Is surgery the only option to release nerve trapped between discs?

Question

Hi doctor,

This is the MRI report of my 56-year-old mother. She has severe back pain and is unable to walk. Currently, she is in bed with traction. Doctor has suggested surgery to release the nerve trapped between the disks. Please help me understand the following MRI report. Is surgery the only option, or are there any alternatives (like physiotherapy)?

MRI lumbosacral spine:

Axial- T2W, Sagittal- T1W, T2W, Coronal- STIR 2d Myelo

Mild degenerative grade 1 anterior listhesis of L4 over L5 vertebral body seen. Hemangioma noted in L1 vertebral body. Marginal osteophytes are seen in multiple lumbar vertebrae—faceted thickening in L3 to L4 and L4 to L5 levels. Dehydration of lumbar disks noted. Annular bulge with right far lateral extrusion and superior migration of L3 - L4 disk seen, causing thecal sac indentation and narrowing of spinal canal and right neural foramina with impingement over the right exiting nerve root. Posterior disk osteophyte protrusion at L4 - L5 level, causing thecal sac indentation and narrowing of the spinal canal and lateral recesses with impingement over the traversing nerve roots. An annular bulge of L2 - L3 and L5 - S1 disk seen, causing thecal sac indentation. Conus medullaris and cauda equina show normal bulk and signal intensity. Bony spinal canal measurements are D12- 14 mm, L1- 14 mm, L2- 13 mm, L3- 13 mm, L3 - L4- 09 mm, L4- 16 mm, L4 - L5- 07 mm. L5- 15 mm. Pre and paravertebral soft tissue are normal.

Whole spine screening: Marginal osteophytes are seen in multiple cervical and dorsal vertebrae. Posterior disk osteophyte complex at C4 - CS, CS - C6, and C6 - C7 levels, causing thecal sac indentation and narrowing of the spinal canal with subtle impingement over the cord and nerve roots. An annular bulge of C3 to C4 disk seen, causing thecal sac indentation. Cord shows normal signal intensity.

Pelvis screening: Bilateral hip and sacroiliac joints are normal.

Impression: Mild degenerative grade 1 anterior listhesis of L4 or L5 vertebral body. Posterior disk osteophyte, protrusion at L4 – L5 level, causing thecal sac indentation and narrowing of spinal canal and lateral recesses with impingement over the traversing nerve roots. Annular bulge with right far lateral extrusion and superior migration of L3 – L4 disk seen, causing thecal sac indentation and narrowing of right neural foramina with impingement over the right exiting nerve root.

Answer 1

Hi,

Welcome to icliniq.com.

Your mother's issue is a common problem. Surgery is a good option but not the best option. Treatment mainly depends on the symptoms and not only the MRI (magnetic resonance imaging) report. Studies have shown not much difference between surgical and nonsurgical treatment. So I would suggest initial nonsurgical treatment with analgesics, muscle relaxants, neuroprotectors, and low-dose steroids. They reduce the inflammation around the nerve and bring down the pain in one to two weeks. Traction or rest for more than one week is not recommended. Once the pain has come down, start back exercises regularly. In 80 percent of cases, everything will be fine in two months. If your mother does not show improvement, we can inject steroid injection around the nerve route under X-ray guidance. It will settle the pain in the remaining 10 percent. If still she is symptomatic, surgery can be considered. In her case, the canal's diameter is below 10 mm at two levels which can be a little bad for nonsurgical treatment. But still, it can improve. As of surgery, there are problems. In her case, several levels are involved. Surgery is needed only in those two levels, which are affected more. Other levels can still cause problems. Since two levels are involved, the levels will have to be fused, usually depending on the operative findings, which will cause more movements in other levels, causing pain. So I would say no to surgery first.