acute praesthesiae of lower half of bodyand the lower half of upper body

[maha660]

A 45 year female with acute tingling,numbness and burning sensation of the lower half of the upper body together with lower half of the body postviral infection.MRI studies revealed :
1-DV 7-8 small posterior disc bulge mildly indenting the ventral theca with no foraminal compromise noted.
2-LV5/SV1 diffuse posterior disc bulge effacing the related ventral theca and mildly encroaching on both neural foramina more on the left side
3-LV4/LV5 mild posterior central disc bulge indenting the ventral theca with no foraminal compromised noted.
What would be the management of such a case ? Is there further investigations needed ? and what is the prognosis

[Godofredo MD]

Hi.

I cannot advise you on the "best" treatment possible as I know only of a few of your symptoms and your MRI findings and cannot do a complete physical and neurological examination on you. However, the treatment started for your condition seems adequate. One week of treatment might not be enough to say that there is no improvement of symptoms as it sometimes takes a lot more time before any results are seen.

You would have to talk to your neurologist to refer you to a physical therapist who will create a regimen that would be suited to your condition. Most of the exercises that would be done would be targeted at strengthening your back muscles to provide more support to the spine.

As for lifestyle modifications, if you are very active, you should probably refrain from activities that would exert twisting forces on your spine. You should refrain from picking or carrying heavy loads as this would put pressure on your spine. If you are overweight, you would need to decrease your weight with adequate diet modification.  You should also be mindful of your posture, especially when sitting, as this might aggravate your condition.

Conservative treatment may be considered ineffective when there is no change in symptoms for a period of about a few weeks to a month on the same treatment regimen, or when symptoms worsen even with the treatment given.

Hope this helps.

[maha660]

Thank you for your answer but I would like you to advise me about the best conservative treatment given in such cases . I have been receiving vit B complex,vit E, corticosteroids,NSAD and pregabalin drugs for about one week and there is no improvement noticed .I would like you also to advise me about the suitable physical therapy needed and which lifestyle modifications that I should do promptly ? and what is the duration after which we would say that the conservative treatment has failed?

[Godofredo MD]

Hi.

Seeing as there is only disc bulging and no tears, as well as only mild foraminal encroachment, the primary therapy would be conservative.

If pain would ensue from this condition, pain medications may be given. Otherwise, the most important thing to do is undergo physical therapy to strengthen muscles that support the spine to prevent further deterioration of your condition. Also, some lifestyle modifications may be needed to ensure that the spine is not traumatized in any way. Prognosis would depend on the response to conservative treatment but many people have their condition well managed with this.

Hope this helps.