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Old 01-01-2010, 07:09 AM   #1
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Disc protusion L4-L5

I am 26 years old female. My BMI is 33. It was 38 at the start of this year. So I'm up-to some weight loss. Here's my problem. I had a severe right sided low back ache and saw an Orthopedic surgeon for that. He examined me, got an xray done and said that I have a disc bulge at L5-S1 level. He put me on bed rest and analgesics. After one week I saw him. At that time I had some numbness in my right sole especially when I sat, though pain was a bit better. He ordered an MRI. The MRI report showed this:

"a broad based central disc bulge of 5mm at L4-L5 causing only mild ventral thecal sac and left L5 root compression. Early degenerative dicogenic changes at L4-L5. No evidence of spinal canal stenosis and cauda equina and conus medularis are normal."

I just finished Medical school so I have no problem understanding the report but I do have problem and am quite unsure of my future.

At 26 years of age I have a whole career and life ahead. I am single right now but I do plan to start a family.

I showed the report to a Neurosurgeon and he was not very good at counselling. My ankle jerk was slightly depressed on left side. He said a central bulge has one good thing and one bad thing. Good thing is that it usually does not result in extreme pain. A sort of pain in which patient can even cry and shout. The bad thing is that if it slips back further it can result in cauda equina syndrome (it is more common due to a central bulge). He said be careful or you will end up in cauda equina syndrome. Don't climb stairs, don't bend, don't lift even a kg of weight from ground, don't travel, etc etc. He also said that your disc is dehydrated (appeared black on MRI) and this cannot come back and all is because you are so obese.

Will I have to do this all my life???? Will I never be able to live a normal life again??????

He also said that disc protrusions can be healed in upto 80 percent patients without treatment. I have read a case report in which a 45 year old female patient's disc bulge got back to it original position in about 6 months. So it sure is possible. But after that cannot I continue with my daily life routine. Yes I know I have to lose weight (I'm up on it), keep my posture straight while standing or sitting. But rest of things???? If someday I have kids won't I be able to carry them up, or even a pregnancy is too dangerous a thing for my spine? I will never be able to participate in sports or stuff like that. I will never be able to bend or sit on the floor or a sofa? All these questions keep popping up in my mind and I feel really depressed.

I went back to my original Orthopedic surgeon. He was more optimistic and reassured me that don't worry. The disc has started to dehydrate and once its fully dehydrated it will relieve all pressure and you will be okay. He did however say that things can aggravate if you don't take care. Rest he told me to do some more rest and then he will start me on physiotherapy and some exercises. I'm still on medication (NSAID) but I feel almost no pain in my back, though I do sometimes have a feeling of slight pain/tension in my right buttock or some time down the thigh. But overall I'm much better, depressed nonetheless. Its been two weeks since my backache started.

When I asked about the MRI findings (left L5 root compression on MRI, clinically I have all the symptoms on right, just 1-2 episodes of pain down both my legs but overall only my right side is bothering me) the Orthopedic Surgeon said: We do tests to see if our clinical findings correlate with it or not. Now you are clinically much better so I will rely on my clinical findings.

So anyone who has gone through it, I will very well appreciate your own feelings and experience so that I can be reassured and get rid of my depression.

 
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Old 01-01-2010, 02:39 PM   #2
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Re: Disc protusion L4-L5

centrino:

I suggest you post this same note on the Back Pain Board. The Spinal Cord Board deals more with cervical spine issues and most of the lumbar stuff is over on Back Pain.

That being said, they do look at the results of the MRI in conjunction with your symptoms. There are a lot of people out there that would have positive MRI findings but no symptoms.

If it does continue to improve you may be in luck. But I wonder why if they were so worried about CES that they would not discuss surgical options with you at this time. Hopefully someone over on the Back Pain board who has some experience with CES may able to help.
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Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

 
Old 01-02-2010, 02:30 AM   #3
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Re: Disc protusion L4-L5

Hi- I totally understand what you are feeling. I have lots of spine problems and am older 51 but we all go through the same stages in this journey-including depression. I have a central extrusion at L5-S1. I have bi-lateral leg issues. My disc is black and pretty much destroyed and I still get flares and episodes of severe nerve root pain along the entire dermatome. I have been trying to treat with epidurals since June to see how that might go for long term management.
I was already in long term pain management for cervical/thoracic. I have widespread issues and have had surgeries that did not resolve pain so was trying to avoid the knife again.

First, a couple weeks is a short time in the spine world. It is good you feel better so fast. Unfortunately what you might discover is the next flare might last longer or expand in symptoms. Or you might find if you take good care you won't have another episode until you are older. How arrogant of the NS to blame it all on your weight. I know underweight, young people with this problem. Keep on your program to good health but don't think it was the only reason you have this.

For now the key is to do the conservative care and see how you do, and see if you do have another episode. The physio will help you strengthen core and back properly and teach you tricks to live with the condition. I imagine you are on your feet quite a bit, there are lumbar braces/support you can wear. There are so many possibilities of a good outcome for you.

The next 3 months take extra good care and caution to help that bulge shrink back.

I also think the NS could have explained that although central herniations are more commonly connected to CES, true cauda eqina does happen but it is rare. More likely is nuisance irritable urinary issues like small retention or leaks. Just trying to help you understand what many of us actually experience.

I kind of feel the NS was leaning on the negative side where the OS you saw is more positive. It is pretty early to gloom and doom, stay positive! Your age is in your favor! You might be in the group that heals and has no more problems!

I will check in later from my computer.

 
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