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herniation vs bulging - what's causing the pain? L4/L5/S1

Sydney siderSSydney sider Posts: 25
edited 05/05/2014 - 8:11 PM in Lower Back Pain
Hello all,

My dad (48 y.o) has been in severe pain for the last 3 months. Pain started mainly on the lower back (out of the blue). We tried physiotheraphy and swimming for 4-6 weeks and received nerve root block injections on L5/S1 bilaterally which helped a little.

The pain is very severe causing muscle weakness, loss of balance and also mobility in both legs. He has a burning feeling on both his knees (front of knees I think).

All surgeons we've been to has recommended a L5/S1 fusion laminectomy+decompression. We have accepted it because we need to increase quality of life for Dad.

Now, reading this MRI report on his lumbar spine has made me nervous. I'll summarise the L4/L5/S1 areas:

L4-L5: broadbased disc bulge, right para foraminal bilateral annular tear, facet joint hypertrophy, mild foraminal neural exit narrowing bilaterally, possible irritation to L4 nerve root weight bearing

L5-S!: broadbased disc bulge, facet joint hypertrophy. Narrowing of left neural exit foramina with probable impingement on left L5 nerve root. Mild narrowing of neural foraminal exit on left, potential impingement on L5 left nerve root weight bearing.

From what I understand, both L4/5 and L5/S1 have disc bulges but L4/5 has a annular tear (herniated disk). However, L5/S1 has more probably impingement of the L5 nerve root (left) while L4/5 only has a mild one.

Do you think L5/S1 could be the problematic disc causing the main pain in the back and burning effect on the knees, loss of mobility and energy? I purely just ask out of experience and will get proper advice, but right now I just need to see if I should be worried about it.

Thanks all, you're lifesavers (quite literally).

http://www.spine-health.com/forum/announcements/spine-health-announcements/mri-reports-why-we-cant-advise Liz spine-health moderator


  • Stmbt1SStmbt1 Posts: 8
    edited 05/09/2014 - 11:18 AM
    Sydney….that's where my issues are. L4,L5,S1. The MRI report quotes they are bulges. The pain mgmt doc says that L4-L5 is herniated with a tear and leaking disc fluid. So right there mixed opinions. I opted out of the spinal injections. The thought of injecting large quantities of toxins into my spine to alleviate the pain for a few weeks was not worth the risk. I have not heard of any success stories with the injections other than the pain kind of going away for a few weeks. I was advised to be conservative with this for at least 12 weeks. Been off work and hardly any activity for 12 weeks now. Spent 3 weeks medicated laying on my back. Spent 8 weeks on PT. They said I was good to go but I was still in pain…go figure. I'm on my 9th week of chiropractic care. He has helped a lot. The x-rays he took were load bearing with me standing up rather than what they did at the doctors office with me laying down. Anyways his load bearing x-rays revealed an S curve to my back. So just for that fact I'm doing the 12 week spinal rehab with him. Interesting too on the MRI…it is not load bearing either. Makes you wonder if it was load bearing if it would indicate even more.

    I had the burning knee pain about 4 weeks ago as well. The chiropractor actually got that to go away. My tibia and knee were shifted opposite of each other. PT had me doing a lot of squats and lunges…..I think that did my knee in anyway. I thought the knee pain was from the back with the pinched nerves and all but fortunately he got that part of the misery to go away.

    Good luck with this process. Unreal for sure.
  • Please exhaust all conservative measures first. Fusion surgery is a huge life altering experience. You should have at least 2 surgeons telling you that it is essential for the structural stability of your spine. All diagnostic tests should be performed to ensure that your pain generators have been correctly identified. Fusions are not performed to reduce pain. You should make sure that you are ready for the rehabilitation also. This is the rest of your lives you're talking about please don't rush into anything expecting a fix.

    Many have success with epidurals. People who have them & get long term relief rarely post on forums. They get on with their lives. As with most spine problems you're reading worst case scenarios here. Many also find relief from RFA's & other procedures far less invasive than surgery.

    Also please heed the warnings about chiropractors. Herniated discs can't be 'cured' with adjustments. There are some very real horror stories here. They can do a lot more harm than good. Please follow the advise of qualified spine specialists, all I have ever seen have told me to NEVER allow a chiropractor to perform adjustments on me.

    I know how frustrating this can be but spine issues are often marathons not sprints. In some cases it can take a very long time to even pinpoint the cause of your pain. I would hate to see anyone rush into fusion surgery & live to regret it. As I've already said, it's the rest of your lives. Good luck & I hope you find some relief soon.
    Osteoarthritis & DDD.
  • dilaurodilauro ConnecticutPosts: 9,856
    Take a look at this, it may help with some of the terms Difference between a bulging or herniated disc
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • The annulus is the fibrous covering of the disc......so a tear is a tear in the fibrous covering of the actual disc. How severe it is, we don't know ...but it mentions leaking so it is probably significant enough to be seen on the MRI....
    The nerve impingement explains why he is having nerve related pain down his legs and why he is having difficulty walking.
  • Thank you for all the informative replies and help both to the members and the mods.

