Disc fragment & Macrophage Resorption of fragment material versus surgery

I injured my lower back on 7-Apr-2010.  I had one epidural injection then an MRI on 14-Apr-2010.  The MRI showed normal L-1, L-2, & L-3 for my age without stenosis.  At L-5: This flattens the ventral thecal sac without significant central spine stenosis or lateral recess stenosis.  There is facet hypertrophy & likely a minimal annular tear.  At S-1: There is mild dessication (desiccation) and disc space narrowing.  There is disc extrusion with inferior migration of a sequestered fragment that measures 7 mm.  The fragment is slightly to the left of midline & contacts the thecal sac and exiting S-1 nerve root.  There is mild edema & enlargement of the left S-1 nerve root.  No significant nerve root compression or thecal sac compression.

Current (Apr-2010) MRI Radiology & Surgical Review of MRI / Impression: Min facet hypertrophy at L-3-L-4; Mild degenerative disc & facet disease L-4-L-5 without stenosis. L-5-S-1 disc extrusion with a sequestered disc fragment.  The disc material that migrates inferior from the disc & contacts the ventral thecal sac and left S-1 nerve.
Progress:  Since The 7-Apr-2010 injury to L-5-S-1 with disc fragment as above I have had 2 transforaminal epidural injections to L-5-S-1 area.  I have had some improvement in symptoms to my left lower back, leg, & foot.  Initially I had severe LBP and pain to my calf with numbness to entire left foot.  Now I have some numbness to left foot (2nd, 3rd, & 4th toes and sole of foot extending towards heal from the toes as listed) and some aching to left calf and lower back.  I was initially unable to walk on the front part of my left foot – but now I am able to do this.  I have intermittent tenant pain and consistent tingling of left foot.

Questions:  
I want to know if the fragment will resorb or be absorbed by my body over time.
I would like to know if surgery is required to avoid nerve damage from the fragment.
I would like reference resources that have tracked disc fragments over time.

[Kalvin]

I saw this the last time you posted it. I’m not sure if I’ll be any help. You do know this a Patient helping Patient type forum, right?

The contact of the fragment to your S1 nerve pretty well correlates to the S1 radiculopathy you’re having although, it could also be from Chemical Radiculitis. I don’t think anyone can state absolutely that your fragment will or will not be absorbed over time, fortunately for you, it’s not in the spinal canal. There have been case studies that have looked at this, particularly involving people that have absolutely refused to have surgery. And there have been very encouraging results, in one case I read that the fragment was absorbed in only 3 months which is unheard off.

As to whether or not the fragment can cause nerve damage, your surgeon would be the one to ask about this because they can migrate, which can have positive or negative results.

References, you’re not going to find the type of data you’re looking for on any patient oriented websites, there have been a lot of case studies on exactly what you’re looking for, but you have to go to sources that are geared more towards medical professionals. You can get the abstracts of some of these studies and I’ll give you a list, but most of these sites require registration and some even charge for full text.

The Spine Journal Online
Interscience wiley.com
Medlink Neurology
Medline (on Medscape.com),
NIH.gov
Google Scholar: I don’t know if your familiar with Google scholar, if not, just do a search on it and when you get to it, do a search on Disc fragment Resorption in the lumbar Spine or something of that nature, it’s a great search engine for the kind of  thing your looking for.

One last thing, post your questions on the Neurosurgery Expert Forum; I’ll give you the link. Questions are answered by a Neurosurgeon and he is very helpful, it generally takes him a couple days to respond to new questions, but he will respond. I doubt if he has time to give you any reference sources, but I’m sure he’ll answer your other 2 questions.

Here’s the link: http://www.medhelp.org/forums/Neurosurgery/show/331


Take Care