Having Pain And Numbness In Leg. MRI Showed Mild Disc Bulges, No Impingement. Surgery Needed?

Posted on Wed, 17 Apr 2013

Question: I just got the results of an MRI on my lumbar spine. I have several levels of bulging discs, "mild" with contact but no impingement. I have several "annular fissures" -- I am having serious pain in my left leg, with weakness and numbness. It has been this way for one year, several rounds of PT, ESI, Chiro, Massage, Yoga...My MRI sounds very benign, but my symptoms are unrelenting...really, no matter what position I take or whether I am sitting, standing, walking...leaning forward seems to help moderately. I guess I am just wondering if such small problems can cause such big pain? I had a C6-7 ACDF 2 years ago that was very successful. I wonder if I am a candidate for another surgery? Your thoughts?

Answered by Dr. Dr. Praveen Tayal (1 hour later)

Hello,
Thanks for posting your query.
Your MRI is suggestive of only mild disc bulges with no nerve root impingement. The pain in leg with weakness and numbness is suggestive of a nerve root irritation or a mild compression.
The treatment is done according to the severity of symptoms. Medicines- pain killers with muscle relaxants and methylcobalamin supplements are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life of the patient.

Physiotherapy like intermittent lumbar traction , back exercise reduces pressure of disc bulge for some time & gives relief. You can also try epidural steroid injections after discussing with your orthopedician. Surgery is not immediately necessary for the minor disc changes like you have.

The indications for surgery with persons with lumbar disc disease are:
(1) persons with a condition called cauda equina syndrome which is a pattern of neurological , muscular and urogenital symptoms due to compression of certain nerves in the lumbar sacral area.The symptoms would be lower back pain,sciatica, bladder and bowel symptoms,loss of sensation in the buttocks and perineum,muscle weakness.
(2)if the neurological deficit is observed to be worsening-if your symptoms and difficulites are progressing
(3)sciatic pain for a 6 to 12 weeks

I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (41 minutes later)

I have had basically unrelenting symptoms for 9-10 months. The leg pain and weakness is now accompanied by numbness in my thigh and foot. I have several annular fissures with "high intensity zones" - I have worked very hard in the last year to try to rehab and it seems that at every lumbar level there is bulging, tearing and foraminal stenosis. Yet, all classified as mild. I just can't understand how I can be in so much pain yet the diagnostic impression is "mild" it makes me feel like I am over-exaggerating.

Answered by Dr. Dr. Praveen Tayal (9 minutes later)

Hello.
Thanks for writing again.
Since your symptoms are persistent and the leg weakness is also present, surgery can be considered. The mild changes can also cause the severe symptoms sometimes due to a local inflammation. You can consider going for epidural steroid injections after consulting with your orthopedician.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar