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

Answered by Dr. Akshay Kumar Saxena and medically reviewed by iCliniq medical review team.

 

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Hi doctor,

I am suffering from disc bulge at the level of L5-S1. It causes pressure at nerve root for past two months. I am under treatment but no satisfactory improvement in these two months. Please help.


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Dr. Akshay Kumar Saxena
MBBS., DNB (ORTHOPAEDICS)., DIP SICOT ( BELGIUM)., MNAMS., SPINE FELLOWSHIP,AARHUS UNIVERSITY,DENMARK
Orthopedics And Traumatology, Spine Surgery

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 doctor,

Thank you for your quick reply. My pain started a year back. On that time, it was paining like hell but now I will give it 3-4 on a scale of 1-10. Yes, the pain radiates from back to left leg, over the past two weeks it has reduced up to the calf of left leg. After 45-60 minutes of walking or 60-90 minutes of sitting on chair the pain becomes unbearable. My shoulders became uneven. There is no sign of weakness in legs. I have attached my MRI and x-ray reports.

My medical history details are, My first visit was a year ago to doctor for the pain. He suggested me not to lift weight and lean forward. He prescribed me Acenac P, Toprazole, Rolosol gel for 3 months. After three months my pain was gone and there was no problem at all. My pain started again two months back and I visited same doctor.  He asked me to go for an MRI and prescribed Nucoxia-MR, Pyrigesic 650 and Omez. After seeing my MRI reports, he gave Indocap SR, Opara-Semi, Rablet 20 and Meganeuron OD plus. He advised me to use Neoprene back support lumbar belt and 21 days phsiotherapy interferential therapy (IFT) and transcutaneous electrical nerve stimulation (TENS) over lower back. After ten days he prescibed me D-Kool, Dolo 650 and Axogurd SR for two months. But I am not satisfied with the improvement. Whenever I asked him how much time will it take, he never assured me. My age is 24 and I am a software developer. Due to this problem I have left my job. This not only making me physically weak but it also affected my career. So, please look into this matter deeply and suggest me what should I do?

 

Dr. Akshay Kumar Saxena
MBBS., DNB (ORTHOPAEDICS)., DIP SICOT ( BELGIUM)., MNAMS., SPINE FELLOWSHIP,AARHUS UNIVERSITY,DENMARK
Orthopedics And Traumatology, Spine Surgery

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.

The Probable causes:

Pars interarticularis defect.

Investigations to be done:

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

Preventive measures:

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.

Regarding follow up:

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

 

Hi doctor,

I have attached my x-ray of LS spine both flexion and extension view. Please inform me does the condition need surgery? How much time will it take to get heal? Please suggest the best for me. Thank you.

 

Dr. Akshay Kumar Saxena
MBBS., DNB (ORTHOPAEDICS)., DIP SICOT ( BELGIUM)., MNAMS., SPINE FELLOWSHIP,AARHUS UNIVERSITY,DENMARK
Orthopedics And Traumatology, Spine Surgery

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


 
 
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