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Herniated Disc Questions and Answers

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Q: Hi! I am a 32 years old male. I am suffering with acute lower back pain from last 6 days. It's all started suddenly when I woke up at the morning but initially I ignored because I thought it could be a result of a sleeping problem. But the same day, in the evening pain increased many folds and then next 3 nights I didn't able to sleep. For your information, I didn't fell anywhere neither I lifted any heavy weights except a 22 hours flight journey from Detroit to Delhi 4 days back. So far I have consulted 5 orthopedic surgeons, I Urologist and 1 Nuro-Surgeon. I did a AP and Lateral Lumbar-Spine X-ray which tells that "Mild Scoliosis of spine is seen with concavity to right, marginal osteophytes seen, L5-S1 disc space is reduced, rest of the IV disc spaces are preserved". My pain starts from centre of the lower back pain and moves towards right hip area and then comes down towards thigh and groin area, it is a continuous pain. I was adviced to do a full abdomen Ultrasonography and the report was clean except "Right Kidney measures 11.2 x 4.7 cms and shows presence of hydronephrotic changes with dilatated ureter {? ureteric calculus} suggest clinical corelation". So I was referred to a Urologist and the Urologist cleared me from any kind of kidney stones because my pain is continuas because for a kidney stone case, the pain should not be continuous. So the Urologist referred me to a Neuro-Surgeons who told me to do Uric acid test and a MRI Lumbar-Spine. In between I was consulted by another 3 orthopedics and also did lots of blood tests like complete blood count with ESR, Serum Uric Acid, Serum C-Reactive Protein and HLA B27 Flow Cytometry, Blood. The blood reports were slightly higher Serum Uric Acid (7.2 mg/dL), C-reactive Protein was <6 and HLA-B27 was negetive,Complete Blood Count was normal (Mean Copuscular Hemoglobin was slightly high: 34.6 g/dL)and ESR was 06 mm at 1 hr. I also did a Lumar-Spine MRI scan and the report was, "Normal lumbar lordosis is maintained. Early anterior and posterior osteophytes are present on lower lumbar vertebrae with small Schmorls nodes on L3-4 and L4-5 end plates. Vertebral heights and marrow signal are maintained. There is degenerative loss of signal in L3-4 and L4-5 discs. A focal left foraminal protrusion with an associated annular tear of L-4 disc is narrowing the ipsilateral neural foramen and contacting the exiting nerve root. A diffuse bulge of L4-5 is present with bilateral foraminal narrowing (L>R). Rest of the IV discs are normal in height and signal intensity.IMPRESSION: Disc degeneration L3-4 and L4-5 with left foraminal Compression at L3-4 and bilateral foraminal narrowing (L>R) at L4-5. Suggest Clinical correlation." Now because of all these confusion, I contacted another Orthopedics and he told me that my pain is at right side but my disc problem is at Left side i.e. L-R. So this pain should not be because of your disc problem It could be a problem of serum Uric Acid. So please let me know what should be the actual reason of this pain because I am totally confused with different opinions and findings and suffering with this pain from last 6 days. Shantanu

A: Hi Shantanu, I do not see any structural issue which would explain your pain. Didn't anyone consider that it may simply be a muscular issue relating to a very long period sitting on that flight or the associated stress? This makes some sense. It could also be an ischemic pain syndrome, in which case, knowledge therapy would be my recommendation. I say give it a few weeks and see what happens. If no relief, begin the treatment. Best, Sensei Adam Rostocki

Q: I have been having everyday lower back pain and pain down my right leg. I did an MRI and here are the results. There is straightening of the normal lumbar lordosis suggestive of muscle spasm. Mild anterior lipping and discogenic endplate changes at the L5/S1 level noted. The L5/S1 intervertebral disc shows reduced T2 signal consistent with disc desiccation. L5/S1: There is a mild diffuse annular bulge with more focal right posterolateral bulge (6mm AP) consistent with right posterolateral disc herniation. The disc herniation contacts the right S1 nerve root in the spinal canal. Does this require surgery? I have had no relieve of pain after doing an epidural injection and being treated with narcotics. Maria

A: Hi Maria, Could you please detail, as specifically as possible, the symptoms you are having in your leg? Locations, being the most crucial criteria... Best, Sensei Adam Rostocki

Q: Hi, I am 44 y/o, had on and off back pain that usually goes away with rest and or muscle relaxer. Episodes been getting more and more severe requiring injection. My latest episode started with back pain right side radiating to right leg. Had to go to ER, was given muscle relaxer injection and pain meds and steroids. Back pain went away but leg pain remained along with extreme weakness of right leg and foot (can't flex my foot upwards) ang numbness in right toes. Had MRI, here are the results:

"The marrow signal is normal. There is no fracture, malalignment, or bony lesions. The tip of the conus terminates at L1 and appears unremarkable.Images through,T12-L1, L2-L2, L2-L3, and L3-L4: unremarkable.L4-L5: The disc space height is minimally decreased and partially dehydrated. There is evidence or a moderate-to-large, broad central/right paracentral herniated disc compressing the descending right L5 nerve root in the lateral recess.L5-S1: There is no compressive lesion or stenosis.IMPRESSION: L4-L5, broad central/right paracentral herniated disc compressing the descending right L5 nerve root in the lateral recess and compressing the sac."

