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I've been having crippling back pain. I just had an MRI, and…

I've been having crippling...

I've been having crippling back pain. I just had an MRI, and this was the impression: 1. Moderate-to-large central disc herniation/extrusion at L4-L5.
2. The thecal sac is compressed to 2.5 mm and the CSF signal is effaced.
3. Additional mass effect at L4-L5 includes posterior displacement of
intrathecal nerve roots and abutment of the bilateral L5 nerve roots as
they exit the thecal sac. What should my next steps be?

Doctor's Assistant: Have you had any recent injuries? What seems to make the pain better or worse?

It started when I fell down the stairs a couple of months ago. I've always had back pain - have stenosis, and get RFA. The last RFA didn't work and they did the MRI. Standing and walking make it worse. Ice, pain pills and doing nothing help a bit.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Fibromyalgia, Stenosis, LOTS of ortho injuries and surgeries.

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Answered in 9 minutes by:
9/16/2017
Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Neurology
Satisfied Customers: 9,664
Experience: Experience of Neurology of over 4 years, well versed in EEG, NCS and EMG alongwith MRIs and CT scans
Verified

Hi,

Welcome to JA and thanks for this question. Im sorry to hear about your symptoms. Actually the MRI report that you have mentioned clearly indicates that one of the discs in the spine (the small pieces of cartilage which are present in between two spinal bones/vertebrae) have been displaced and it is pressing down on the spinal cord. Secondly, there is also displacement of the nerve roots at the same level and they are being compressed by the disc as well. The pain that you are experiencing in the lower back is likely due to this problem and it is also possible that the pain radiates down into one or both of your legs because of this condition.

Now this is a fairly advanced disease however there are still various treatment options available for this. The first one is physiotherapy which strengthens the muscles of the back and the strengthened muscles can then keep the disc in place and improve the symptoms significantly. Usually this would take a few months before it starts to truly work but physiotherapy is certainly indicated in this situation. The second thing which should be started are painkillers which can include anti inflammatory agents like ibuprofen at a dose of 600 mg thrice daily, muscle relaxants like flexeril or tinazidine, stronger painkillers like oxycontin etc. Also specialized medications targeting the nerves like lyrica or neurontin would also be useful here. Thirds, injections of steroids into the spinal cord may also be helpful here as they can provide relief for upto 6 months at a time as well. Now surgery is definitely an option in this scenario as well and that can solve the problem in most cases, laminectomy which is a procedure in which the disc itself is operated upon so as to relieve the compression can be considered. But there are many other options which can be tried here as well, such as,

Nutritional supplements for the bone, joints & discs like Glucosamine, Chondroitin, MSM etc C)

Traditional/herbal medicines like Devil’s claw Secondary Root, or Limbrel (Flavocoxid), or Noni concentrate, or Nettle Root extract, or S adenosyl methionine etc

Following are some additional measures to help with severe pain;

Diathermy therapy

Ultrasound therapy

Laser therapy (Cold laser therapy or Low Level Laser Therapy)

Interferential therapy - a type electrotherapy

TENS (Transcutaneous Electrical Nerve Stimulation) – another type of electrotherapy

COOLIEF Cooled Radiofrequency treatment

Calmare Scrambler Pain therapy (medical device)

Iontophoresis

Lumbar traction therapy

SMT (Spinal Manipulative therapy)

IDD therapy (Intervertebral Differential Dynamics Therapy)

Since you have tried RFA already the other options can be considered and a spinal stimulator can be implanted or even spinal pain pump can be implanted as well to hep manage the pain.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

http://www.justanswer.com/medical/expert-dr-muneeb-ali/

Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Neurology
Satisfied Customers: 9,664
Experience: Experience of Neurology of over 4 years, well versed in EEG, NCS and EMG alongwith MRIs and CT scans
Verified
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