion. I am attaching the MRI reports for your kind advise.. Please check and advise whether I need to go for it. My current medications are Renerve plus and a painkiller. Thank you

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#

Hi,

Welcome to icliniq.com.

A few observations are as follows.

  • Your pain is on the right side and the MRI (date of examination not visible) says about the disc with stenosis more on left side (attachment removed to protect patient identity).
  • Kindly inform me about any neurologic defects that your doctor found on clinical examination.
  • Could you be more specific on your current and past walking distance, standing time, pain aggravating factors, etc?
  • The MRI sections in the second and the third attachment shows degenerate disc with extrusion more on the right foraminal para central areas with lateral canal stenosis.
  • No doubt that you can be helped by surgery, but fusion is the end surgery. You can have a lot of problems like decreased movement, adjacent segment degeneration, implant and fusion related problems, increased cost, neurologic damage chances, etc.
  • Instead, first I suggest that you to discuss about transforaminal endoscopic discectomy with your doctor.
  • You have a lot of advantages with this new procedure. These are fusion alternative surgeries that an young person like you will mostly benefit.

Treatment plan:

Evocative discogram proceed transforaminal endoscopic discectomy.

Regarding follow up:

Revert back with the answers to the above questions to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Thank you doctor,

I am really grateful for your detailed advice. It is giving some positive news to me as I consulted almost six doctors and all recommended for the fusion which was my cause of worry. Regarding neurologic defect, my doctor did not mention anything about that. Post my earlier surgery, I was able to go for a morning walk around 4 km, for every 2 km I took a 5 minutes break since I felt some stiffness in my lower back. I was able to stand for around 5-10 minutes. After that, I get the same stiffness as mentioned above. Almost a month back, I went to the office and had severe low back pain where I could not sit, stand, walk or sleep. Then my doctor advised me for a bedrest of almost six days and later the low back pain reduced by 50%. But, the buttock and calf pull on the right side was not reduced. In fact, during the sleep, I get up many times due to this pulling pain. I had some severe tingling effect and severe hot feel on my right feet. Later, I was advised with Neugatrip, Etoshine and Renerve plus for a month. With these medicines, I was able to manage my pain. Now, I am almost going to complete the one month course. I stopped walking due to the pain and I am unable to stand for more than 4 minutes. In the office, I will get pain in the lower back if I sit for more than 30 minutes. While getting up from this position, I get lower back pain along with the buttock and calf pulling pain for a few seconds.

#

Hi,

Welcome back to icliniq.com.

  • I have not seen your x-rays. But, I still believe that your symptoms are due to your L5-S1 nerve pressure and chemical interaction.
  • For further pain, you could undergo a transforaminal epidural steroid injection, which is a day care procedure and get interim relief.
  • In the meantime, please get updated on these path-breaking new procedure.
  • I will be even more informative if I can see your earlier MRI, x-rays, doctor's notes, operation record, present doctor notes, etc. Then, I can form a firmer opinion and guide you better.

Revert back with the details requested to an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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