Q. I am suffering with disc bulge. Please get me a solution for it.

Hi,

Welcome to icliniq.com. You have mentioned from MRI findings as L5/S1 disc bulge, instability at L5/S1 level and pars defect of L5 with likely compression of both exiting L5 nerve roots. I would like to know few more details such as,

• What is the duration of back pain and its intensity on a scale of 1-10?

• Is there any radiation of back pain going down in your legs? If yes, which leg and how much distance can you walk before the pain becomes unbearable?

• Is there any attending numbness, paresthesias, weakness in the legs? Or is there any bladder or bowel disturbance associated with it?

• I would like to see your MRI films and dynamic x-rays to understand the instability caused by the pars defect. So, kindly attach the images and send it across to me.

• If a personal visit and clinical examination is not possible, then I would like someone to do a detailed neurological examination including assessment of motor, sensory and evaluation of deep tendon reflexes of both lower limbs. So that it will get clear whether this documented compression on MRI also is correlating with the clinical picture.

• Kindly tell me your detailed medical history including previous treatments and allergies to any medications etc.

Revert back with your MRI and x-ray films to a spine surgeon online -->  https://www.icliniq.com/ask-a-doctor-online/spine-surgeon

Hi,

Welcome back to icliniq.com.

I have gone through your clinical history and the investigation studies (attachment removed to protect patient identity).

• You actually need to know that there is a pars defect of L5 vertebrae which has caused L5/S1 instability. As a result of which there is an associated degeneration of disc at that level. Most probably this is the cause for your back pain.

• From observing your MRI images in detail, there is no apparent pressure on nerves. So it is very difficult to explain the radiating leg pain on walking long distances. Although, I must confess that the foramen of L5/S1 is tight bilaterally so it can lead to some pressure. But, I can assure you that it is not very severe by any stretch of imagination.

• Since I have not clinically examined you, I have to take your word that you are otherwise neurologically normal with no associated motor weakness, no numbness, etc.

• So what needs to be done in your case is x-ray LS (lumbosacral) spine - lateral (flexion and extension views) to check the instability because of that pars defect.

• For you the key remains intensive back strengthening exercises, proper posture counseling, abdominal strengthening exercises, gentle anti-inflammatory medications and adequate supplementation of calcium and vitamin D.

• This is a general outline of your management after going through all the reports. But I must tell you that your back pain can increase because we can see that there is a pathology at L5 level which is contributing to it. Since you are very young , if you follow your exercise regime religiously, then you will become better over a period of time.

• Also in the event any above mentioned neurological symptoms progress, then you have to physically see either me or a good spine surgeon for a thorough neurological evaluation.

• Lastly, I would like to mention that do not take pain killers indiscriminately as it can lead to a lot of other complications. Your should rely on intensive physical therapy over a long period of time for long-term benefit.

Pars interarticularis defect.

X Ray LS (lumbosacral) Spine - lateral (flexion and extension views)

1. Avoid lifting any heavy weight.
2. Avoid acute forward bend especially in morning.
3. Avoid traveling on uneven surfaces especially in two wheeler for a long-time.

Revert back with the x-ray report to a spine surgeon online.---> https://www.icliniq.com/ask-a-doctor-online/spine-surgeon

Hi,

Welcome back to icliniq.com. I have gone through your x-rays and they look fine with not much instability at the L5/S1 region. As of now you can continue with the regimen I have advised. It includes,

• Intensive back exercises.
• Core strengthening.
• General conditioning and abdominal strengthening exercises.
• Posture counseling.
• Gentle anti-inflammatory medication as per your body suitability for few days.
• Adequate calcium and vitamin D intake.
• Precautions as advised.

You should improve clinically if you observe these measures and workup accordingly.

Revert back after three to four weeks to a spine surgeon online -->  https://www.icliniq.com/ask-a-doctor-online/spine-surgeon

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Akshay Kumar Saxena

Experience: 17 + Yrs

Orthopedician And Traumatology

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