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  • olyjack
    Participant
    Post count: 2

    Thank you Dr. Corenman for this forum and website. WHat a great resource for us lay-people!

    I am almost 40, healthy and active. I recently had an MRI to diagnose the cause of my sciatic pain and as suspected found a herniation. I have met with an orthopedic surgeon and am moving forward with oral steroids plus physical therapy to see if I experience an improvement in my symptoms. He said I am a good candidate for microdiscectomy but thought pursuing non-surgical options first would be the appropriate way to move forward. I gather that epidural steroid injection would be the next step in this progression if PT and oral steroids don’t lead to improvement.

    This recent injury leading to the MRI occurred about 2.5 weeks ago. However, I had been treating a prior low back injury from soccer with PT, chiropractic and massage for the past 3 months with some improvement but not enough to get me back to playing soccer or regular interval training. My concern is that I may have had a herniated disc longer than I thought (perhaps from the soccer injury) and thus should consider surgery sooner rather than later. Is this concern valid? Also, I have read that herniations with little loss of disc space and/or little disc degeneration are more likely to re-rupture post surgery. Does this correspond to your findings?

    Here are the MRI findings:

    L5-S1: Disc dessication with mild loss of disc space height and a mild circumferential bulging annulus. There is a large, superimposed bilobed left paracentral disc extrusion. The extrusion measures 11 mm in AP diameter and extends 15 mm inferiorly. It narrows the left lateral recess and displaces the left S1 nerve roots, which are not well seen. There is minimal displacement of left S2 nerve roots within the thecal sac. Mild right, and mild to moderate left neuroforaminal narrowing. The exiting L5 nerve roots are grossly unremarkable.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    I agree generally with your findings and prognosis. I however would immediately go to an epidural as your herniation is quite large and most likely extruded (not contained by the posterior longitudinal ligament-“There is a large, superimposed bilobed left paracentral disc extrusion. The extrusion measures 11 mm in AP diameter and extends 15 mm inferiorly”).

    The only question is whether motor weakness is present. You can test the S1 nerve by reading here (https://neckandback.com/conditions/home-testing-for-leg-weakness/). If you have weakness, I would consider surgery much sooner than later.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    olyjack
    Participant
    Post count: 2

    Thank you Dr Corenman. A follow up for clarification: I am unsure after reading the section on epidural injection whether a nerve block or steroid would be the better procedure for my condition. Can you please elaborate a little on this and is this something that most osteopathic doctors would know?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    A nerve block is similar to an epidural but the entry point is different. There are two different types of “nerve block”. One is a selective nerve root block (SNRB) where a small amount of steroid and numbing agent is injected right around the nerve exiting from the foramen. The other is a transforaminal epidural steroid injection (TFESI) where a large volume is injected at the foramen and is essentially an epidural injected through the foramen into the canal.

    This is compared to a typical “epidural” (ESI), really called an epidural steroid injection where the fluid is injected through the back of the canal through the laminar junction/ligamentum flavum.

    Physicians (D.O. or M.D.) who deal with spine disorders on a regular basis should know all about these injections.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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