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protruding disc/to treat or not to treat
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protruding disc/to treat or not to treat

I am 23 and very active in fitness activities.  Back in March I started having pain in my right buttock and down my leg.  A couple months ago, an MRI revealed a moderate to severely protruding disc at L4-l5.  

I've seen several doctors and tried PT, chiropractic, etc.  At this point, I am still able to get by in my daily life and can maintain some level of physical activity.  I've found that I do the best while maintaining moderate workouts (obviously avoiding anything stressful to my back).  My discomfort typically ranges from moderate to minimal.

My Orthopedic doctor recommended a set of epidurals.  However, with some risk and discomfort, I don't know if it is worth it..especially since I am not disabled because of the pain.  Also, is it true that the best I could expect from the epidurals is 3 months of pain relief (no long-term benefit).

It is starting to seem like I may be waiting this one out, staying healthy and being a little careful.  Is it true that this may just disappear (remember my age and health level) or is that just wishful thinking?  Is there any damage, such as scar tissue formation, that I risk by not aggressively treating and managing the nerve inflammation on a constant basis (thru epdidurals or however).  If this is a risk, when does it realistically become a concern (1 year from injury, 6 months, etc)?

Thank you for your comments!!!
Brian Young
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Dear Brian:

Sorry to hear about your disc.  Each patient is individual and so the information given to each is likely alittle different.  If there is no spinal cord involvement, that is compression, then I would think it is safe to try and wait for surgery.  First, I would not have high velocity chiropractor techniques done on your back.  Second, I would follow the instructions from your PT very closely.  Make sure that your posture, activity, etc incorporates fine tune spinal column maintenance.  Such as good form in lifting objects, reducing spinal load (weight lifting etc), proper sitting technique, etc.  The epidurals may help in getting you rehab'd if pain is a problem.  Talk with your neuro doctor, PT, etc very closely about what you need to do to keep from surgery.

The risk is having your disc compress your spinal cord.  This depends somewhat of the etiology of your disc herniation.  If it was trauma, then likely rehab etc will keep that from happening.  If you have a degenerative disease then it will be more difficult to keep this from happening.  What ever the source of the herniation, if it is known, that is what needs to be corrected.

Sorry, I wasn't much help.  Remember that surgery is the last option and often the results are mixed.

Sincerely,

CCF Neuro MD
16 Comments
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Can you please tell me what a protruding disc is.  After having an MRI I was told that c5 & c6 are protruding.  I have had problems with the left side of my body, such as loosing strength, numbness, tingling etc.. Could a protruding disc affect my menstural cycle as well.  My cycle has been off for the past six months and I have noticed that when I do not have my cycle I have a pain that radiates from my kneck to the womb.  Please advise if menstural irregularity is sometimes an effect of protruding discs.  Thanks for your response.  Gina
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Dear Gina Gice:

A protruding disc is where the collagen material that separates the vertebrae and allows the vertebrae to move smoothly, migrates away from its original location.  This is not uncommon and may or may not cause pain.  It depends on how far the disc moves out of it's original location.  I cannot tell you about yours because I have not seen your MRI.  Usually, a disc at C5 and C6 will not cause menstration problems.  I would look for another source of your menses irregularity.

Sincerely,

CCF Neuro MD
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My wife has had bad muscle spasm's in her lower back for about 2 years now. It is something that comes and goes. She seen her doctor regarding this, and the doctor put her on Oxycocet to help her with her pain. She went for an MRI on her back in December, and got her results back today. From what she has told me, the doctor informed her that the disc between her L4 &L5 is buldging around the sides ( i guess it has been compressed). He has also informed her that there is really nothing that can be done about this. He said that there was not really any guarantee that surgery will help her and that she should just continue to take the Oxycocet for the rest of her life. That sounds quite fishy to me. We are going to get a second opinion regarding this. Does this sound at all familiar to anyone? Is there a certain route we should take with this? I definately do not want her to just keep taking the percocet's, as they are a narcotic and extremely addictive. I would greatly appreciate any help we could get on this matter. Thank you kindly in advance.
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Dear Martin:

Yes, I would get a second opinion from a neurologist.  I would not just say that a herniated disc needs only medical therapy.  I would tell you that bedrest for several days, then vigorous rehab, pain management (without narcotics is possible) and see what happens.  Lifestyle changes must happen and correction of bad habits of lifting and bending need to be changed.  Weight loss is helpful (if needed).  Don't settle for just the medication route, your wife will not benefit from this approach.

Sincerely,

CCF Neuro MD
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Thank you very much for your time in answering my question. We really appreciate it. She is going to see a specailist next wednesday, hopefully with some positive results, other than narcotics. Again, thank you. Take care.
Martin & Celina
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I hope things clear up.

