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RH, Board Certified Neurologist
Category: Neurology
Satisfied Customers: 1949
Experience:  Expert in various areas of Neurology
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L5/S1 disc bulge annular fissure

Resolved Question:

I have increasing pain in my feet and legs since being diagnosed with moderate disc bulge L5/S1 and annular fissure 8 months ago. The disc is also degenerative. However MRI shows no compression on the nerve root. Why then do my feet feel worse then my back? Especially at night? Is this chemical radiculopathy or is it something else I should test for? How do you test for it? Should I consider epidural steroid injection or surgery as conservative measures including pregablin med so far are not helping.
Submitted: 4 years ago.
Category: Neurology
Expert:  RH replied 4 years ago.

Even without any compression of the nerve root, there can be inflammation of the nerve root - this is called radiculitis and this is appreciated more on MRI of LS spine with contrast and most of time MRI without contrast is ordered so it can be missed. Prior to considering surgery or epidural steroid injection, I would recommend getting EMG done to justify whether the source of this pain is radiculitis at that level of the disc bulge. Need to rule out other causes of pain such as peripheral neuropathy.
Customer: replied 4 years ago.
Thanks. If it is shown to be from the nerve root at the level of disc bulge can it be fixed without surgery?
Expert:  RH replied 4 years ago.
yes what is generally recommended is that if there is inflammation of the nerve root and no oral medications are working, then the next step is epidural steroid injection - if there is temporary relief from this and the pain returns, then surgery will likely help. Another thing to try is lumbar traction is physical therapy which will help stretch out the muscles as well in addition to manual decompression of that area.
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