Disc Herniation

My doctor said I have severe disc herniation. Symptons started with pain in my neck radiating down to my lower back. I can feel pain & weakness from my buttocks down to my legs. I have no sensation in my 2nd and 3rd toes on my right foot and I have severe spasms in my right leg. My doctor recommended bed rest and time off work. I went to physiotherapy for 3 months(acupuncture, massage, traction) but that didn't help. I still have the neck and lower back pain whenever I sit.  The spasms are not so bad after being off work and resting. Now I have new symptons where I have numbness, weakness and pain in my arms and hands. My doctor has prescribed oxycontin to help manage the pain and I'm trying to do a gradual return to work but has been very difficult. My last MRI was done 9 months ago and the results showed the following:

History: Degenerative disc disease, osteoporosis, severe back pain
At T5-T6 there is a small central protrusion, not impinging upon the cord. Other disc spaces in
the thoracic spine are unremarkable. No central stenosis or foraminal narrowing. Assessment of
the cord is limited secondary to motion
At L3, there is a vertebral body hemangioma
L3-L4 Minor bulging
L4-L5 Broad-based central disc herniation, measuring 6 mm AP. It causes some narrowing of
both lateral recesses
L5-S1 small left paracentral protrusion and annual tear, not impinging on the nerve roots.
IMPRESSION:
At L4-L5, broad-based herniation causes some narrowing of both lateral recesses.
No compression fractures

I don't understand the MRI.
What else can be done to help me with this pain.

Thanks

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There is a material that cushions the space occurring between the vertebra (bones of the spine). This material may sort of be squished out from in between the two bones; this is called a herniated disc. The disc may push on surrounding structures, namely the spinal cord and/or the nerves exiting from the spinal cord. Most often, it is the nerves that are pressed on, and not the spinal cord itself.

In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people every require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications.

In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers.

In some patients, after conservative non-surgical therapy is tried for 4-6 weeks and the pain is still severe or if other symptoms/indications arise, surgery is the next step.

It would be best for you to discuss surgical and non-surgical options with your physician. I would also suggest you discuss with your physician in obtaining an MRI of your cervical spine since this has not been performed. You mentioned having symptoms in your upper extremities which would not be explained by the lumbar spine findings.


Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.