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MRI Notes and Myleogram Notes To Follow



  • Not necessarily. Unless it is causing bladder or bowel problems, an extruded disc would never be considered a medical emergency. Any surgery would be considered elective. Probably the majority of patients with a ruptured disc end up having surgery, but it is not necessary. Actually the way I read your report says there is a small herniation at L3-4. None of us have medical training, but I would be surprised if that is the source of your pain.

    You do have a lot going on but most of it is mild or moderate in nature and does not immediately jump out as the pain generator. I doubt that a surgeon would simply perform a microdiscectomy on you at the L3-4 level and leave it at that.

    You need to have flexion/extension x-rays to see how unstable the lumbar spine actually is. Retrolisthesis is mentioned and may turn out to be greater than thought once you see it on the flexion studies. Also there are degenerative changes at every disc level from L3 to S1. As I mentioned previously, these may be similar to most people have after a particular point in their life-span or, it may be a significant problem in your case.

    Your symptoms that you describe correlate more to an L5 and/or S1 spinal nerve root radiculopathy. However, the testing indicates that no neural root compromise is noted. There is some mild stenosis which can cause nerve root compression, but it is not clear on the MRI or myleogram that the nerve is being affected.

    Are you under the care of a fellowship-trained spinal specialist? Have you had any steroid injections to see if that calms down the sciatic-type pain you are having? Most of the changes in your back as noted are degenerative. Just what the surgeon would recommend doing about them will vary. He might want to do a discectomy but it may increase the instability in the adjacent levels...and thus, he may recommend fusion. Or he may recommend conservative treatments to get the L3-4 to heal on its own without surgery.

    You say it has been six months that you've been in pain, but have you been doing any conservative treatments to help the disc heal? These would include physical therapy, steroid injections, etc.

    Please tell us where you are in your treatment and who has been treating you thus far...that will help to know what to suggest might be the next step.

  • As stated before, I am seeing a neuro guy. I have had cortizone quite a few times this year. I just finished a 20 Mg. dose pack two and a half weeks after a regular dose pack and steroid shot in emergency room around November 26th or so. The second dose pack was given around December 13th.
    I have had facet joint blocks and radial frequency ablation treatments done as of this year March made the third time around. My behind feels very I guess the word would be "heavy" kind of like somebody kicked my rear end. I have still burning foot pain and kind of little jumpy things going down my leg. My entire bottom spinal area is really stiff and sometimes I feel like I don't want to walk around. I can't get comfortable even with flexaril at night. I just want this over. I have an emg tomorrow and a flexsion x-ray as suggested but am almost ready to run out into traffic so somebody will help me. This hurts like heck but I'll be patient, that's what God would want so i'll be good.
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  • Well, it certainly sounds like you are ready for a surgical procedure. It will be interesting to see what your neurosurgeon suggests. Then you will probably want to get at least another opinion with a different spinal specialist.

    Sounds like you have maxed out on the steroids and will not want to take anything more for awhile.

    As I'm sure you know, there are no quick fixes with back surgery...and often, even the experts are not 100% sure in how to approach a problem. The spine is very complicated and you can see how the problems become intertwined.

    It can be difficult to know what levels to operate on, etc. Do you do as little as possible, or do you do all the levels that show some problem? Even the simplest procedure requires a period of healing and recovery.

    I hope you will get some answers tomorrow and that your surgeon will then know what needs to be done to help you.
  • Thanks for all the hellp folks, I truly appreciate all the hellp everybody has given me so far. Hopefully by midweek, I should have an answer, you know the drilll, get the procedure then wait half a week to find out what's next.

    Pastor Leo
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