Lumbar disc extrusion

In this video, Dr. Castanet will show you a patient’s lumbar MRI with a large L4-5 disc extrusion. He’ll also orient you to the anatomy to include the subcutaneous fat, the paraspinal muscles, laminae of the neural arch, evolving disc degeneration of several of the discs, a herniated and extruded disc, the neural canal, the spinal cord, individual nerve roots of the cauda equina, the abdominal aorta, and more.

He (I) will also discuss the natural history of low back pain and disc lesions. Disc herniations tend to improve with time, although sometimes they do not, and the pain can last for years without any relief. Many of the patients that come to me with pain have had it for years or decades, intermittently. I suggest treatment if you have pain that doesn’t resolve in a few days to a few weeks.

In this video, I also show you sagital and axial images of the lumbar MRI scan in different weighted images, including T1 and T2 images. This patient’s images show a very large, extruded disc herniation on the left side of the L5-S1 disc, and this corresponded to expected left sided sciatica, i.e. pain in the distribution of the sciatic nerve. This patient also developed left foot drop, which is weakness of his left foot dorsiflexion. That means he had weakness in lifting his left foot up.

This raises the question of when surgery is indicated for low back and leg pain and disc herniations. There are generally, two big indications for immediate surgery. One is something we call cauda equina syndrome. That is when the disc herniation, or rarely, some other mass, puts so much pressure on the nerve roots, that it causes problems with bowel or bladder function, so that you become incontinent, or you cannot defecate or urinate. These are very rare complications of disc herniations, occuring in much less than 1% of cases. And in these cases, you want to go immediately to the hospital emergency room and get surgery as soon as possible, within hours. The second case is when you have progressive neurological weakness. The tricky part about this is that when weakness occurs, in assciation with a disc herniation, which is not commonly, it often occurs quickly and is not progressive. And it often recovers with time. This is more difficult topic that has to be discussed with your physician(s).

If I can help you with your back, disc or sciatic problem, please call me at 404-558-4015.