
Suggest Treatment For Multiple Discal Herniation

The reading for the Lumbar Scan is as follows:-
Desiccated L4L5 and L5S1 discs with minimal degenerative anterior listhesis of S1 on L5. Satisfactory verbal alignment otherwise. There is a broad based disc bulge and central to right paracentral annular tear at the L4-5 level with a little flattening of the anterior thecal sac and minor right exit foraminal narrowing but no discrete nerve root compression. There is a minimal disc bulge and small central annular tear at the L5S1 level but no appreciable canal or exit foraminal narrowing. Dehydrated disc and small left posterosteral disc bulge and annular tear present at the L3L4 level with minor left exit foraminal narrowing but no discrete nerve root compression. Normal signal throughout the visualised lower cord.
My Cervical Spine reads as follows:- Straightening of the Cervical spine with partial loss of lordosis. Satisfactory verbal alignment otherwise Desiccated disc and advanced degenerative disc space narrowing at C5C6 Level. Dehydrated discs at remaining cervical levels with mild/moderate C6C7 disc space narrowing. There is a moderate sized broad based disc osteophyte with a right sided preponderance at C5 C6 level with moderate to high grade right and somewhat less pronounced left exit foraminal narrowing. There is a similar broad based disc bulge at the C6-C7 level with moderate exit foraminal narrowing bilaterally. Normal signal throughout the cervical and visualised upper thoracic cord. Symtoms in the neck are very sore upper limbs when moving or driving. I have been getting a lot of physiotherapy. My physiotherapy states there are no neurological findings in back or neck..last time I was scanned for neck was last year and got reviews from Healthcare magic. How do I get rid of the trapeziuz muscles pain in upper arm bilaterial.. can you give me your opinion on both these scans.. I have attached both of them. I may send you another copy in a later email of the last back scan taken six months ago and the neck scan taken six months ago. Thanks.. Scan s attached
Multiple discal herniation
Detailed Answer:
Hi XXXXXXX
thank you for coming back and for trusting HCM
I read carefully your query, looked at your report and understand your concern
First of all I want to assure you that unfortunately even suffering from multiple discal herniations your spinal MR isn't that bad and you don't have reason to worry too much
You have three discal hearniation at lumbar region but those are all minor ones and what's important those don't cause medullary changes
Instead the cervical herniation (the one at C5-C6 level) is a little bigger than all the other ones
It hasn't provoked medullary changes but unfortunately it is in contact with the medulla
Anyway in my opinion as I do with my patient suffering from multiple disc herniation:
you should absolutely avoid physical stress, on working days (when you have to do even minimal physical activity) you should alway wear lumbar fortress and cervical collar, best physiotherapy is your case is swimming and walking.
In my opinion you should try pregabalin for the pain you are suffering at the upper muscles (it is called cervico-brachial syndrome)
Start with low dose and increase it gradually till 300 mg
I would be interested in seeing the first examination of your cervical spine to understand better the cervical herniation progress
In the future the most important advice is to avoid physical stress and wear cervical collar and lumbar fortress
Schedule periodically spine MR (each year)
Hope my answer will help you in understanding the result of your examination and fast recovery
Wish you all the best
Stay healthy
Feel free to ask further questions or discuss with me for further doubts
(if you still have your old examinations please upload them)
Best regards
Dr Eris Ranxha
Neurologist


