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  • tamtamr
    Member
    Post count: 2

    Hi Doc,
    My MRI two months ago showed L5-S1 herniated disc (medium to large) extrusion. Initially I had lots of pain in my left feet toes specially two toes next to big toe. After resting, I got better and my pain in feet was gone. I am mostly pain free if I don’t sit for whole day (which is my job. I am a computer professional). Two days ago, after having whole morning without any pain, all of sudden my back started hearting really bad.I have pain my buttock area and now I feel some pain going on right leg as well. Is this something normal or should I be going for second MRI to make sure herniation is not growing? Also my bladder is feeling so much pressure now a days is that because of muscle got all tight around that area or something else.I am doing stretches suggested by physical therapist and taking Aleve when the pain is too much.
    Should I wait some more time or its time to look for surgical option. Most of the time I have full strength in my legs and my calf muscles rarely hurts but pressure on bladder is something new. Please advice.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    The disc herniation you describe initially (first two months) was improving without surgery like 70% of disc herniations will. There is a 10% rate of recurrent herniation however. This includes patients who have had and HAVE NOT HAD surgery. It is a possibility that you have extruded another fragment. None the less, you could have stretched the nerve somewhat over the existing herniation and re-aggravated the nerve.

    As long as there is no motor weakness or bowel/bladder involvement, then you could continue conservative treatment. You do however mention bladder involvement. It is very unusual that the herniation is so large that it would compress the entire canal which is what it would take to cause cauda equina syndrome (see web site) and bladder involvement. I see this condition about once per year and see at least 400 patients with disc herniations.

    If you do have cauda equina syndrome, you should have numbness around your rear and back of the thighs and significant pain around the “saddle region”. This condition is an emergency and you would need to see a specialist “yesterday”.

    In my opinion, you should see a reasonable specialist for a surgical opinion. This would develop a relationship with that physician and the information would be helpful. You have to remember that a spine surgeon is there to help you understand what your options are to make a surgical decision and not to force you into surgery.

    Let me know how you do.

    Dr. Corenman

    tamtamr
    Member
    Post count: 2

    Thanks for the prompt reply doctor. I guess bladder symptoms which I mentioned before was false alarm as I thought I was having issues but after seeing my doc, he said you will be wet without your knowledge will be the alarm. I have nothing like that at all.
    I am waiting for my recent MRI results. But I am feeling pain now in my right leg for sure. I do feel fine in the morning and full strength but at the end of day, I get really tiered and my back hurts. My doc said I should take Aleve morning and evening as it gets rid of my pain and wait one more month to see any improvements.
    Should I see a chiropractor or message therapist? Will that help at all? My doc do not want me to go Physical therapy because it made me worst few months back when the problem started. Is the back pain is normal as long as I don’t have pain in my legs?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Your physician recommended against physical therapy because of a bad response the first time you sought care so it makes sense that further care from the same therapist might still aggravate the radiculopathy. Therapists are not always similar and some are more talented than others. A different therapist may improve the outcome. Discuss this with your doctor.

    Chiropractors are the same. In the face of nerve irritation from a disc herniation, some chiropractors can improve symptoms and some can aggravate them. It really depends upon the chiropractor. Some chiropractors incorporate massage in their treatment programs and massage typically will not aggravate nerve compression.

    Back pain can occur from a disc herniation which presses onto the posterior annulus but this is not typical. (See the section on back pain in neckandback.com). Back pain normally occurs from discal instability. The typical treatment is a good therapy program. In addition, an epidural steroid injection can be helpful for the back pain and the radiculopathy.

    Hope this helps.

    Dr. Corenman

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