Back Pain with Partial Sensory Leg Anesthesia – additional opinion
25-year-old male had an outbreak of sharp pain in the loin, and afterwards complained of partial sensory anesthesia in his leg. He has been given prescribed treatment that included blockades, magnetotherapy, and ultrasound massage with hydrocortison. He experienced back pain for the first time after lifting a heavy thing, and got a pain relief after taking a pain-killer and applying Finalgon ointment. After few months the pain reoccurred. The patient then got a MRT test and was prescribed Finalgon and Milgamma pills, but developed an allergy towards Milgamma. The main findings of his MRI study are L4-5 subarticular and central disc protrusion causing significant impression on nerve roots in the canal, and small left paracentral L5-S1 disc herniation.
The patient asks about the information from his MRI study, the decision about surgery, the possibilities for surgery and the complications.
Being at home, the patient stood up from the chair and suffered a sharp pain in the loin. After this outbreak he kept on complaining of the partial sensory anesthesia in his leg. He consulted a doctor in a local hospital who asked him get the spinal tomography. Since June 5th up to now the patient has been given the hospital treatment. The treatment prescribed is as follows: blockades, magnetotherapy, and ultrasound massage with hydrocortison.
First time the patient experienced the back pain last year. This young guy lifted a heavy thing (a log) and immediately got a pain. After taking a pain-killer and applying Finalgon ointment (active substance: Nonivamide* +Nicoboxil*), he got a pain relief. In the end of December the pain reoccurred. The patient then contacted the hospital again, got a MRT test and upon the diagnosis, was prescribed Finalgon and Milgamma pills. But he soon developed an allergy towards Milgamma and stopped the intake of the pills. Until May he had had no outbreaks.
I have reviewed the MRI study. The study includes a localizer and T2 SAG and T1 AXIAL images.
The study is limited, since there is only a localizer for the axial images and there are no T2 axial images. Also the axial images are only around the discs and not continuos- missing some information.
The information that I can get from this study shows evidence of a large L4-5 Left subarticular and central disc protrusion causing significant impression on the left L5 and S1 nerve roots in the canal.
Also noted a small left paracentral L5-S1 disc herniation touching the left S1 nerve root.
The main finding is The L4-5 protrusion.
The decision about surgery is mainly clinical.
The natural history of discs is evolution, if there are neurological findings on exam or intractable unbearable pain, surgery should be done.
There are a few possibilities for surgery ,some are micro invasive. Some are more invasive and include laminectomy and for 2 levels- fusion and laminectomy.
If possible clinically, I would avoid surgery since there are complications especially with larger surgeries like scaring and disc protrusions above the treated levels.