Please note that I am aware that any information you may share, in regards to this condition, should not be considered as diagnoses or as recommendations for treatment. Patient: A 32 y.o. female, mother of three, elementary school teacher.There are no disability or workmans comp claims involved. Patient has a 2 year history of severe and unrelenting lower back, buttock and hip pain which originated with sudden onset of severe radicular right leg and back pain. Radicular leg pain lessened after 6 months but continuous severe back and buttock pain remain. She has had 2 MRI's and the results read as follows: Normal bony structure alignment and no evidence of bone marrow replacement disease, decreased signal in the disc material at L3-L4 through L5-S1, compatible with degenerative change. There is identified abnormal central and leftward disc protrusion with slight effacement of the thecal sac at L5-S1. Disc space narrowing is noted at L5-S1 level also. L3-L4 and L4-L5 show no abnormal posterior protrusion of disc material. Bony size is normal. The conus shows no abnormality. There appears to be abnormal central and leftward disc protrusion with associated slight effacement of the thecal sac and obliteration of the epidural fat on the left at the L2-L3 disc. Degenerative disc disease L3-L4 through L5-S1.(Feb. 1998) Patient is interested in obtaining any information on surgical procedures and treatments for this condition. Pain is severe and constant in low back, buttocks and hips and involves some leg pain with residual numbness in posterior right thigh and lateral right foot. Right calf has become 1 inch smaller than left. Would like to know if these symptoms are typical for L5-S1 disc herniation and/or degenerative disc disease. Please note that prior to this disc rupture, periodic mild low back pain(1 x a year) was only symptom. Current symptoms occured suddenly and were not the result of an accident but did present six weeks after vaginal birth of third child. All conservative treatments have been tried; PT,TENS therapy, chiropractry, cortisone epidural injections, facet injections etc. No decrease in symptoms was obtained from any of these treatments. Please be specific with response in regards to potential surgical procedures or treatments. Patient is considering discectomy with possible fusion at L5-S1 level only or a posterior interbody fusion ( at all four levels)with instrumentation (Varigrip system to be removed later). Is fusion (at four levels) with instrumentation a typical procedure considering the degenerative disc changes present at L5-S1 through L3-L4? Patient is also considering undergoing a caudal block and radiofrequency treatment but has concerns about effectiveness, potential risks, lasting results and potential increase in nerve damage by not having surgery. Please share any information with the assurance that this will be perceived as only that. Thank you
We are talking about two different conditions that may play on each other. The first is the disc herniations. The report describes some mild to moderate disc herniations at multiple levels of the lumbar spine associated with degenerative changes on the MRI. Symptoms from a large disc at L5/S1 would include shooting pain radiating down the side and back of the leg into the calf and the bottom of the foot. This may be associated with numbness in the same distribution and/or weakness of the calf muscle.
The second issue is instability of the lumbar vertebrae. This can be due to degenerative changes at multiple levels with or without disc herniation. Chronic, unremitting back pain is a typical symptom. This may be evaluated by doing plain x-rays of the lumbar spine in flexion and extension to see whether there is abnormal movement of the vertebrae.
Much of what should be done depends on the severity of degeneration, disc herniation and instability seen on the imaging studies. It is difficult to make a definitive plan without seeing the patient and the imaging studies. Your friend is young and should be sure the diagnosis is correct before having a long and arduous multi-level fusion procedure.
Your friend should discuss these issues with her surgeon.
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