What does abutment of the nerve root mean?

Hi,

Welcome to icliniq.com.

I have gone through your query with diligence and would like you to know that I am here to help you. Abutment of the nerve root means that the disc is touching the nerve root. Treatment of a disc bulge alone is mostly non-surgical. If there is an annular tear, then you will need surgery sooner or later, and sooner the better.

I hope this helps.

Thank you

Hi,

Welcome back to icliniq.com.

I have gone through the images (attachment removed to protect patient identity). The tear does not appear big, but there is compression of the left nerve root at this level. In my opinion, based on these images, I would advise surgery. My choice would be a discectomy and foraminotomy on the left side. As of now, you are having only pain. This is a very good time to operate. You are also having osteophytes (bony projections) and canal stenosis. In due course, you may develop weakness in your great toe. It is better to operate before further complications develop.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

In the axial view, there is an irregular shape. The smooth curve is altered, and we see an outpouching on the left side. In the sagittal view, there is a black line in the posterior part, and there are osteophytes. These findings are suggestive of a tear in the annulus on the left side.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

As per the images you have sent to me (attachment removed to protect patient identity), there was an annular tear and prolapse of the disc. If there is a generalized disc bulge (without an annular tear), the bulge can be treated with physiotherapy. But when there is an annular tear with herniation of the nucleus, there is no chance for it to heal by itself. The second doctor is correct. You have had pain for two months. You have an annular tear and prolapse as per magnetic resonance imaging (MRI). All three of these say that surgery is needed. Physiotherapy is not useful now and may even be harmful at the current stage.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

The spinal canal is a small space, and the foramen through which nerve roots exist is an even smaller space. Now, there is an annular tear in the disc. Through this tear, the disc nucleus has protruded. The protrusion of the nucleus creates two problems. Chemical irritation of the root and mechanical compression of the root. Your pain for the past two months is because of this, and so the treatment would be removing the prolapsed part of the disc. This surgery is very much needed. Without this surgery, the root will continue to be mechanically compressed and chemically irritated.

Right now, you have only pain. Over time, with continued irritation and compression, you may develop weakness in the toes or the foot. So, please undergo the surgery as soon as possible. Once you do a surgery, you may need bed rest for two weeks and light work for six months. After that, you can return to your work.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

I am not sure about the sequence of this (attachment removed to protect patient identity). If this is a myelogram, then it is a prolapsed disc pressing the nerve root. Your pain is likely due to a disc prolapse, which is irritating the nerve root.

I hope this helps.

Thank you.

Hi,

Welcome back to icliniq.com.

Thanks for uploading the images (attachment removed to protect patient identity). The compression is due to the same disc, which we have already seen. In this image, you are seeing the compression from the front; in the earlier images, you saw it from the side and above.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Let me answer your questions one by one:

As I had earlier said, the protrusion of the nucleus creates two problems: chemical irritation of the root and mechanical compression of the root. The huge bolt of pain is due to nerve root irritation and compression. The indent is due to a muscle spasm caused by pain. So the treatment would be removing the prolapsed part of the disc, so there is no mechanical compression and no chemical irritation of the root. This surgery is very much needed. Without this surgery, the root will continue to be mechanically compressed and chemically irritated.

Right now, you have only pain. Over time, with continued irritation and compression, you may develop weakness in the toes or the foot. So please undergo the surgery as soon as possible.

I am not able to appreciate much in this MRI image (attachment removed to protect patient identity), but the fact that you had an episode of a bolt of pain along with muscle spasm categorically says that it is time for surgery.

My first preference would be a laminectomy and discectomy. Disc replacement would not be my choice. If needed, a polyetheretherketone (PEEK) cage can be used. The most important step to be done is to remove the prolapsed disc. Others can be decided by the treating surgeon.

Thank you.

Hi,

Welcome back to icliniq.com.

There is mechanical compression and chemical irritation to the nerve roots. This is aggravated during movement. So the body's innate mechanism wants to avoid movements. So there is muscle spasm. The signals to the muscle in the site of indentation are obstructed since they travel via the nerve root, which is compressed.

The foot and leg have turned red and swollen, again due to chemical irritation and mechanical compression of the nerve roots. This causes a spasm of the muscles that supply your toes. I am afraid that you have reached a stage where you are having all the classical signs of radiculopathy or compression and irritation of the nerve root, like:

1. Back pain.
2. Back muscle spasm.
3. Spasm of toes.
4. Shooting pains.

You need to undergo surgery at the earliest. A delay may further damage the nerve root. Please feel free to ask further doubts.

I hope this helps you.

Thank you.