Please let me know what that means, I was referred to see a neurosurgeon ASAP. What do you suggest my options are?Thanks in advance. Ralph

A: Hi Ralph, You have foot drop being blamed on a compressed L5 nerve root. This is diagnosed as foraminal stenosis due to a herniated disc. The surgical approach is invasive decompression. This surgery can fix everything in some instances, but often does little or actually makes the problem worse. If things do not go well, good luck getting any other surgeon to even look at you...

There are other possible explanations for your pain, as well, including regional ischemia. It seems the symptoms do correlate to the L5 pinched nerve diagnosis, but may not correlate 100%. I do not have enough info here to determine this. Alternate treatments include waiting it out, nonsurgical spinal decompression or a variety of conservative approaches like physical therapy or chiropractic. Hope this info helps. Best, Sensei Adam Rostocki

Q: I injured my back on 01/15/10, from horsing around in good fun with my husband. I didn't feel immediate pain. Within 24 hrs my lower back hurt (lumbar region)at both the center & right side. By 01/19/10 the back pain increased, and had pain in my right buttocks as well. Was not able to stand upright from a sitting position without the aide of pushing against something, i.e., table, bed, etc. Muscle spasms began that afternoon and I was in so much pain, that I went to the ER that evening. Took Xrays (showed no damage) gave me Dialudid & Valuim which did not help w/the pain. Sent me home that evening with a script for Flexeril and 600mg Motrin. Went to my Primary Care Physician on 01/28/10 with same symptoms, prescribed Vicodin w/Tylenol (7.5mg/500mg) and more Flexeril (10mg). Drugs made pain a bit more bearable, but still was hitting a 10 on the pain scale. This lasted for 3 1/2 weeks from the date of the ER visit. Sleeping and sitting was painful. Felt better standing (with weight shifted to my left side/leg) and walking. As of now 03/02/10, back pain and spasms have subsided, thank God! But now I have a sciatica condition, pain in my right buttocks, wraps around to my hip area, down the back of my leg and foot/toes. Below the knee on the right side and back of calf muscle are numbness/tingling, with burning or a pinching sensation on my right ankle, numbness varies to the top and bottom of my foot. Numbness can vary with all 3 smaller toes on my right foot. Sitting aggravates the sciatica. Walking and standing feel better. PCP sent me for a MRI. MRI report is as follows:Female, Age 40

Technique:MRI sequences were obtained in multiple orthogonal planes as needed. No contrast was given.

Findings: There is a large extruded disc herniation at L5-S1 on the right that extends slightly cephalad. It measures 1.3cm in height and 1.0cm in depth. there is flattening of the thecal sac on the right and impinging on the exiting L5 nerve root on the right as well as the descending nerve roots on the right. The thecal sac is pushed to the left. The conus is at L1-2 and appears unremarkable. The L1-2 through L4-5 discs has normal height and signal. The aorta is normal in size. The paraspinal muscles and soft tissues appear unremarkable. No marrow infiltration is seen. No compression fractures are seen. No spinal stenosis is seen aside from the compression caused by the large herniation.

Impression: Extruded disc herniation at L5-S1 on the right extending cephalad. There is impingement on the exiting L5 nerve root on the right and the descending nerve roots on the right.

Going to Orthopedic spine specialist per referral of my PCP. I would much appreciate your thoughts/opinions to this. My questions to you are as follows:Is this a structural problem that can only be remedied by surgery?Could an epidural provide relief or a solution? What medical treatment, if any, would I benefit from?Thank you in advance. Danielle

A: Hi Danielle, Thanks for the comprehensive letter. Usually I have to ask for much more information in order to provide an opinion, but you came through with it all right off the back. I am surprised that the herniation is implicated so much in these impingement theories, since it is noted as pressing more forward than back. This is merely an observation...

The disc could be the cause of your pain. It is certainly possible. However, the symptoms you have may also be a bit wise spread for this L5 nerve root to explain. This could be explained due to compression of the descending nerve roots, but not necessarily.

As far as treatment, there is no singular recommendation which seems ideal. My thoughts are...

Time may resolve it all with or without any treatment.Non-surgical spinal decompression is unlikely to be useful, since the disc is extruded.Surgery may help and also may do nothing or make the condition worse. I would avoid it if possible.Epidurals will do nothing except act as longer lasting drugs. They will not cure anything.

I guess your choices are to wait it out for a while and see, learn to live with it and hope it resolves eventually, or acquiesce to surgery. Physical therapy and such may be prescribed, but if they help, I speculate that it is actually TIME providing the benefit, not necessarily the exercise... Best, Sensei Adam Rostocki

Q: a recent back spasm has me in fear to get back on track to exercise again. what should i start doing? Judy

A: Hi Judy, It depends on the reason for the spasm and the type of exercise performed. I advise that you contact you doctor for specific instructions. Best, Sensei Adam Rostocki

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