L4-5 disc extrusion
In this video, I’ll show you the lumbar MRI scan of a 78-year-old, male, physician who came to see me with left sciatica, muscle weakness of his L5 innervated muscles, and tingling and numbness of his lateral left leg.
I treated this gentleman 6 years ago for sciatica, and he has done well since that time. He said he caused this recurrency by lifting his grandchild, and his pain is worse than it was 6 years ago. After I treated him 2-3 times, he went for a new lumbar MRI scan and it was compared to his previous MRI scan from 6 years ago. Now he has a disc extrusion at L4-5 on the left side; 6 years ago, he had a disc hernation on the left, at L4-5, but it was not extruded. Extrusions don’t seem to make much difference in terms of the prognosis of disc herniations. They improve just as readily as other herniations. This extrusion is not severe in size; I would grade it moderate in size. Nonetheless, it is more painful than 6 years ago, and concerns him more. On exam, he does have 4/5 weakness in his hallux and foot dorsiflexion.
He wants to get two neurosurgical opinions, but would prefer to avoid surgery. Given his MRI findings, I don’t think his problem is surgical, and I expect he’ll recover within 6-12 weeks as he did the last time I treated him. Six years ago when I treated him successfully, he had tried one lumbar epidural steroid injection, but it only helped for two weeks, so he doesn’t want to try that again. I do think, if I can’t help him sufficiently, that he should try another injection, and I think the neurosurgeon will tell him the same. But I think he’ll recover from spinal decompression treatment and will probably not require an epidural steroid injection.
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