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  • yunakahn1
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    Post count: 1

    L5-S1 left paracentral extruded disc herniation detected. Theres severe left lateral recess narrowing compressing the descending left S1 nerve root
    L4-L5 right foraminal disc herniation detected. There is abutment of the extraforaminal segment of the existing right L5 nerve root
    L1-L2 small focal midline disc herniation detected abutting the ventral thecal sac
    no evidence of spinal stenosisi or neutral foraminal narrowing.
    After first epidural shot still no relieve. Whats my next options to treat this?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    MRI findings are only a portion of the diagnosis. I have seen patients with incredibly large herniations and no symptoms! I can discuss what symptoms an MRI can generate but without knowing what the symptoms a patient is suffering from, this is a guessing game.

    You have two potential leg pain generators, the L5-S1 extruded left disc herniation compressing the left S1 root and a foraminal herniation on the right compressing the L5 nerve root. The L1-2 disc disorder is more likely than not, not causing symptoms.

    The S1 nerve compression causes left buttocks pain that can radiate down to the bottom of the foot. This pain would increase with sitting and bending forward and be relieved by standing and walking. Weakness of the gastroc/soleus group of muscles could cause difficulty with pushing off on the left foot.

    The right foraminal herniation at L4-5 does not make much sense. If this herniation is in the foramen, it should compress the L4 nerve root and not the L5 nerve root. If this herniation is in the posterolateral position, it could compress the L5 root but the radiological report is confusing regarding this detail.

    If this right foraminal hernation is causing L4 root compression, you should have pain that radiates to your ankle that would be worse with standing and walking and improve with sitting and bending forward. However, if this herniation truly causes L5 and not L4 compression at this level, the pain would radiate to the top of your foot and be worse with sitting and bending forward. Watch out for foot drop, the slapping of the foot with walking and the feeling of an unstable foot that can easily sprain the ankle.

    I cannot begin to tell you about epidurals without you first describing your symptoms. See the section under “Conditions”; “How to describe your symptoms” to explain your pain.

    Dr. Corenman

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