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What Are The Treatment Option For Disc Dehydration And Linear Angular Bulge?

Posted on Fri, 20 Dec 2013

Question: My MRI shows L4 L5 There is disc dehydration and a nilnear annular fissure. 2 mm angular bulge not causing central spine stenosis. There is faucer hypertrophy and normal appearing foramen. What re my treatment options?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I have gone through your reports of MRI lumbo-sacral spine. I would like to reassure you that these abnormalities are minor and surgery is not needed at present. Treatment options for you at this stage include: 1. Medications such as pregabalin or gabapentin capsules; if there is pain, tingling or burning in legs, 2. Physiotherapy, including IFT/traction/ultrasound and back extension exercises. If the nerve pain in the leg is severe, epidural injections may be needed in some cases. I hope my answer helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

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

Follow up: Dr. Sudhir Kumar (22 hours later)

on 7-18-2013 my Uric acid was 6.3. My Dr. gave me Rx (I do not know the name)...It went to 4. The meds stopped. On 11-9-13 my acid uric was 5.3. The doctor put me on allopurinol for the rest of my life. I have not started the med. Considered the fact thar normal range of acisd uric is 4-7. And my acid uric is 5.3,,,do i need to take this med?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: I do not think you need allopurinol. Detailed Answer: Thank you for getting back. High uric acid needs to be treated, however, if your uric acid is normal, then, there is no need to treat it. Moreover, you have no symptoms related to high uric acid such as joint pains in the feet (gout). So, in my opinion, you do not need allopurinol. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (46 hours later)

Thank you for answer... Annullar fissure will be repaired? Should I refrain from exercise?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: Yes, it will be repaired. Detailed Answer: Thank you for getting back. The annular fissure would be repaired on its own. You should continue back extension exercises. It would help you in the long term. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (3 hours later)

I thank you so much for your great answers. I have one last question: My problem started with pain in my left hip around XXXXXXX 2013. after seeing chiropractors and massage and so on it progressed to low back in left side. when I saw Dr on July, he ordered some x-rays, It showed minor artrose on left hip and nothing in back. CT Scan showed diverticulitis (sigmoid), He put me on medications and I felt better. blood test showed Uric acid level of 6.3. He asked and I had joint soreness and some little stiffness. I think he gave me something to lower my Uric Acid. Next time my Uric acid was 4. He sent me to physical therapy. Physical therapy helped a lot. I stopped physical therapy and started swimming and chiropractor after a couple of weeks my pain was worse than ever. could not bend. pain shooting down all the way to small left toe. progressively worse even numbing and tingling in left hand and even moving to right hand and extremities. nd now MRI shows Annular fissure. Do you know why is getting worse? Do you know how long I have had annular fissure? Why is getting worse? He has put me on methylexate to remove inflammation. Is it wise?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: Thank you for getting back. Detailed Answer: Your symptoms in hands can not be explained on the basis of L4-5 problem. It indicates problem in cervical spine. So, an MRI of cervical spine should also be done. In addition, we need to exclude a disease of peripheral nerves of feet and hands by doing nerve conduction studies (NCS). For relief of nerve pain, pregabalin or gabapentin capsules are preferred. Physiotherapy, including IFT/ultrasound and traction would also help in recovery. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (10 hours later)

What about exercise....swimming.... running... jugging... hiking on treadmill....lifting weight.... hanging down from a bar and lifting up.... push up....walking?

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Regarding exercising, all activities are permitted, except lifting heavy weight and forward bending. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (3 hours later)

how long usually takes for it to heal?

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: It usually takes about 6-12 weeks for it to significantly heal. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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