viccMemberJanuary 13, 2012 at 8:33 amPost count: 2
I am a 60 year old male who has just seen his ortho doc after an MRI. she told me the radiologist saw a large rupture at l4-l5 with a big piece of disk pushing on the nerve. she sent me to a back surgeon this coming monday but when I asked her for her opinon, she told me that he would probably want to do a fusion
been getting as educated as much as i can before then, but i cannot find criteria used to determine what method of treatment is indicated. can you shed some light for me?Donald Corenman, MD, DCModeratorJanuary 13, 2012 at 1:25 pmPost count: 8436
Let us assume you need surgery as the conservative care discussion is carried under another thread.
Surgical discussion hinges upon your history, the symptoms and the findings of a physical examination. If you have weakness or leg pain and no lower back pain, then a simple microdisectomy is most likely all the surgery that is needed if there is a large herniation present. However, if the herniation is associated with instability of the segment (spondylolisthesis or angulatory collapse), a fusion may be indicated.
If you have lower back pain as your predominant symptom, and that herniated segment is identified as the pain generator, a microdiscectomy may still be indicated but the success rate of surgery drops somewhat.
Dr. CorenmanviccMemberJanuary 14, 2012 at 12:23 amPost count: 2
I think I fall into the last category. 3 weeks of extreme lower back pain (on percocet, yuk), resolved immediately with a 6 day prednisone regimen. legs are not painful but weak to the point where I can collapse if not careful, especially on steps.
are success rates for microdiscectomy vs fusion posted on this site?Donald Corenman, MD, DCModeratorJanuary 14, 2012 at 12:44 amPost count: 8436
A thorough physical examination will reveal if you have weakness from neurological compromise vs. weakness from pain inhibition. The examination can identify the specific nerve root that is involved.
Even with “extreme” lower back pain. if it only has been present for 3 weeks, in my practice I would consider only a microdiscetomy as long as there is no instability of the segment as noted earlier.
Recovery is much easier from a microdiscectomy than from a fusion. If you do not get relief from this surgery, a workup for lower back pain would be in order.
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