[ravi_xmn]

#9994

Hello Doctor,

I am from New Delhi, India. My father (64 years old) having a disc herniation at below 3 levels (L5-S1, L5-L4,L4-L3) of lumber spine and
discs are coming out as per MRI scans. We are also taking Physiotherapy from last 7 days but it is not helping us much.

Our Doctor has suggested Surgery but to looking his age and he has Blood sugar, heart disease. We are not willing to go for surgery at his age n health conditions.

So, if there is a better approach or if you can suggest us anything that will be helpful.

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MRI LUMBO-SACRAL SPINE report contents:-

1) Loss of lumber lordosis. Alignment of vertebral bodies is maintained.

2) Marginal osteophytes and fatty changes are seen at D10 to L2 vertebra.

3) Vertebral bodies and posterior elements in the lumber region are normal.

4) Evidence of disc dessication is seen at L3-L4, L4-L5 & L5-S1 levels.

5) Right paracentral disc protrusion is seen at L4-L5 & L5-S1 levels compressing the anterior thecal sac and cauda equina nerve roots.

6) Disc bulge is seen at L3-L4 level (postero enctral & lateralised to right) compressing the anterior thecal sac and cauda equina nerve roots.

7) Right L5 & S1 nerve roots are compressed in lateral recess at L4-L5 & L5-S1 levels respectively.

8) Focal spinal canal stenosis at L4-L5 & L5-S1 levels.

9) Rest of the inter-vertebral discs are normal.

10) rest of the spinal canal reveals normal dimensions.

11) No cord/conus compression or abnormal signal intensity is seen within the cord.

12) Conus ends at L1 level.

13) Bilateral sacroiliac joints are normal. No evidence of joint effusion seen.

IMPRESSION:- MR FEATURES ARE SUGGESTIVE OF:-

1) Disc dessication at L3-L4, L4-L5 & L5-S1 levels with right paracentral disc protusion at L4-L5 & L5-S1 compressing the anterior thecal sac & cauda equina nerve roots.

2) Disc bulge at L3-L4 level (postero central & lateralised to right) compressing the anterior thecal sac & cauda equina nerve roots.

3) compression of right L5 & S1 nerve roots in lateral recess at L4-L5 & L5-S1 levels respectively.

ANTERO POSTERIOR DIMENSIONS OF THE SPINAL CANAL ARE:-
L1-L2 —— 18 mm
L2-L3 —— 16 mm
L3-L4 —— 15 mm
L4-L5 —— 11 mm
L5-S1 —— 10 mm
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If you can give us some time on this and suggest a better way to proceed as per above mentioned MRI report contents, if MRI scan reports are required then i can do SCAN of these and send over to you.

Please let me know if you can be helpful to us in this.

Thanks & Regards,
Ravi
New Delhi, INDIA

[Donald Corenman, MD, DC]

#9995

There are two questions you pose. One is if surgery could be indicated. The other is whether surgery is safe for your father’s age and medical condition.

The second question first. Diabetes (blood sugar) and heart disease by themselves in a 64 year old do not preclude surgery. The amount of heart disease (lets say complete blockage of the left anterior descending coronary artery) would preclude surgery until that condition is taken care of (heart cath). The skill of the anesthesiologist would be important as this makes a big difference.

Is surgery necessary? You do not indicate the symptoms that your father complains of to determine if surgery will be helpful. See the section “How to describe symptoms” to explain what impairment your father exhibits.

The radiologist also did not use descriptors to indicate severity (mild, moderate or severe) of the nerve or cauda equina compression. There is a big difference between “mild compression” and “severe compression”. Again, the descriptor is in the eyes of the beholder. The radiologist might use moderate to describe compression while I might find the compression “severe”.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[ravi_xmn]

#10000

Thanks Dr. Corenman for your valuable feedback, below are the other details so that you can get more info about his codnition:-

1) Heart Disease – Its in below minor coronary artery, I mean its not that major. He is taking below medicines from last 7 years, below tablets are related with Cholesterol & BP also.

Medicines:-
– Ecosprin-75 (Aspirin delayed Release tables USP)
– Atocor-10 (Atorvastalin Tablets IP 10 mg)
– Metolar XR-25 (Metoprolol Succinate Extended-Release capsules 25 mg)

2) Blood Sugar – Its in control level now – he is taking this medicine — Glador 1 (Glimepiride Tablets I.P.)

—————————————————————–

Severity of Pain – Moderate, it is in between Mild & severe.

—————————————————————–

Condition of his Lumber Spine:-
1) Pain started in lumber spine, lower back and then go in to right leg u up to Knee.
2) If he stands 4-5 minutes, pain gets started.
3) But if he sits down for few mins, he fills relaxed.
4) he is taking complete bed rest these days.
5) He is using Lumber Cushioned belt for his back.
—————————————————————–

Exercises which we have tried through Physiotherapy are:-
1) Laser for pain relief.
2) Manual Therapy.
3) Tapping
4) Exercises etc.

—————————————————————–

So, my questions are:-
1) Is there any alternate to avoid Surgery in his case, if yes then what it can be.

2) But if surgery is the only option left for us then which surgery it will be ?

3) Do we need to continue with Physiotherapy or just stop it, as he is not getting any relief in pain from last 10 days.

4) Is there any other treatment/option you would like to suggest us, as his Heart Doctor has denied to give him Anti-Inflammatory tablets (Tablet name is – Dolonex-DT).

—————————————————————–

Please suggest a better way to proceed further, we shall be thankful to you for this.

Thanks & Regards,
Ravi

[Donald Corenman, MD, DC]

#10008

Your father’s coronary disease does not sound to be that significant and his hypertension is most likely under control. He has type II diabetes and that sounds to be also in control with oral medications. None of these disorders sound to be so bad as to preclude surgery. Again, the skill of the anesthesiologist would be important to create a safe environment.

In regards to you father’s spine generated pain, the symptoms lead me to believe he has either lateral recess stenosis or foraminal stenosis. See the website to understand these conditions. Standing up narrows the nerve hole that the nerve “lives in” and compresses this nerve. When sitting, the “hole” enlarges and the pain disappears.

If one of these disorders is the actual diagnosis, the next step I would use is epidural steroid injections. These injections are very helpful to both diagnose the disorder (see pain diary on the website) and treat the disorder (reduce inflammation and therefore pain).

Finally, surgery can be quite helpful if the diagnosis is in hand. I cannot tell you what surgery is necessary without a thorough understanding of the spinal disorder.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[ravi_xmn]

#10039

Thanks Dr. Corenman for your valuable feedback, i’ll find out more on “lateral recess stenosis or foraminal stenosis” and then come back to you for further guidance/help.

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