    EnglishGirl, I think that is great advice. I hope we have done enough to confirm (we went to about 3 specialists, one of which was a neurosurgeon who told us the fusion will be required). Dad did get a epidural, but that sadly wore off after about 2 weeks as he was doing hydrotherapy and physiotheraphy.

    We have gotten the surgery date thankfully in mid June. Dad is now on endone 5mg to manage his pain until the op. I know there are still ways out there to perfectly check what the diagnosis is (discography/myleogram) but we are all so very close to collapsing, especially Dad. The surgeon is very confident most of the pain can be taken away after rehab but we shall have to see.
  • Hit It on the head!
    Avoid the discogram since the MRI clearly hitt the cause. It is excruciatingly painful.
    Sometimes it's time and it appears to be that time for dad.
    English also told the truth, pain is not a part of surgery needs. It may or may not resolve. The focus is the nerve decompression and that could intensify for months afterward. Just hang in there and encourage hope. It is a marathon, not a sprint.
  • Yeah opted out of the injections. My instinct was telling me no. I'm looking into the accurascope procedure where they make a 3mm incision at the base of the sacrum and go in with the laser and camera. They can trim the discs where the nerves are pinched as well as bone. My L4-L5 is black on the MRI. EnglishGirl the chiropractor has helped me a ton. With the disc issues my spine resembled an S curve as well so I felt that getting the spine in alignment would not be a bad idea. I've been in horrible pain and the chiro has adjusted me to where I can breathe and function. Lots of not so easy choices to make.
  • I have had a fusion it was the one where they go in through your abdominal cavity its called ALIF that's anterior lumbar interbody fusion] and its a MASSIVE OPERATION .with a very long recovery time I am also 48 in 24 hours ! and its my third operation and I tell you what my consultant told me .a fusion WILL NOT TAKE THE PAIN AWAY the primary reason for doing a fusion is to stabilise the spine if you get any pain relief that will be a bonus ..so please don't rush into a massive operation mine was at L4/L5/S1 without considering all other options .my problems started on my second operation where the consultant who was a lovely guy but lacking in surgical skills {bit off more that he could chew !] and left me in a mess I was hunched over in pain and life was bad .the pain got so bad I went to see many consultants but they all refused to operate when they read my MRI it was 7 long years surfing the web to find someone that did ADR [artificial disk replacement] after another year on a waiting list I saw this guy and he was shocked at my MRI but did offer me a fusion {ADR was not an option due to deterioration of my spine }..so thinking that a fusion would help I said yes hoping that I could get out of pain ..that was 2 and half years ago and I am still in agony and I have other problems .like swelling of my legs and feet I am still unable to wear anything on my lower legs due to nerve damage .I don't have a social life I need to be lay on my recliner because normal chairs kill my back and my legs shut down I don't have a sex life because the operation has caused ED and as I am in pain all the time ..the last thing I want is my wife anywhere near me [in a sexual way} that's not anything against her its just I carnt be sexualy active ..so there are lots of things to bear in mind before a fusion ,one don't expect a easy ride and fast recovery you may have ongoing pain and even more problems you may have to take painkillers for the rest of your life .and beware of comment like ;;I was back at work within 3 weeks or I was back horse riding in a month ..it wont happen ..expect at least 12 MONTHS to recover ,and even if he had a good operation and recovers before that his spine will always be weak .and this only applies to men you could be permanently damaged sexulay due to damage on the nerves when your spine is being fusion {there is more info on this subject on the spine health information sections] and his groin area will be very painful for about 2 months ...I have also had the operation from the rear but I did not have any instrumentation on the first two operation ..the last operation was the big one ..I have end plates screws /cages ..it looks like a mecharno set !}on xray ..he may fair better that me if its his first operation and he is otherwise fit and well .do lots of reading about fusions and find out the type the consultant is offering .and ask lots of questions .as for your MRI we cart comment on it ..its against SH rules ..sorry and good luck
    1997 laminectomy
    2007 repeat laminectomy and discectomy L4/L5
    2011 ALIF {L4/L5/S1}
    2012 ? bowel problems .still under investigation
    2014 bladder operation may 19th 2014
  • anelsen15 said:
    Stmbt1 u won't do injection but will do surgury? I'm confused a bit, help me understand the logic? If the surgury fails you could have much worse than some steroid in spine
    I too, would take surgery over an injection any day. First of all the medication they use for the injections are not FDA approved for use in the spine. Another thing, they are a big waste of money, I have had several only they work for a couple of days. If your pain is coming from a herniated disc, why mask the pain? Just have it fixed with surgery.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • I did have injections for pain relief prior to my surgery. I had a leak/tear during my lumbar surgery and was told, by my surgeon, that he believes the injections may make you prone to spinal leaks By the way, my surgeon is considered tops in the field of Orthopedic Surgery. I also had a great neurosurgeon that operated alongside of him.
    Cervical Laminectomy and fusion C2 to T1 June 2012, Anterior Hip Replacement November 2012, Laminectomy, Discectomy Foriminotomy, L3 to L5, February 2014, evacuation of Hematoma April 2014.
    Cervical Myopathy, DDD, Spinal Stenosis, osteoarthritis
  • RTgirl2011RRTgirl2011 Posts: 512
    edited 05/14/2014 - 3:05 AM
    anelsen15 said:
    RTgirl2011, everyone is entitled to thier opinion, but most doctors will try injections first, especially if their is no danger for neurological issues. My question to you is what do you do if the surgury fails? Injections do not only mask the pain, they can break the inflammation chain and allow some healing. Im no proponent of injections but they are a valuable tool in pain treatment, but you dr makes the call. Also RTgirl2011 no offence but FDA have approved many things that caused lots of damage so just because its approved does not make it totally safe. For someone who has a SCS, using the term "just get it fixed" regarding back surgury does not sit very well with me, you imply its easy and has no complications. That accurascope may become a fusion if it fails among many other things. I am just trying to put other side of coin for syd to see, the injections did not mask my pain it healed much of it but somehow this point is being missed, Im telling you for me it worked, out the dogs mouth. Not sure what else I can say.
    Get it fixed is exactly what I did. I had pain in my right leg not caused by herniated disc. I got the SCS to fix it. My L5-S1 is bulged when I finally blows, guess what I am having another fusion to get rid of that problem. My surgeon lets me make my own decision on whether I want injections or not. He agrees with me on they are a waste of money. Before you tell me I have a crap surgeon, he is the chief of neurosurgery at the hospital where I had my surgeries at. Surgery may not have worked for you but its the easy fix for me.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • dilaurodilauro ConnecticutPosts: 9,856
    Some folks have had excellent results from their spinal surgery, be it a ALIF, PLIF, 360 for our lumber or ACDFs for our cervical area.
    Then there are others who had problems. I know that Tony (backache) has had major problems after his fusion. But that is one situation. Readers should never be swayed one way or the other about the comments we make here.