Hi I have also uploaded my last lumbar report taken in July 14..i have a very good spine surgeon who does not seem to concerned about either.. have I arthritis..of the neck.. I am very worried about this one..i am worried about becoming paralised and having nerve damage..how can this be avoided..is it advisable to request an injection.. I fear surgery and my surgeon does not seem to think that I need it.he is very positive..i am the one that is in fear.. thank you so much..
also is this stenosis of the neck..is the C5C6 disc dangerous to be left the way that it is.. i take it extremely easy, walk a lot and swim..is a disc osteophyte dangerous..i fear using the use of my arms..as mentioned before the other s settled..thanks for advice on medication..would you advise me to get steroids
The same situation
Detailed Answer:
Hi again XXXXXXX
thank you for coming back again
Dear, I carefully examined your old spine images and fortunately I don't see progress of herniations.
Discal protrusion and herniations are mechanic disorder and they can be managed in the same way, by controlling them with collar or fortress.
You can absolutely use hands and one of the best medication to relief pain is the one I prescribed you, pregabalin.
Judging on the progress from July till now, as we see a stationary situation I think that if you be careful in avoiding physical stress, wear protection like cervical collar and lumbar fortress you will never need surgery.
I would not go for steroids as the only benefit would be decreasing the pain but herniations will still be there.
As a conclusion dear XXXXXXX at my working place, I have seen a lot of cases with spine MR which were much worse than yours and never got surgery, and what's more important that are fine.
Progression of discal herniation is easily detectable so you don't have to be worried too much.
Continue swimming and schedule periodic examinations.
Wish you all the best dear XXXXXXX
Stay healthy
Hope I have clarified your doubts
If so please close query otherwise feel free to ask for any other questions or queries
Regards
Dr Eris


Continue physiothrapy. No rheumatismal arthritis. Blood results are fine.
Detailed Answer:
Dear XXXXXXX
I know you are upset but you have no reason to be worried too much
We have talked earlier (September) and I still have the same opinion
Continue swimming, start pregabalin which cause a little fatigue but if you start at low dose you will suffer no side effects
Pregabalin will help you to avoid uper muscle pain. It has mild sideeffects like drowsiness which is manageable for the first week. Later it will decrease.
I cannot comment on kyphosis unless I personally examine you. But scans show it is not bad kyphosis.
At your blood result I don't see signs or confirmation of arthritis so you don't have to bother about that
Hope I have clarified all your doubts
Wish you all the best
Please don't forget to close query if you are satisfied and have no further doubts or questions
Stay healthy
Regards
Dr Eris


I was wondering if you could let me know what is there any spinal stenosis and would you recommend working with this condition.. is it degeneration of the discs..the pain I experience in the arms is like a needle in the arm when I move in a certain direction.this is a recent event (13 weeks).. should I continue with physiotherapy..? many thanks for all your advice.. you have been extremely helpful..also when you mention herniation.. what do you mean.. are these bulges or herniations..also what is a diccated disc and what level of pragbin should I take initially? thanks...also I note there was a disc bulge in c6c7 is this big?
Continue swimming, avoid physiotherapy
Detailed Answer:
Hi again XXXXXXX
as we have talked earlier in my opinion you should avoid physiotherapy and just continue swimming
I saw again MR and there is no reason to worry about kyphosis because it isn't that bad
There aren't spinal stenosis seen but the one at cervical region (the one called bulging) is in contact with medulla
It hasn't cause medulla changes so you aren't missing anything
You can work but avoid physical stress and wear cervical collar and lumbar fortress
Pregabalin must be started at 75 mg and increase the dose each week by 75 mg
Doctors talk about protrusion, bulging and herniation which are the same and mean the same thing
The biggest herniation you have is the one at C6-C7 level.
Hope I have been helpful to you
Wish you all the best dear XXXXXXX
Regards
Dr Eris


Afraid that physiotherapy can damage you
Detailed Answer:
Dear XXXXXXX
I am glad that you are so careful and that is an insurance that you will stay safe in the future
I reexamine the cervical report and saw the image.(sorry, I haven't been careful on typing)
The biggest herniation is at C5-C6, the C6-C7 is a minor protrusion, nothing to worry about
Dear I am not advising physiotherapy because I am afraid that during exercises you can be damaged
As you told yourself some movements provoke needles, which is caused from the contact of nerve root with the disc
In my opinion ultrasound or acupuncture in your case will help you in muscular relaxing but after some hours you will feel the same
It has no influence at herniation, and what's more imptortant physiotherapy isn't indicated at acute stage, when patint is on pain
Dear XXXXXXX I hope things will turn back for the best
Just wear cervical collar and lumbar fortress on activity
Use pregabalin to avoid those needles and soon you will feel much better
Wishing you good health and hopping in your fast recovery
Thanks for trusting us
Best regards
Dr Eris


