Neurosurgery Expert Forum
Herniated L4-5
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Herniated L4-5

Hello, I took an MRI in February and it showed a right paracentral disc herniation with mass effect. My neurosurgeon first ordered 3 steroid injections with no success, I went to physical therapy and in my third week, I started having pain numbness and weakness in my left leg down to my foot. The physical therapist checked my knee reflexes and I had none. She called and made an appoointment to the neurosurgeon. His PA saw me the next day because he was in surgery. EMG study was ordered and the physician checked my reflexes also. I have pain in my right buttocks as well as the left and down both thighs. The test was done only on my left leg and the doctor said that it looked okay. I have not been in yet for the results yet but I do have a return appointment. My neurosurgeon said that he would order a myelogram if the PT and injections didn't work. How could the EMG show normal results when I have numbness in my big toes and pain in my thighs down my leg. Should both legs been tested and do the EMG study sometimes miss nerve compression. I have been in pain now for six months and I have had surgery before by the same neurosurgeon L5-S1 in 2002 lumbar laminectomy. I have not had any problems since until 2010 when I ruptured L4-5 in January. Is a myelogram a good test for me and do you think I will benefit from surgery at this point. Physical therapy mostly used ice and tried  periformis exercises but my pain level was too much. When they checked me they decided to release me back to the neurosurgeon. Please give me some input on this matter.      
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I dont know what you are really planning: to loose you strengh in your left leg??? Then you become someone who needs a lifelong rehab???
Dear, in this case MRI decides not your steroids injection and not your neurosurgeon, I even feel from your history that your PT is the most aware one because she is the first who refused to continue excercising on your ill disc!
For what EMG and 6 months waiting for weakness???IT IS AT ALL NOT COST EFFECTIVE. Do a surgery ASAP, if needed you can insert a posterior dynamic fixator (for example Coflex) if only your neurosurgeon insist on fixation
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Thanks Dr. for your opinion. I really thought like you that surgery should have been performed also. I do see the neurosurgeron on Wednesday and since he was the one who did'nt think surgery was the answer, I have to let him know that I am not going to continue to accumulate all those medical expenses because even with insurance, I have to pay a great portion of the bill. At this point, if he insist on more expensive tests  and do not want to fix the problem via surgery then I have no alternative to seek another neurosurgeon. I hope it won't come to that point because he did a marvelous job with my previous surgery and have 28years of experience. Again, I really appreciate your opinion.  
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