    The most important thing for you to do is to review everything, all your options with your doctor(s). Then when surgery, any surgery is recommended, I would seek a second opinon to make sure that everyone is on the same page.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • anelsen15 said:
    I don't believe I said he was crap surgeon ? I simply stated mine is very highly regarded along with many others I've seen who promote injections as first step. My surgeon cannot force injections but he does not have to do surgury if I don't try conservative measures. If their is neurological issues or some mechanical issues, yes no injection necessarily but surgury is not for pain relief primarily. I was able to avoid a thoracic fusion from the permanent relief I got from ESI , thoracic is the hardest area of spine to work on and I knew the dangers of it far outweighed risk of trying injection.

    I have
    Rt, have u read some of the horror stories on failed surgury? I'm glad it worked but I think u portraying it as easy fix is misleading to most , their are many factors involved in surgury and even injections. If ur surgury had failed would you wished u tried the injection? My guess is yes. Fusions often wear out discs above and below requiring more surgury, have u considered this before so easily leaning on fusion?
    I have been to most prestigious drs in us, seen sports drs and not one said injections were waste of time, they said try it , it may not work but it's worth a try to get pain under control or avoid surgury. No false promises. I knew their are some rare complications and some effects down the road but surgury has far worse risks. Fusion for pain relief soley has been called unethical by drs
    The problem with the discs above or below the fusion herniating is called adjacent disc disease. I have had surgery because of this problem. Never once has the thought crossed my mind about getting an injection. Like I said why mask the pain and cause possible nerve damage with numbing a compressed nerve with an injection. What levels have I had fused, you ask, L3-L5 and my L5-s1 is herniated as well. I can't have anything done with it until July when my Medicare kicks in. Then I will have another fusion to fix that disc. Next thing you know you will be telling me I am to young for Medicare since I am only 34. By the way, I also have the diagnosis of failed back surgery syndrome. I am in pain pretty much all the time in my lower back. I know first hand the horror stories of failed surgeries.
    Discectomies 05/08 and 04/11, fusions L4-5 Feb 9,2012 and L3-L4 June 28,2012, Staph infection washout 3/2/2012, Bulged L5-S1. SCS trial on January 17th, 2014, which was a success! Permanent SCS on February 20th.
  • thoracic spine painthoracic spine pain Posts: 566
    edited 05/16/2014 - 1:19 AM
    Rt Girl on the same day on another thread after the post had been surgery is an easy fix, it was posted and I quote

    'Has anyone ever herniated disc while having a SCS? I am suddenly having major sciatica in my left leg. My l5-s1 is really bulged. The surgeon told me it could go any day now. I turned the current up on the SCS to help cover the pain but its not helping. I will have to have a myelogram to check for a compressed nerve, which I am not looking forward to. I hear they are really painful.'

    I would have expected a myelogram before the other surgeries? I've had one, it didn't hurt at all. Not nearly as painful as the fusions and operations already had. I wouldn't even worry about a myelogram if I had undergone the many complex surgeries and believed them to be an easy fix.

    I have to say this and it's not rocket science just pure mechanics - with fusions it can be a domino effect as the discs above and below have to take the extra pressure. I have read it in journals and the Drs know it can happen. Seems like the domino effect is exactly what happened. Something is just not sitting right.

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