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Q. How to correct PIVD and nerve compression?

Answered by
Dr. Atul Prakash
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 08, 2016 and last reviewed on: Sep 17, 2020

Hi doctor,

I am an army man. I am having PIVD L4-L5 and neural compression at L5-S1. I have a little numbness in my left leg and I do not have any control on my left big toe. As of now, my doctor has recommended for surgery. I need your opinion on this case.

Dr. Atul Prakash

Dr. Atul Prakash

Fitness Expert Orthopedics And Traumatology Physiotherapy Spine Health
#

Hello,

Welcome to icliniq.com.

  • The MRI films that you have sent shows only the L5-S1 level and I will pass that as normal (attachment removed to protect patient identity).
  • The MRI report, however talks about a L4-L5 extruded disc, which could be significant, but I need to see the films and will appreciate long sagittal cuts too.
  • EHL (great toe dorsiflexion - extensor hallucis longus) weakness is a result of L5 nerve root pressure either from a L4-L5 disc prolapse or a far lateral L5-S1 disc prolapse.
  • You are being an army man may need to be made fit to return to duty as soon as possible and here the indication for surgery are more liberal. I agree with your surgeon, but need to see the MRI films to be sure of the radiologist report.
  • Now, the recovery of the weakness of the great toe is iffy and I must point out to you that it may not recover despite surgery too, but at least surgery will help you in two ways.
  1. Best recovery chance provided by surgery.
  2. Persistent pressure and extruded disc are more likely to cause local scarring and take longer to resolve if treated conservatively.

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

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