L4-L5 Central Disc Extrusion- Surgery?

[cmac36]

Two months ago I went through the most horrible pain of my life.  I gave birth to two children without any medication or epidural and this was far worse. I ended up off work for a month on short-term disability, but was able to walk within a week of the acute stage ( had back spasms and bruising, as well as radiculopathy into both legs)  During the bed rest phase I could still maintain my dignity and use the washroom/shower unassisted. Thank goodness for small mercies:)

MRI results came in last week and I have been diagnosed with a central disc extrusion at L4-L5. Mass effect on the traversing L5 nerve root, both sides. This is causing causing moderate stenosis on the same root. Foraminal stenosis is also present. L3-L4 has a broad-based disc bulge and minimal disc dessication. My doctor has referred me to a neurosurgeon.

I have returned to working out as of a couple weeks ago and also do 30 minutes a day of physio-prescribed stretches and core exercises.  I am also using a foam roller. I am seeing a podiatrist this week as well to check for leg length discrepancies. My profession is physically demanding ( elementary school teacher) and some days I am in agony by lunchtime.

Has anyone else been diagnosed with a central disc extrusion?  From my understanding they are more rare.  At first the doctors didn't believe the problem was in my back as most of the pain was concentrated there, and not in my legs.  I did have some pain and numbness as well as "shocking" sensations in the outer parts of my hip, leg, and foot, but the pain was not even close to what was present in my lower back. Originally I was told I had sprained my back.

ANYWAYS, sorry for the long-winded explanation.  I have been off of the Percocets and Flexiril for the past 5 weeks and now use ibuprofen only on the odd day to manage the pain.  I am finding the stretches are helping me manage quite well.  

I am a former runner, used to run 30 miles a week, and crossfitter.

Currently I am strength-training and walking. Using the stability ball a lot to help with my core.

Any opinions or advice on whether or not I will need surgery?  I seem to be doing better, but have heard a central disc extrusion is very serious.

Thank-you:)

[Mterelak]

Hello, I'm curious how you're doing now? I'm in a simular situation and I'm off to see more docs today. A detailed update would be appreciated :)

my extrusionis at S1-L5 and is about 14 mm. I'm not in constant pain, but when they pain hits it's about an 8.

Many thanks
monique

[cmac36]

Thank-you for your insight! I saw the neurosurgeon on April 9 and he said no surgery at this time. He says there is enough room in the spinal canal in his opinion and he showed me what he meant using my images. I was happy to hear that, but it left me wondering what the future will hold. He told me the material will eventually get pushed back in and will heal over thinly, predisposing me to issues in the future. I am now virtually pain free but I cannot return to running as the pain returns for a few days afterwards if I do. So now I am speed walking instead. However, I am bummed that this is affecting my active lifestyle. I lost 60 pounds in the six years I was running and I certainly don't want to put the weight back on. I am in Canada and sometimes I think our free healthcare affects the specialists' decisions. Do you think I should seek a second opinion? I am worried my cauda equina nerves could eventually be damaged if it ruptures again. Currently those nerves are free and clear. I don't want to leave it and end up being incontinent or lose bowel control in the future!

[S. Kaul, MD]

Hi there!

You would probably require a surgery with the disc protrusion causing mass effect and stenosis to the corresponding nerve roots; since this is unlikely to respond well to conservative management. I would suggest discussing the situation and the appropriate management plan with your treating doctor.
Hope this is helpful.

Take care!