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  • binky
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    Post count: 1

    THis is an amazing website and forum Dr Corenman- thank you for creating it

    Ive had a herniated L5 S1 for probably 20 years, been trying to manage with PT for a while with mixed results. Last month it started to bother me a little more than usual and then i did a cross country trip which put me in the ER when i got home; in addition to bad back+leg pain I had some scary symptoms (bowel/bladder changes). CES ruled out by the doctors and they diagnosed BPH and irritated back nerves based on MRI (there was a prior MRI 3 years ago – basically there is a minimal change) –

    “Sagittal images reveal disc desiccation at L5-S1. There is a Schmorl’s node at the inferior endplate of L5. Minimal Modic type II endplate reactive changes are present of the anterior margin of the L5-S1 endplates.
    There is a 5 mm retrolisthesis at L5-S1. The extruded disc at L5-S1 has slightly progressed since 2019. No additional significant interval changes are demonstrated since the most recent previous examination. At L5-S1, mild facet arthropathy is present, as well as retrolisthesis and moderate size
    broad-based/central extruded disc with slight inferior migration and slight posterior deviation of
    the proximal S1 nerve root bilaterally. There is no significant central canal stenosis, but mild
    bilateral neural foraminal encroachment is present. There is a minimal Modic type II endplate
    reactive change at the anterior margin of the L5-S1 endplates, as well as a pre-existing Schmorl’s
    node at the lower endplate of L5. Remainder of the lumbosacral spine is otherwise unremarkable.”

    When the injury happened 20+ years ago, I changed my exercise patterns. I dont run anymore, dont lift anything remotely heavy (20 pounds is the max and i rarely go there) – the only exercise i do is swim. So i am trying to be very careful. My medical team is suggesting epidural injections as an aggressive step if i want to go there, though i am not sure that will address radicular pain only the low back pain from the arthritis. Question is – what is the most likely trajectory of this injury if i do nothing other than PT and injections? The efficacy of PT has gone down over time but it still helps. My preference is to never have surgery – but Im in my mid 40s and i worry about a major surgery down the road if there is additional degeneration which causes stenosis – ie when i am really old. I have seen some of my older friends (70+) with fusions and it was really hard on them. Is surgery inevitable here at some point?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    You note: “My medical team is suggesting epidural injections as an aggressive step if i want to go there, though i am not sure that will address radicular pain only the low back pain from the arthritis. For your stage in this HNP/spur nerve compression, injections are a good choice. The injections are actually more effective for nerve root pain than lower back pain.

    Your herniation: “moderate size broad-based/central extruded disc with slight inferior migration and slight posterior deviation of the proximal S1 nerve root bilaterally” is not huge but is not unsubstantial. If the injections don’t control the pain, a microdiscectomy is not a big surgery and has good results in the right hands.

    Dr. Corenamn

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