Continue swimming and avoid physical stress
Detailed Answer:
Dear XXXXXXX
it has been a pleasure for me explaining and clarifying your doubts
In my opinion I would strongly reccomend you to continue swimming not diving.
It is worldwide confirmed that is helpful at all herniations levels
Epidural will reliaf your symptoms but herniation will be still there, still the same
As you aren't suffering unsupported pain I would not go for it
You can use pregabalin for pain
Yes, dear XXXXXXX I have seen patient getting operated, before and after surgery
We have tried to avoid surgery as long as we could
If surgery is undertaken before medullary changes then the recovery is full and no symptoms remains afer surgery
As a conclusion surgery isn't your first choice at your stage so don't think about it.
I hope I have been of help XXXXXXX
Wish you all the best
Stay healthy
Best regards
Dr Eris Ranxha
Neurologist


thanks for all your advise.. you have been absolutely excellent..
I hate to bombard you with questions but is this arthritis of the neck.spondolytis..when you mention that surgery is not an option .. are you saying that it will never be an option..i guess I worry about the muscle pain on both arms but hopefully it will go by itself..
Thanks so much..i appreciate you answering all my queries..thanks
Not arthritis, discal herniation
Detailed Answer:
Dear XXXXXXX
thanks for being in continues touch with us
As we discussed, the blood test have excluded arthritis so forget about it.
I read your physiotherapy report and understand that they are treating you with the right caution
Anyway in my opinion I think it is too risky,
and I don't think it will help in recovering
Especially now when you are on pain
If it is possible short swimming will be the perfect physiotherapy
Surgery isn't necessary now and if you stay at your current status (no neurologic signs present ) it will never be an option
Unfortunately medicine isn't an exact science.
Being totally honest, if you spine stays like this for the future year probably it will stay like this for all your life, time will show it
Muscle pain can go away even by itself but it will need more time
If you start pregabalin it will go for sure earlier
It has been a pleasure XXXXXXX so feel free anytime you want to discuss further uncertains or doubts
Wish you all the best
Regards


also.the herniation that you see now c5c6..was this worse in the last scan..and also with the arm pain.that I am experiencing.. could that get worse with continuous use of the arms.. I am extremely careful..i will go to my doctor tomorrow to get the pregabalin..do you have to remain on that forever.. I don t like taking too many drugs .. I used to take axicalm and antripline.and tyndenol..this is what I take at the moment.. you are very good to reply to all my silly questions but these are very important and I find this service excellent
Just wear cervical collar
Detailed Answer:
Dear XXXXXXX
the risk isn't depended on how much you use your arms
It is all on protecting the neck
If you wear cervical collar probably it won't make hernia disappear but at least won't let it worsening
You can work but avoid physical stress, avoid fast changes of your neck position ( no rapid movements), don't make long walks, don't stay to long on the same position
Continue swimming
Take pregabalin till pain and needles are permanently gone than you can stop it
Carefull it must decreased slowly
You will be fine XXXXXXX don't worry too much
Wish you all the best
Regards
Dr Eris


Electronervography. It is not very big herniation.
Detailed Answer:
Dear XXXXXXX
there are test to find which nerve is suffering or which one has been damaged
It is called electronervography
In your case I don't think it will be helpful as we know the cause of your pain and the localization of discal herniation
Desiccated disc means that when discs of vertebral column lose that heights they became dry and lose the congruence with other near anatomical structure
So they have higher risk to cause discal herniation
Disc osteophyte are border changes of discs cause by long time changes (micro calcifications to borderline of disc) due to rheumatismal changes but it is not arthritis
Hope I have been of help to you XXXXXXX
Wishing you good health and fast recovery
Regards
Dr Eris

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