small disk protrusion with fissure

[salyakoob]

Hi

1) Kindly indicate whether small disk protrusion with fissure is one and the same as herniated disk. BTW the affected area is L5 S1 and from MRI findings no pinched nerve has been identified.

2) Can this case be treated in a non-surgical way, i.e, non-invasive way, via exercise, muscle strengthening, etc.

3) Worst case scenario if a sugical procedure is required (like diskotectomy, not really sure about the spelling), what is the average cost for such a procedure in the US.

Your help is highly appreciated.

Thanks & Regards




This discussion is related to Surgical Risks L5-S1 Herniated Disk.

[dr_simran]

Hello Dear,


Yes,small disk protrusion with fissure is one and the same as herniated disk.

Acute Phase
Rehabilitation Program
Physical Therapy
Physical therapy for acute radiculopathy should emphasize analgesia through passive modalities, stretching activities, and soft tissue mobilization initially and then advance to McKenzie-type activities to regain segmental motion. Once segmental activity has been normalized or improved and the patient's pain has reduced, then the patient may begin a walking program and a progressive lumbar stabilization program. The stabilization program should be steadily advanced and the patient should have a generalized conditioning program initiated as well. Physical therapy such as hydrotherapy, massage, and hot/cold therapy.
Transcutaneous Electrical Nerve Stimulation (TENS) is a treatment in which a painless electrical current is sent to specific nerves through electrode patches that are placed on the skin. The mild electrical current generates heat that serves to relieve stiffness, improve mobility, and relieve pain
Treatment methods should be focused on pain relief and maintaining quality of life.

Refer http://www.spineuniverse.com/displayarticle.php/article180.html
Surgical Intervention
The treatment of radiculopathy depends upon the pain severity, degree of functional limitation, and neurologic status. Surgical emergencies include cauda equina syndrome and a rapidly progressive neurologic deficit. Relative surgical emergencies include painless weakness with or without numbness, less than antigravity strength, or extreme leg pain unresponsive to a selective nerve root block (SNRB). The above clinical scenarios are thought to be biomechanical rather than biochemical in origin; thus, they are amenable to immediate surgical intervention. All others require a minimum of 6-12 weeks of adequate nonsurgical care prior to considering surgery. Treatment is directed toward alleviating pain.

For those patients with chronic LBP unresponsive to nonsurgical managment, lumbar fusion remains the surgical procedure of choice. Unfortunately, suboptimal clinical results are obtained by a significant proportion of patients. Lumbar disc arthroplasty has been developed as a potential means to improve the long-term outcome of these patients. Although these devices have had relatively good early clinical results, questions still remain about the long-term efficacy in maintenance of motion and relief of pain, life span of the devices, and results of randomized comparative trials with fusion.
Other Treatment
Early in the care of radiculopathy, interventional procedures may be employed in cases of severe pain, lack of progress, or significant functional impairment. In a position statement, the North American Spine Society recommended the use of epidural steroid injections in lumbar radicular pain caused by structural abnormalities such as disc herniation and spinal stenosis. If no improvement occurs, confirmation of the diagnosis is required. MRI is the test of choice, but it is important for the lesion, as seen on MRI, to corroborate with the location of symptoms. In borderline or ambiguous cases, electrodiagnostic testing can be helpful. If the diagnosis remains uncertain, a fluoroscopically guided SNRB may be employed as a diagnostic aid.
Appropriate nonsurgical rehabilitative interventions include oral nonsteroidal anti-inflammatory drugs (NSAIDs), spine-specific physical therapy, avoidance of provocative influences, and fluoroscopically guided steroid injection. If a comprehensive conservative program fails, an open surgical or other less invasive procedure (chemonucleolysis or percutaneous discectomy) is offered. Long-term analyses have not shown surgical intervention to be superior to a more conservative approach. Less invasive treatments may be successful in up to 80% of persons thought to be appropriate surgical candidates.
Intradiscal electrothermy (IDET) is perhaps the newest and most innovative treatment aimed at chronic LBP resulting from IDD. Targeted thermal therapy with the IDET procedure is designed to modify annular collagen, thermocoagulate annular nociceptive nerve fibers, and cauterize ingrowth granulation tissue. These effects promote collagen remodeling and changes in the annular integrity (causes contraction and thickening of annulus collagen, thereby stabilizing annulus fissures). A study evaluating the outcome after IDET has shown success rates of 70-80% based upon an improvement of 2 points on a 10-point visual analog score and sitting tolerance. This procedure has provided an alternative to major spinal surgery in the treatment of chronic LBP related to IDD

The average cost for discectomy would vary between   $5000-$30,000
Refer http://www.spineuniverse.com/displayarticle.php/article180.html
http://www.emedicine.com/sports/topic63.htm#section~Treatment

Best

[salyakoob]

Dear

Have you any idea about a herniated disk treatement called "peridural catheter thearpy". This technique is microinvasive. Applogies for any inaccurate or any incorrect information as I do not have the full literature on the same.

Regards,

[dr_simran]

Hello Dear,
Epidural steroid injections are a common treatment option for many forms of low back pain and leg pain .Epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.
The effects of the injection may be temporary  providing relief from pain for one week up to one year . It is very beneficial for a patient during an acute episode of back or leg pain.
Refer http://www.spine-health.com/treatment/injections/lumbar-epidural-steroid-injections-low-back-pain-and-sciatica
Best