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Leg Pain, Disc Bulging, Stenosis, Disc Protrusion. MRI Done, Discectomy Done. Do I Need Level Three Spinal Fusion?
Question: I had previous L4/5 and L5/S1 discectomy about a year ago. But I have very bad leg pains n numbess. My doctor suggested another MRI and below the results; which he suggested a lumbar fusion may solve my agony. First of all may I know what it means by:
(1) At L3/4 - diffuse disc bulging associated with central disc protrusion is seen indenting the thecal sac. Mild lateral recess stenosis.
(2) At L4/5 Diffuse disc bulging associated with an annular tear. There is moderate narrowing of both lateral recess and mild narrowing of both neural foraminal.
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots.
I had been through many conservative ways & methods and all not helping. Do I really need another surgery & will it be advisable to do all 3 level fusion? Thank you very much & really hope to get some advises soon.
(1) At L3/4 - diffuse disc bulging associated with central disc protrusion is seen indenting the thecal sac. Mild lateral recess stenosis.
(2) At L4/5 Diffuse disc bulging associated with an annular tear. There is moderate narrowing of both lateral recess and mild narrowing of both neural foraminal.
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots.
I had been through many conservative ways & methods and all not helping. Do I really need another surgery & will it be advisable to do all 3 level fusion? Thank you very much & really hope to get some advises soon.
Hi,
Thank you for sharing your thought with me
(1) At L3/4 - diffuse disc bulging- means jelly like material inside the disc had spread out which can cause pain
(2) At L4/5 Diffuse disc bulging associated with an annular tear- means the outer covering of the disc has a tear, which can cause severe pain
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots- means the disc has bulged out towards left side pressing onto the left nerve root resulting in more of left leg pain and numbness
I think you should try epidural steroid injection or left L5-S1 root block injections before surgery, as some patients get good relief after these injections
If still no relief you may undergo surgery, I think you may benefit from revision microdiscectomy at l5-s1 and l4-l5 levels. I do not feel l3-l4 disc bulge is significant.
So to conclude, try injections, if not better revision discectomy ; that would be my line of management
Hope I have answered your query. Please accept my answer in case you do not have further queries.
Thank you for sharing your thought with me
(1) At L3/4 - diffuse disc bulging- means jelly like material inside the disc had spread out which can cause pain
(2) At L4/5 Diffuse disc bulging associated with an annular tear- means the outer covering of the disc has a tear, which can cause severe pain
(3) A left posterior lateral disc protrusion is seen. There is moderate narrowing of the left lateral recess and neural foraminal. There is contact with left L5 and left S1 nerve roots- means the disc has bulged out towards left side pressing onto the left nerve root resulting in more of left leg pain and numbness
I think you should try epidural steroid injection or left L5-S1 root block injections before surgery, as some patients get good relief after these injections
If still no relief you may undergo surgery, I think you may benefit from revision microdiscectomy at l5-s1 and l4-l5 levels. I do not feel l3-l4 disc bulge is significant.
So to conclude, try injections, if not better revision discectomy ; that would be my line of management
Hope I have answered your query. Please accept my answer in case you do not have further queries.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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