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

Answered by
Dr. Renjit George Marcus
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 27, 2020
Hi,
This is the MRI report of my 56 year old mother. She has severe back pain and is unable to walk. Currently in the bed with traction. Doctor has suggested surgery to release nerve trapped between disc.

Please help me understand the following MRI report . Is surgery the only option or any other alternatives (like Physiotherapy).

MRI LUMBOSACRAL SPINE

Axial: T2W ,Sagittal: TlW, T2W Coronal : STIR 2d Myelo

Mild degenerative grade I anterior listhesis of L4 over L5 vertebral body seen.
Haemangioma noted in Ll vertebral body.
Marginal osteophytes seen in multiple lumbar vertebrae.
Facetal thickening L3 - L4 and L4- L5 levels.
Dehydration of lumbar discs noted
Annular bulge with right far lateral extrusion and superior migration of L3 - L4 disc seen, causing thecal sac indentation and narrowing of spinal canal and right neural foramina with impingement over the right exiting nerve root.
Posterior disc 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 of L2-L3 and L5-S1 disc seen, causing thecal sac indentation.
Conus medullaris and cauda equina show normal bulk & signal intensity.
Bony spinal canal measurements are D12: 14mm. Ll: 14mm. L2: 13mm. L3: 13mm.L3 - L4: 09mm.L4: 16mm L4- L5: 07mm.L5: 15mm.
Pre and para vertebral soft tissue are normal.
WHOLE SPINE SCREENING:
Marginal osteophytes seen in multiple cervical and dorsal vertebrae.
Posterior disc osteophyte complex at C4 - CS, CS - C6 & C6 - C7 levels, causing thecal sac indentation and narrowing of spinal canal with subtle impingement over the cord and nerve roots.
Annular bulge of C3 - C4 disc seen, causing thecal sac indentation.
Cord shows normal signal intensity.
PELVIS SCREENING:
Bilateral hip & SI joints are normal.

IMPRESSION:
Mild degenerative grade I anterior listhesis of L4 or L5, vertebral body.
Posterior disc 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 disc seen, causing thecal sac indentation and narrowing of right neural foramina with impingement over the right exiting nerve root.
# Hi.
This is a very common problem.
Surgery is definitly a good option but not the best option.
Treatment mainly depends on the symptoms and not only the mri report
Studies have shown not much difference between surgical and non surgical treatment
So wat i would suggest is an initial non surgical treatment with analgesics. Muscle relaxants. Neuroprotectors and a low dose streoids to reduce the inflammation around the nerve. This will bring down the pain in one to two weeks. Traction or rest for more than one week is not recomended.
Once the pain has come down strat on back exercises.This has to be done regularly. In 80% of cases everything will be fine in two months.
If she doesnt show improvement a steroid injection can be given around the nerve route under xray guidence. It will settle the pain in the remaining 10%.
If still she is symptomatic surgery can be considered.
In her case the diameter of the canal is below 10 mm at two levels which can be a little bad for non surgical treatment. But still it can improve.
Considering surgery there are problems. In her cass several levels are involved. Two levels areinvolved more. Surgery will be done only at that levels. Other levels can still cause problems. Here since two levels are involved the levels will have to be fused usually.. depending on the opetayive findings which will cause more movements in other levels causing pain.

So i would so no for a surgery first

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