[arvj1211]

#5094

32 years old male. Lumbar Disc Bulge MRI in L5-s1. Pain 6 on 10 in my back, leg, foot – all on right side. I can do my activities but have to stay very straight and be careful, because heavy movements increase pain. Do you think it will heal. What specific exercises should I do?

[Donald Corenman, MD, DC]

#5098

You leave me with little information in which to work with. There are basic questions that need to be answered. When did the symptoms start? How severe are the symptoms? What makes the symptoms worse/ better? How are the symptoms affecting your life? What have you done for treatment? What treatment has worked? Where exactly are the symptoms- leg vs. back? What do you do for a living?

This is but a very small sample of questions that need to be answered. Every individual is different in the response to the symptoms and what needs to be considered in treatment.

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.

[arvj1211]

#5100

Doctor,

Here are the responses

When did the symptoms start?
A>2 months ago. Got worse after 1 month. Right now reduce by 50% but plateaud.
How severe are the symptoms?
A> 6 on scale of 1 to 10
What makes the symptoms worse/ better?
A> Worse when sitting long, Adduction, Abduction and lifting heavy stuff. Gets better on stretches but not totally
How are the symptoms affecting your life?
A> Reduced social life, cant sit too long
What have you done for treatment?
A> 3 weeks PT. Symptoms reduce by 30-40%. But they were working mainly on Piriformis. Also- gave up after 2 Chiropractic sessions.
Where exactly are the symptoms- leg vs. back?
A> Back – (Right side) near SI joint, facet joint, buttock
Leg – Hamstring, Calf, Right side of lower leg, foot near toes, under foot.
What do you do for a living?
A> Computer engineer ( I know I used to sit long!)

MRI report suggests:
1. L5-S1 mild disc bulge
2. Transitional segment of lumbosacral juntion
3. Likely Partially Lumbarized S1 segment. Small S1-S2 disc

I kind of understand what report means. Although I am not sure if the precise diagnosis of pain is the disc bulge causing nerve irritation.

Q> Can this heal in 3-4 months?
Q> Can you please suggest couple of exercises.

Thanks for your guidance

[Donald Corenman, MD, DC]

#5102

I understand your symptoms started 2 months ago, consist of right lower back and right leg pain and are now 50% better than at time of onset. Your symptoms are worse with sitting and increase with more prolonged sitting. The symptoms are a 6 on a VAS scale of 1-10.

By the sounds of your symptoms, it sounds like you might have a disc herniation that is compressing the S1 nerve on the right. Disc herniations that compress the nerve root typically will cause more pain with sitting and relieve pain with standing or lying down in the fetal position. Your back pain also could be from nerve compression as it is on the same side as the leg pain.

The report of a “mild disc bulge” concerns me as the radiologist did not point out any compression of the nerve root. Transitional segments and lumbarized segments rarely cause this type of pain. It might be helpful to gain another set of eyes on your condition such as a spine surgeon. There may be more to the MRI than was interpreted.

If you do have nerve compression and you have undergone 2 months of treatment with some relief and you have no motor weakness, the course you are on seems to be giving you some improvement. 50% improvement in 2 months is reasonable. An epidural steroid injection might be very helpful but you would need to see a spine surgeon or an interventional physical medicine physician to see if you are a candidate. Ask your current doctor if you could take NSAIDs like Motrin. Your physical therapist is the best one to determine what exercises you should be doing at home.

Disc tears and herniations do not heal (see website) but the nerve becomes less irritable over time and most people adapt to the compression and do not need surgery.

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.

[arvj1211]

#5103

Doctor
Thanks for your analysis.

I think you are right when you say another set of eyes to look at my condition. So I would need someone to take a look at the MRI and accurately report on it.
Question> Whom should I go to accurately report(2nd time) on the MRI – Radiologist/ Spine Surgeon/ Orthopaedic / Pain Management specialist ?

From what I have read, Disc Bulge is different from Disc Herniation. On the MRI I did not see the Herniation, although I do notice a mild bulge. (I may be wrong). But if you get a chance can you please comment on my MRI video.

A Pain Management Specialist told me that instead of a Transforaminal Epidural Steroid injection at the surgery center, I could get a Cortisone shot in his office. I was thinking if my symptoms dont reduce by another 30-40% in 1 month I will go for some injection (Also I am avoiding NSAIDs because of GI issues)
Question> Is the cortisone shot a trial and error approach? Your thoughts highly appreciated on when to go for injection.

Thanks a lot!

[Donald Corenman, MD, DC]

#5105

The MRI does not note any significant herniation but the views are limited and using that source can be misinterpreted. You are correct that a disc bulge is different from a disc herniation. The disc bulge is in the arena of annular tears and degenerative disc disease but can be a precursor to a herniation. None the less, there is no significant evidence of a herniation on the limited views.

The physician you see next depends more upon the skill and knowledge base of the practitioner than the speciality they have. Most likely, a good PM&R doctor who specializes in interventional injections would be the best individual to see.

The physical examination can reveal which nerve is irritated or if the pain originates from the sacroiliac joint. Even though there is no compression of the nerve, the nerve can still generate pain signals. An injection may be very helpful. An office injection will not target a specific structure but just the systemic exposure to the steroid may give relief.

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.

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