L5 S1 Disc Herniation

[lyco03]

I had a MRI after approximately two months of lower back pain.  I called my doctor after two weeks of pain.  My family doctor first felt the pain I was having may have been a kidney stone, as I had low back pain radiating around my left side into my left testicle. I was x-rayed and had a CT Scan. Both tests were negative and the pain was diminishing.  I decided to go back to my lifting and running and within 30 minutes of finishing my run, my pain was back with a vengence.  I waited about another two weeks to call again.  This time the pain was still in my left testicle radiating down my buttocks and into my legs.  I am unable to take a full stride with my right leg, when I do it is a stabbing pain in my back and goes down my legs. Sitting, standing, even laying down present pain.  My MRI report reads as follows:

Diagnosis
    1. Large right paracentral HNP L5-S1 with right S1 nerve root impingement.
    2. Noncompressive disc bulging at L4-L5.
    3. More mild degenerative disc disease elsewhere as described.

Comments
     At T12-L1 through L3-4 there is disc desiccation and minimal disc bulging with minimal indentation upon the ventral thecal sac but no focal hernaited nucleus pulposus or spinal stenosis.  Multipe Schmorl's nodes are present in this zone.
     At L4-5, there is a broad-based disc bulge flattening the ventral aspect of the thecal sac but not causing significant spinal stenosis or lateral recess narrowing.
     At L5-S1, there is a large right paracentral herniated nucleus pulposus with an indentation upon the right anterolateral aspect of the thecal sac and posterior deviation of the right S1 nerve root at its origin.  The degree of central canal stenosis is still mild, as the thecal sac is rather capacious here.  This focal disc herniation is superimposed upon a more broad based disc bulge and ther is mild bilateral recess narrowing.
     I cannot appreciate a L5 pars interaticularis defect.
     The vertebral body bone marrow signal and visualized retroperitoneal soft tissuestructures are normal, allowing for a circumaortic left renal vein, a normal anatomic variant.


As I do not do physical activity the pain begins to diminish over weeks.  The problem with this is, I am a federal correctional officer and part of a tactical team, that means that I must wrestle with inmates on an almost daily basis as well as be in peak physical shape as I have training in which we run and do other physical activities on a monthly basis.  So far my team leaders have been accepted to the fact that I have something going on, however I need to know what I am looking at, so I can get an answer to everyone involved as well as myself.  I have heard of injections, but I do not want to play with them only to have the pain return when the injection wears off.  What is the likely hood of surjery as well, what type, and what is the approximate recovery time, I feel this may be the best result, however I don't really want to do it.  I have just had my referal to an orthopedic spine specialist but it may take 4-6 weeks until I see him.  Anybody with any advice??

[kittyluv1]

The difficulty with pursuing surgery on your lumbar spine is that it may cause a reduction in the movement and function of your low back. This could be a problem given your very active work situation and lifestyle.
Your symptoms are definitely related to the MRI findings particularly at L5-S1 where there is nerve root involvement.  The fact that you are also showing evidence of degenerative disc disease in multiple areas also puts you at risk for additional injuries given your duties as a correctional officer.  
It is unfortunate that you have to wait for so long to see the spine specialist as I feel he may be able to offer you other treatment options that may delay the need for any invasive surgery.  Epidural injections can reduce inflammation and swelling and hopefully reduce the pressure on the spinal nerve root.  The object is to get the nerve root free of increased pressure and reduce the risk of permanent nerve damage.  Injections could relieve your pain for a long time depending on the extent of nerve involvement. There is only mild central canal stenosis (area through which the spinal cord travels) but evidence of more narrowing of the spinal nerve root openings.
Hopefully you can get an appt earlier and the different treatment options can be explored in more detail.
Post again with an update -- and best wishes for a successful outcome!

[kittyluv1]

The difficulty with pursuing surgery on your lumbar spine is that it may cause a reduction in the movement and function of your low back. This could be a problem given your very active work situation and lifestyle.
Your symptoms are definitely related to the MRI findings particularly at L5-S1 where there is nerve root involvement.  The fact that you are also showing evidence of degenerative disc disease in multiple areas also puts you at risk for additional injuries given your duties as a correctional officer.  
It is unfortunate that you have to wait for so long to see the spine specialist as I feel he may be able to offer you other treatment options that may delay the need for any invasive surgery.  Epidural injections can reduce inflammation and swelling and hopefully reduce the pressure on the spinal nerve root.  The object is to get the nerve root free of increased pressure and reduce the risk of permanent nerve damage.  Injections could relieve your pain for a long time depending on the extent of nerve involvement. There is only mild central canal stenosis (area through which the spinal cord travels) but evidence of more narrowing of the spinal nerve root openings.
Hopefully you can get an appt earlier and the different treatment options can be explored in more detail.
Post again with an update -- and best wishes for a successful outcome!