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Discal Hernia.

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Dear Dr,

I was operated for a discal hernia 19 years ago,and started to have severe pains in my lower back preading down to my Right foot for the last 30 days,i have consulted a general practinioner before consulting a sopecialist,i have done X-Ray's and and an MRI yesterday just to make sure i am well aware of my medical case before any specialist diagnosis,i need to know what are my options for the treatment to come (Currently i am on a pain killers like Valtarein or Diclo..)


Category: Family Physician-GP

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Category: Spine Surgeon
 32 Doctors Online

Consult Reply by Dr. Goutham Cugati - Neurosurgeon


I understand that you were operated 19 years back for similar complaints. But from the attached reports, I am not able to find about of the level at which you were operated before. If you have information on that (like L3-4L4, L5-S1 etc spinal levels) please let me know.

As per the symptoms you have mentioned, the pain is quite severe.
MRI does show probably a significant change at L5-S1 level on the right side(correlating to the side of pain). This is the most probable culprit lesion for the pain.

Clinical examination will also add to the decision making in an individual case.

With this background, the options would be
1. pain intolerable + clinically neurological deficits present (weakness of particular muscle, sensory loss) -- surgery to be considered
2. pain intolerable + clinically no neurological deficits -- pain killers + physiotherapy (surgery is an option)
3. pain tolerable + clinically neurological deficits present -- surgery to be considered
4. pain tolerable + clinically no neurological deficits present -- pain killers + physiotherapy.

In some cases, epidural injections may also be considered.

With prior history of surgery to your lumbar spine(if it were to be in the same level), re-surgery will be a little risky. But if the pain is intolerable and the clinical features are strongly in favour of significant problem then you must not differ surgery.

So while consulting your Doctor discuss all the possible options. If possible give non surgical options a try.

Hope this helps

With regards

Dr Goutham Cugati
Consultant Neurosurgeon

Patient replied :

Dear Dr

Thanks for the prompt reply,as i recall i was operated for the L3 & L4

L5 was kept untouched,pain is somehow tolerable when on Voltarene 150 mg but that is only between two intakes of 12 hours intervals, once the Pain killer effect is off i feel a severe burning sensation in my Right leg spreading down to the extremeties of my foot,there is no numbness feeling as of now.what is the Epidural injection?is it a risky procedure?is it done in the spine or is it a muscle injection of B Complexe vitamins?please note that i am overweight,if i opt for a surgery does this affect my ability to walk correctly,will my lumbar base be able to endure the weight pressure?



Thanks for your reply.

For burning pain just pain killers is not sufficient. Your specialist will definitely prescribe medicines for treating this burning pain(Neuralgic pain).

Epidural injections mean - medicines being given to your spine directly to the to space around the spinal cord where the nerves are present. It will give longer relief in many patients.

In an overweight/obese patient who has had prior surgery, the decision of surgery will be taken with caution. If the surgery is definitely indicated then there should be no reason not to get it done. You should be able to do all your routine activities after the surgery if there are no complications.

Hope this helps, please feel free to discuss further. Regards

Dr. Goutham Cugati
Category: Spine Surgeon
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
Dr. Goutham Cugati and 4 other Medical Specialists are ready to help you

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