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  • azzkel
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    Greetings, Dr. Corenman! I’m writing on behalf of a good friend of mine, who is currently in hospital in Saint–Petersburg, Russia, due to disturbing back and left leg pain. He was hospitalized two weeks ago when the pain became intolerable. My friend is a 29 y/o male. He works as an engineer and spends a lot of time in front of the PC. Nevertheless he does exercises, walks a lot and rides a bike. He had a long history (~15 years) of lower back problems, with pain occurring sometime every year. In January 2013 the back started aching again and he did an MRI scan, here are the findings (I’ve translated them from Russian up to my knowledge and understanding) (picture here, I cannot properly attach the link, but you can copy and paste it into the browser):
    imageshack.us/a/img24/7097/mityamri0801132.jpg

    On the series of lumbar T1 and T2 weighted MR-images lordosis is normal. L5 vertebral body is posteriorly displaced by 0.8 cm. On T2 disc height and signal intensity of L4-S1 discs is lowered.
    Dorsal medial L4-L5 disc bulge up to 0.6 cm, pressing on the epidural space and spreading into the adjacent foramina.
    Dorsal diffuse L5-S1 disc bulge up to 1.1 cm, pressing on the wall of dural sac and spreading into the adjacent foramina, more on the left, and caudally along the S1 body up to 1.1 cm. Anteposterior width of the spinal canal is narrowed to 0.9 cm.
    Dorsal Th12-L1 disc protrusion up to 0.3 cm, pressing on the anterior epidural space. Spinal canal width is lowered at the levels of disc herniations, Spinal canal signal on T1 and T2 is normal. Minor Schmorl’s nodules of Th12–L5 vertebrae. Vertebrae are normal in shape and size, signs of degeneration in vertebral bodies.
    Impression: Signs of degenerative changes of the lumbar spine. Herniation of discs L4-L5, L5-S1(with caudal spread). L5 body retrospondylolisthesis.

    The pain resolved without intervention, however one day in March all of a sudden the back pain returned and he lost feeling of his legs. He was given an injection by the ambulance team and prescribed some medicine. After a few days he could walk again, returned to work and even went to the swimming pool once, but then came the radicular pain in the left leg and partial numbness of the foot. He stayed at home for some time but the pain persisted and he decided to go to the hospital on April 26. Another MRI scan was made on May 3, here are the pictures and the findings (again translated from Russian):
    imageshack.us/a/img809/9196/mityamri1030513.jpg
    imageshack.us/a/img153/1258/mityamri2030513.jpg

    On this lumbar T1 and T2 weighted MRI lordosis is normal.
    Degenerative changes of intervertebral discs are observed: Th12-S1 level demonstrates lower signal intensity and disc height, L4–S1 levels show lower disc height.
    Th12-S1 level shows right posterior paramedian disc bulge with a sagittal dimension of 3mm, pressing on the anterior wall of dural sac. Right foramen is moderately narrowed. Anteposterior width of spinal canal is 19 mm.
    L3–L4 level shows dorsal disc bulge of 3 mm.
    L4–L5 level shows posterior medial disc bulge, with a sagittal dimension of 4-4,5mm, pressing on the anterior wall of dural sac. Foramina are moderately narrowed. At this level anteposterior width of spinal canal is 16 mm.
    L5–S1 level shows left posterior paramedian sequestered disc herniation with signs of caudal migration to lower 1/3 part of S1 vertebra, with a sagittal dimension of 12 mm and vertical size up to 15 mm, pressing on the anterior wall of dural sac and left S1 root. Anteposterior width of spinal canal is 11 mm.
    Degenerative changes are observed in intervertebral joints as thickening and surface roughness of articular facets. Schmorl’s nodules of Th12–L5 vertebrae. Adipose degeneration and osteophyte growth on vertebral bodies. Paravertebral soft tissues normal.

    Impression: Degenerative changes of lumbar vertebrae. L5–S1 left posterior paramedian sequestered disc herniation. L4–L5 posterior medial disc protrusion. Th12-S1 paramedian disc protrusion. Signs of spondyloarthrosis, spondylosis.

    He was put on conservative therapy (laser therapy, magnetic therapy, some percutaneous injections), but there’s been no improvement since he had been hospitalized two and a half weeks ago, radicualr left leg pain and numbness in the foot are still there. He can barely walk more than 10 meters without rest, and the pain now interferes with his sleep.
    A senior surgeon at the hospital said that a surgery is necessary, an endoscopic microdiscectomy in this case. Two other independent doctors (though not surgeons) gave similar views.

    I’d like to ask your opinion: do the diagnosis and the choice of treatment look correct? Here in Russia medical services are sometimes a serious gamble, it’s hard to find a decent doctor.

    Best regards,
    Yegor

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Based upon your description of his symptoms and the MRI evaulation, your friend has multilevel degenerative disc disease which has caused him intermittant lower back pain for years. He recently developed an extruded disc herniation at L5-S1 which is compressing his S1 nerve root (and possibly his L5 root too). With his significant symptoms, he more likely than not will require a discectomy.

    I cannot comment on the quality of spine surgeons in Russia as I have no experience with medical care in that country. Try to fing the most experienced surgeon and ask the hospital staff what they think of his work.

    Dr. Corenman

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