Is surgery necessary for my L5/S1 disc bulge symptoms?

Question

Hi doctor,

I suffered a back injury at work nine months ago while lifting an order of 20 batteries weighing 44 pounds each. When I lifted the last battery of the order, I felt a sharp pain in my lower back and my left leg that made me collapse, and I was rushed to the hospital. I have seen a number of doctors over the last nine months without any improvement.

I was diagnosed with an L5/S1 broad annular tear, a paracentral disc bulge, compression of the exiting nerve canal, and a swollen S1 nerve root. Symptoms that have occurred since my injuries are bladder issues (dribbling, unable to stop peeing and leaking during the night in bed), muscle spasms leaving indents in my lower back, redness in my left foot (photo attached), muscle twitching in the left thigh, calf, and big toe, left big toe and two other toes sticking up with pain, a swollen Achilles tendon, a swollen foot, and lower back pain (radiating to the left leg).

The treatment I underwent since the injury was a nerve-blocking injection in the L5/S1, nine weeks of physiotherapy and hydrotherapy, and three months of a medication program that included Endone 5 mg twice a day and Gabapentin 100 mg twice a day. My doctor suggested L5/S1 disc replacement surgery. I would like to get your opinion on the treatment. I have attached some MRI scans and photos.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have reviewed your report (attachment removed to protect the patient's identity). Firstly, I would suggest you undergo endoscopic or microsurgical discectomy surgery for your back pain as soon as possible without further delay. You can also consider disc replacement as an option.

Regarding your symptoms, I would like to tell you that we human beings have a jelly-like material (disc) between the spine bones (vertebra). They act as shock absorbers. But as you lifted quite a bit of weight, there was significantly increased pressure in the disc, so the covering of the disc (annulus fibrosus) ruptured, and the inner material of the disc came out. This is causing pressure on the nerve or nerves that are coming from the spinal cord towards the leg and causing all of your symptoms.

Another important thing is weight reduction and activity modification. Both are risk factors for disc prolapse, which you have. So even after surgery to prevent recurrence at other levels, you need to reduce weight. You should not lift a heavy weight or bend your back in front. For the redness in your left foot, I wanted to ask when you developed this problem.

Do you have a fever or other symptoms that suggest infection?

I hope this helps.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have reviewed your report (attachment removed to protect the patient's identity). As I have already explained, this injury is due to lifting heavy pounds. Considering your symptoms, you will have an improvement in pain immediately after surgery, but the tingling and numbness will take some time to improve.

As there is already bladder involvement, it needs surgical intervention as soon as possible. The longer the compression stays, the longer it will take for improvement and many times some symptoms may not improve.

I hope this helps.

Thank you.