Dr. Sharoff Lokesh Mohan
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had surgery on my spine for disc herniation last year. But still, I am not feeling recovered. I have full details and MRI on the file attached. Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. I have seen your MRI reports (attachments removed to protect the patient's identity).I see that the surgery was done only at L4 to L5, but there is still a small protrusion at L5 to S1. The residual pain can be due to that level of disc protrusion where surgery was not done. You should now wait, continue with physiotherapy, and hopefully get better with time. Otherwise, you will need an assessment after six months with an MRI (magnetic resonance imaging) to check the disc status. Alternatively, you can do MRI with contrast to look for fibrosis and adhesions around the area of surgery at the L4 to L5 level, which can cause nerve pain again. This is only a second-opinion platform. This professional advice I provided stands subject to the actual examination of the report and image and is based entirely on my inputs. It should be correlated with clinical findings. I hope this helps.
Thank you and take care.
Probable diagnosis
Treatment plan
Patient's Query
Hello doctor,
Thank you for the reply.
I had these treatments before and did MRI again. The result are, lumbar lordosis is smoothed without segmental displacements of lumbarization of the L5 vertebra. In the structure of the intervertebral discs, degenerative-dystrophic changes are noted, without a decrease in the height of the discs, with the presence of, diffuse protrusion of the disc at the level of L4 to L5 up to 0.07 inches, with a displacement of the posterior longitudinal ligament and compression of the dural sac and diffuse protrusion of the disc at the level of L5 to S1 up to 0.19 inches, with a right-sided paracentral hernia of the disc 0.23 inches, with pushing back of the posterior longitudinal ligament and compression of the dural sac and root from the opposite sides, more on the right. The bodies of the lumbar vertebrae are rectangular, with clear contours, small marginal osteophytes, single intrabody cartilage impressions, and degenerative changes in the projection of the endplates. Yellow ligaments are not thickened. Facet joints at the level of the study are not changed. The spinal cord at the level of study of the usual shape, structure, size, and contours are even and clear. The roots of the ponytail are of the usual shape and thickness, its contours are clear and even, and the location is usual. The spinal canal and intervertebral foramina with signs of secondary narrowing at the levels of protrusions. Subdural space without pathological signals. Paravertebral soft tissues are not changed. The conclusions are, MRI signs of osteochondrosis of the lumbosacral spine, lumbarization of L5 vertebra L5-S1 disc herniation, and bulging disc L4 to L5. Secondary spinal stenosis.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Your pain is due to an L5-S1 disc bulge, as seen on your MRI scan, which matches the clinical features you mentioned. You will have to go through the same process as you did before for your L4-5 level, like painkillers and physiotherapy, and if it does not work, then the last option will be surgery. This is only a second-opinion platform. This professional advice I provided stands subject to the actual examination of the report and image and is based entirely on my inputs. It should be correlated with clinical findings. I hope this helps.
Thank you and take care.
Probable diagnosis
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Orthopedician and Traumatology
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