21-year-old female patient having shooting sciatic pain; stiffness in back; radiating pain through buttocks, hips, and legs; worsening pain with extended periods of sitting; some leg weakness. MRI demonstrates L5-S1 disc bulge with no nerve impingement. Diagnosed with degeneration of lumber intervertebral disc with degenerative disc disease and lumbar spondylosis. Surgery is not recommended, physical therapy not helping, cyclobenzaprine & other pain medication no longer working.
Backstory: "pulled" back in May of 2021 with excruciating, immobilizing pain. Got better in one week, pain is now constant.
(MRI & X-ray images included)
Why is not surgery recommended? It can be solved with single or multiple level dynamic posterior fixation method.
Emre Sengul Surgery was not recommended because there was no nerve impingement and because of the patient's age, though I greatly appreciate the feedback
Vivian Mills Get an EMG/NCS done to determine if there is underlying radiculopathy as the cause of the symptoms. MRI sometimes does not correlate with the symptoms.
Consider Cognitive-behavioral Therapy as it really helps with chronic pain syndromes.
Interventional pain management in form of steroid injections under fluoroscopic imaging is very useful too.
I agree that surgery should not be recommended in this case at the moment.
Far lateral disc gerniation can justify the nerve impairment in this level, however its a few rare. Medical treatment and physiotherapy was a true decision at fist step but a typical radicular pain which does not responds to medical management should be considered for surgery. Howeve complete history taking and physical exam are necessary.
What is the neurological status of the patient objectively (the "leg weakness")? With this MRI, a neurologic deficit should be further evaluated to rule out other causes of neurological involvement. Also, the SI joints should be evaluated as a possible pain generator (often causes b/l buttocks pain with radiation downwards, and with a pain pattern that worsens with prolonged sitting).
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