CCF Neuro MD
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I HAVE A REINJURY TO A DISC AT THE L5-S1 LEVEL. THE DISC WAS HERNIATED 2 YEARS AGO AND SEEMS ITS HERNIATED AGAIN. THE FIRST TIME IT WAS PROTRUDING TO THE LEFT AND NOW IT SEEMS IT HAS GONE SOMEWHAT TOWARDS THE BACK. THIS LAST HERNIATION OCCURRED ON 9-9-99. I WAS PUT ON PAIN PILLS AT THAT TIME AND WAS ALSO SENT TO PT STARTING IN OCTOBER. THE PT SEEM TO RELIEVE ALOT OF THE PAIN. I AM A WORKMAN'S COMP CASE AS I WAS INJURED ON THE JOB. I HAVE HAD THREE MEDICAL EVALUATIONS. ONE IN OCT.99 BY A WORKMANS COMP REQUEST WHICH STATED HER RECOMMENDATIONS OF AT LEAST 6 MORE WEEKS OF PT. I HAD ANOTHER EVALUATION BY ONE OF WORKMANS COMP DOCTORS 12-22-99 WHICH I JUST RECIEVED HIS EVALUATION WHICH SUGGESTS AND WORKMANS COMP IS ABIDING BY THAT MY PT BE ENDED BECAUSE AT THIS POINT THAT DOCTOR FEELS I AM AT THE HIGHEST LEVEL OF RECOVERY IN PT. HE SUGGESTS LUMBAR EPIDURAL INJECTIONS OF WHAT TYPE HE DOES NOT MENTION. I FINALLY GOT TO SEE A NEOSURGEON THAT TREATED MY DISC TWO YEARS AGO. I HAVEN'T RECIEVED HIS REPORT YET BUT HE TOLD ME HE WOULD RECOMMEND CONTINUING PT. HE SAID HE DIDN'T THINK THE INJECTIONS WOULD DO ME MUCH GOOD AND I DO NOT NEED SURGERY. DO YOU FEEL I HAVE REACH THE MAXIUM RECOVERY TIME IN PT (I'VE BEEN GOING THREE TIMES A WEEK SINCE OCT.) I DO NOT WANT THE INJECTIONS BUT THEY ARE INSISTING THAT I HAVE THEM OR THEY WILL DENY MY CASE. I HAVE 30 DAYS TO APPEAL THIER DECISION. COULD YOU PLEASE TELL ME THE SUCCESS RATE ON THESE INJECTIONS AND ALSO RISKS INVOLVED SO MAYBE I'LL HAVE EVEN MORE PROFESSIONAL OPINIONS TO ADD TO MY APPEAL REQUEST. THANK YOU FOR YOUR TIME
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Dear Denise:

I am very sorry to hear about your problem.  What you ask is actually not ethically correct for me to make any sort of statement.  I have not examined you, have not seen the films of your back, read any of the rehab reports, etc.  Any statement that I would give to you would be only educational and advice.  Thanks for being truthful, but I should not make any statements that might be legally used for malpractice or insurance matters.

Sincerely,

CCF Neuro MD

PS.  Stick with the PT
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SORRY TO PUT YOU ON THE SPOT, BUT COULD YOU AT LEAST GIVE ME THE PRO'S AND CON'S OF EPIDURAL INJECTIONS. ALSO A BRIEF DESCRIPTION OF THE PROCEDURE. ALSO WILL THEY GIVE YOU ANY TYPE OF ANESTHETIC LOCALLY BEFORE THEY DO THE ACTUAL EPIDURAL. AS I AM NOT REALLY KEEN ON ANY NEEDLES BEING POKED IN MY BODY. IS IT A REALLY PAINFUL PROCEDURE. THANKS AGAIN
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Dear Denise:

It is mildly painful, and as in anything the pain varies by individual and who is doing the injection (experience).  The needle is placed in the epidural space and medication is given.  If you have given birth then likely you have had an epidural.  There may or may not be reduction of the pain, but usually there is relief.  The duration depends on the lesion and medication given.  However, the relief is only for a limited time.  Yes, most will given local anesthesia.

Sincerely,

CCF Neuro MD
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Hello. I was the person to post the question regarding my wife's back problems above. Just recently (2 days ago) my wife has been having severe pains in her abdomen (mostly the left side)and back, that shoots into her back, and curls her right over into the fetal position. We went to the ER at the local hospital (2 days in a row), and spent many hours there to find that they can't seem to figure out whats wrong with her. She did a pregnancy test, bloodwork, got an ultrasound and x-rays. She has had an ovarian cyst in the past and says that the pain is similar. She cannot stand straight up (she is hunched over from the pain) and has a hard time sitting up on her own from lying down. She rates the pain (on a scale of 1-10) at a definate 10. When the pain subsides, she rates the pain at a good 4-6. We didn't get any answers from the doctors at the hospital, and have no idea where to go from here. She will be contacting her family doctor today. We are also wondering if you might know if the pain is related to her buldging disc in her back. Any help would be enormously apperciated. Thank-you. Martin
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Dear Martin:

Sorry, I can't help.  Without seeing the films I have know way of knowing how bad the disc problem.  Sorry.

Sincerely,

CCF Neuro MD
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I was diagnosed with degenerative disc disease in october of 99 and i been thru physical therapy several times and I've had an "ESI" DID'NT do any good now i have a protruding disc on top of my other problems I'am seeing a pain speacalist tommorrow and he is doing a nerve block tell me what will they do next.
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Avatar_n_tn
I was diagnosed with degenerative disc disease in october of 99 and i been thru physical therapy several times and I've had an "ESI" DID'NT do any good now i have a protruding disc on top of my other problems I'am seeing a pain speacalist tommorrow and he is doing a nerve block tell me what will they do next.
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Avatar_n_tn
I was diagnosed with degenerative disc disease in october of 99 and i been thru physical therapy several times and I've had an "ESI" DID'NT do any good now i have a protruding disc on top of my other problems I'am seeing a pain speacalist tommorrow and  he is doing a nerve block tell me what will they do next. if that does'nt work what options do i have.
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