Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Spinal Disc Herniation
Question: Hi, I have a bulging disc at L5-S1, I have tried all sorts of medication, including painkillers, naproxen and Etoricoxib tablets, indomethacin and tramadol, 5 times x 14 days in 10 months period of time, with no pain relief. Also tried kinetotherapy and physiotherapy (twice in ten months). I am doing daily kinetotherapy exercises for 30 minutes and I go swimming 4 times a week. It helps only but for the moment, then the pain comes back. The symptoms are getting worse, I feel numbness in my legs, and I have seen 4 surgeons so far and they did not recommended yet the surgery. The pain gets worse when sitting on the chair at the office, also when lifting the coccyx off the seat and sometimes standing, walking helps but after a while the pain is worse. Might there be a tumor or anything with the tailbone related, could they miss something on the MRI - what other treatments or investigations do you suggest? despite the terrible pain I still see the surgery the last option.
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at those images that you have provided I do not think there is any marked spondylolisthesis, it s a very mild one at L5-S1 but very mild, I do not think it plays much of a role and doesn’t influence any management decision.
I do not see any tumor, of course a complete exam contains more tests than you provide, but I think you can feel pretty reassured, a tumor would be visible on MRI, especially one large enough to compress nerve roots.
In terms of treatment, regarding medications you can tried medication used for chronic and neuropathic pain. There are two main groups either anticonvulsants such as gabapentin, pregabalin or antidepressants such as duloxetin, amitriptylin.
If the addition of those drugs does not work, before considering surgery local injections with corticoids and anesthetics are usually tried to provide some relief while continung physical therapy.
As for additional tests, if the MRI belongs to 10 months ago it may be repeated since you say to be getting worse, otherwise if it is recent is not necessary. If the doctors have any diagnostic doubts about the bulge causing the symptoms then nerve conduction studies can also be done.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Looking at those images that you have provided I do not think there is any marked spondylolisthesis, it s a very mild one at L5-S1 but very mild, I do not think it plays much of a role and doesn’t influence any management decision.
I do not see any tumor, of course a complete exam contains more tests than you provide, but I think you can feel pretty reassured, a tumor would be visible on MRI, especially one large enough to compress nerve roots.
In terms of treatment, regarding medications you can tried medication used for chronic and neuropathic pain. There are two main groups either anticonvulsants such as gabapentin, pregabalin or antidepressants such as duloxetin, amitriptylin.
If the addition of those drugs does not work, before considering surgery local injections with corticoids and anesthetics are usually tried to provide some relief while continung physical therapy.
As for additional tests, if the MRI belongs to 10 months ago it may be repeated since you say to be getting worse, otherwise if it is recent is not necessary. If the doctors have any diagnostic doubts about the bulge causing the symptoms then nerve conduction studies can also be done.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
