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  • Jyotirmai
    Member
    Post count: 15

    This is to get your kind and super specialized opinion for my case which is said to be because of disc protrusion and compression.

    History: My pain on back which radiates to right leg– thig, calf and heels , first time this triggered on 2007, which was than relieved in due course of time (about two to three months) without much of the treatment treatment like exercise, physiotherapy etc. Since then I got three-four “attacks” in these 4 years which generally lasts for a month or two and get relieved by rest and little bit of exercises. Exercises were not regular….

    Present issue: This time, pain is troubling me from last two months with somewhat more intensity, I have tried with some physiotherapy for two weeks and exercise but not returned normal routine life. Even in the days when there is no pain, I feel difficulty in walking and standing for more than 10-15 minutes…
    O/E: SLR: R —700 ;L — 800

    MRI REVEALS: MR findings are suggestive of mild retrolisthesis of L5 on S1 vertebral body with degenerative changes in L5-S1 disc with a broad-based right paracentral and foraminal protrusion. On comparison with the last MRI scan of Feb, 18,2008 there is significant interval increase in the degree of disc protrusion and compression of right lateral nerve roots.

    Kindly suggest the best suitable treatment (surgical and non-surgical) for this, also please let us know if ozone therapy will be suitable for this case.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    You report back and right leg pain that radiates to the heel, onset in 2007 that faded away without treatment in about three months. For the last four years you have had four “attacks” that have lasted about one to two months each.

    You apparently have had another “attack” that has lasted more than two months with more intense symptoms.

    The MRI was read as significant degenerative changes at L5-S1 which have advanced in the last two to three years. There is either a disc herniation or bone spur protruding into the lateral recess and foramen on the right. (Look up lateral recess stenosis and foraminal stenosis on the web site).

    I assume your leg pain is worse with standing and walking and improved with sitting and bending forward. You need to identify whether your back pain or your leg pain is worse and what actions cause increased pain. If you can identify that differentiation, I can give you more information.

    Dr. Corenman

    Jyotirmai
    Member
    Post count: 15

    Thanks for your prompt response!! You are absolutely correct my leg pain become worse when I stand or walk. I cannot stang for more than 15 minutes and walking above 70-80 Mtrs is tough.The action which causes the pain is driving car and climbing stairs. one of the reasons- this time it is aggravated becasue of climbing of stairs to 3rd floor for 15-20 days At times i get some releif when I sit. But now a days during that also i need to change posture and need to sit in curved posture. Also i can not sit for 20- 25 minutes at a strecth, without support at back. I have sent you some MRI snapshot in e-mail, i am not aware how to attach them in this forum…Also can u please throw some light on ozone therapy…Thanks!!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    Most likely, you have foraminal stenosis. The foramen is the location where the nerve exits the spinal canal. Stenosis is a narrowing of this opening. The foramen narrows with spinal extension (extension occurs with standing and walking) and widens with flexion (bending forward or sitting). What most likely happened is that the herniation or bone spur that was compressing the nerve enlarged slightly and the nerve root became momentarily severely compressed. This will cause the nerve to swell and have a tighter fit within the foramen. Now, when you stand and walk, the nerve root becomes more irritated and pain results.

    The treatment is a physical therapy program to start and a selective nerve root block to medicate the nerve. If that treatment is ineffective, surgery might be warranted if your pain or impairment is significant enough. Surgery might be as little as a foraminotomy or as much as a TLIF (see website).

    Ozone is oxygen gas that instead of the state O2- has an extra molecule of oxygen and is O3. Ozone is highly corrosive. The extra oxygen molecule will attach to many tissues and oxidize that tissue. It is also found in a gas state. Injecting this into the body is fraught with complications and it is hard to think where this injected gas would be necessary. Injection of any gas into the body could cause an embolism which could cut off blood flow to the embolized blood vessel.

    Dr. Corenman

    Jyotirmai
    Member
    Post count: 15

    Thank you very much,once again for honest and accurate information!!! I was planing for ozone treatment, but now I will drop this option…
    Kindly,refer my e-mail to mail ID: [email protected] with MRI film snapshot attached.
    I am looking for long term solution as my age is 31 yrs.
    In case of surgery, I wish this is done with expert and safe hand, I would be highly obliged if you can suggest some doctors in INDIA for this…
    Thanks for your precious time !!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    I reviewed your MRI images you sent to me and you have a large right sided herniation with an extruded fragment at L5-S1 which is compressing the S1 nerve root. This nerve innervates the calf muscles among other motor groups. Please check to see if you have gastrocnemius/soleus weakness by tiptoeing across the room. If you find you cannot hold your body weight up well on your right foot, you have weakness of that muscle group.

    If you have weakness, in my opinion, you need surgery. If you don’t have weakness and have tried and failed standard therapy (epidural injections and physical therapy), you would also be a candidate for surgery.

    The surgery is a discectomy of the right L5-S1 level. I prefer the microdiscectomy technique but there are different techniques to perform this surgery. In the hands of a skilled surgeon, it should be a simple operation with a 90 to 95% success rate. There is a video on the web site of this operation that you can view. The recovery is generally relatively quick.

    I cannot tell you what surgeon to choose in India as I do not have contacts there at this time. Word of mouth can be helpful and looking at any writings or papers that this surgeon has produced may give some insight into his thought processes.

    Good luck!

    Dr. Corenman

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