Disc extrusion, nerve compression. Do I need surgery?

[ms_mb]

In the past year, I have had 3 episodes of severe lower back pain, each lasting aprox. 3-4 weeks.  2 months ago, I experienced another one, but this time the pain went down the back of my right leg as well.  While driving to work one day, the pain was so bad that I had to pull over to stand up and  try to stop it.  When I got to work, the outer side of my right foot was numb.  This combined with the pain prompted me to go to the hospital the next day.  I was diagnosed with sciatica and had an MRI booked.  After that was done I went to see my doctor.  She reviewed the report and referred me to a surgeon.  She mentioned that they may want to remove one of the discs in my back, which makes me nervous.  Any other suggestions or options??  I am only 27 and would prefer to not have this be a lifelong condition.
Here are the MRI results, hope they help.

MRI THE LUMBAR SPINE

FINDINGS:        

There are five lumbar vertebrae.

There is a minor scoliosis of the lumbar spine with convexity to the right.  The vertebral body height is well preserved at all levels.  There is no abnormal signal seen.  The conus ends at the lower border of L1.

At L2-L3 and L3-L4 there is no disc disease seen.  The spinal canal is adequate.

At L4-L5, there is minimal diffuse disc bulge seen extending into the neural foramina bilaterally with no compromise of the exiting nerve root.

At L5-S1, there is significant disc desiccation and disc height narrowing.  A large focal right para-central disc extrusion is seen at this level measuring approximately 1.2cm in the maximum AP and 1.9cm in the maximum transverse dimension.  Craniocaudally, this measures approximately 2.6cm in length.  This exerts significant compression of the exiting right L5 nerve root and mass effect on the traversing right S1 nerve root which is displaced posteriorly.  There is also significant indentation on   the right anterolateral aspect of the thecal sac from the extruded disc.  In addition, there is mild diffuse disc bulge also seen at this level which exerts narrowing of the neural foramina bilaterally.  The left exiting L5 nerve root is however not compromised.

IMPRESSION:

A right paracentral disc extrusion at L5-S1 level exerting significant compromise of the exiting right L5 nerve root and mass effect on the right traversing S1 nerve root.


  

[yardwench]

Can I ask you to sort out my MRI for me.  I am getting several different answers from doctors.  I have a grade 1 spondy.  If I quote from my MRI would you be able to tell me what to do?  Here goes:

Theres is mild disc dessication without significant disc bulge, foraminal stenosis, or canal stenosis at L2-3 and L3-4.
At L4-5 there is broad-based mild dis bulge.  Very slight anterolisthesis is seen at this level.  There is facet arthropathy as well at this level which is moderate to high grade.  Findings do result in  moderate canal stenosis and lateral recess stenosis.  The exiting roots appear spared but the traversing L5 nerve roots show mass effect within the lateral recesses.  No high grade canal narrowing.

L5-Sl shows mild broad-based disc bulge but this does not result in significant forminal or canal stenosis.  No discrete mass effect is seen on the exiting nerve roots.

I have been sufferering with sciatica pain on the left side for 6 months without any relief. The pain starts upon purposeful walking and standing as if to stand and look at something in a grocery isle.  I am taking 4 ibuprofen every 3 hours with no relief.  I don't want a fusion I just want them to go in and clean up the stenosis and bulges.  Is this too much to ask or is it unapproachable due to the spondy?  Please help.  The Neurosurgeon took all of 5 minutes to tell me he wants to fuse L4-5, clean up the arthritis but said to my face that this would'nt guarantee being pain free???  The Orthopedic doctor said that what I am experienciing is nerve pain and that I didn't need a fusion   Help???????  I am 53, very active, workout 3-4 times a week, female and becoming very upset with the answers that I am getting from the medical field.  Can you shed some light on this????  I hope???

AZ/Michigan

[Godofredo MD]

Hi.

Sorry for the late reply.

It would be better to talk with your surgeon first to properly assess your condition, before undergoing any further manipulation of your spine by a chiropractor, which could potentially aggravate the symptoms. You should ask him/her if the manipulation would be bad for your condition.

Hope this helps.

[ms_mb]

Thanks Dr. Godofredo.  I will definitely weigh the pros and cons of surgery after I speak to my surgeon.  
Do you think seeing a chiropractor is a good idea at this point?  
I do have a physiotherapy appt. booked for next week, and plan to follow with them as needed.  

[Godofredo MD]

Hi.

Unfortunately, your MRI findings reveal that significant nerve compression is occurring at the L5-S1 levels which would possibly need surgical treatment.

Although conservative treatment with pain medications, heat treatment and physical therapy could possibly lead to some relief, the apparent severity of disc extrusion would suggest such measures would only be temporary and if no surgical treatment is done, the condition might worsen.

You should talk to your surgeon about the pros and cons of surgical treatment and the apparent need for it based on clinical presentation and MRI findings.

Hope this helps.