Significant Thecal Sac Deformity at L5-S1 herniated disk - what to do?
I have a large CENTRAL herniation at L5-S1 that is causing significant deformity of the Thecal Sac. The Herniation is right in the middle, and the Thecal Sac is distorted into an off-kilter U-Shape going slightly to the left, and it looks like the Thecal Sac itself is pressing into the place where the nerve roots would normall be on that side. I have mostly severe back pain and some leg pain, mostly up high and a little in a specific spot on the front edge of the heel on my foot. This is subsequent to a bicycle accident I had last Ocotber where I fractured my Pelvis in several places with networks of non-displaced fractures that didnt need surgery... but my low-back pain that persisted for months after my accident finally got my primary care doctor to send me for a CAT Scan and then for an MRI that diagnosed this moderately large central/slightly para-median disc herniation at L5-S1, as well as a large broad-based bulge as L4-L5.
WHAT SHOULD I DO?
I got sent to a NeuroSurgeon first, to get it checked out as to whether it was a surgical emergency, and I was offered the MicroDiscectomy surgery and told to come back if/when I decide that I want it. I am now waiting to get an appointment date with a Neurologist, but I want to do whatever I can to help my body in the meantime while I am waiting.
Based on your MRI results, it would appear that you are a good candidate for surgery.
Whenever there is a significant disc herniation that is pressing against the thecal sac, surgical intervention is really the only recommended treatment option,
The longer the nerve tissue is irritated/compressed, the greater the risk for permanent damage that even surgery would be unable to repair.
You do have some involvement of the L4-L5 area as well, While there may not be any evidence of nerve involvement at this level, progression of degeneration of that disc could result in future problems. Much would depend on your age and whether you have been diagnosed with arthritis, etc.
I am not sure of the need for a neurologist appt unless you want to verify that there is definitely nerve involvement and how it is affecting your lower extremity, The MRI provides the information you need, the EMG/NCS studies will just let you know the extent of the nerve involvement Either way, surgery seems to be your best option.
How comfortable were you with the neurosurgeon? If you feel he is rushing you, you might want to consider a second opinion just to verify his treatment plan.
As for what you can do in the meantime, just continue comfort measures as much as possible with anti-inflammatory meds, pain meds etc. Protect yourself from any additional risk of injury (ie falls)
Post with an update and let us know of your progress.
Best wishes ----
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