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Forum Name: Spinal problems and back pain

Question: Diagnosed with Bulging Disk in lumbar region


 hole_n_one - Thu Jan 13, 2005 5:59 pm

I am 28 years old and over the summer started having these pains in my left calf. Did not think much of it as it seemed to only occur when sitting. The pain didn't stop me from doing anything. I kept playing golf, softball, and walking/running on a treadmill 3-4 days a week.
One morning I woke up and my back hurt like hell. Went to the doctor and scheduled my for a MRI. The MRI showed a bulging disk I believe in the T1-S5 region.
The doctor referred me to a pain management facility and they basically wanted to give me an epideral block injection.
From what I know the epideral only minimizes the pain and doesn't really fix anything. I didn't do the epideral as i wasn't to thrilled about a needle in my back. The pain lasted for a while longer but by the end of the summer the pain stopped. I stopped playing golf and walking/running. From about September to now I have not had any pain.
But this week the pain came back. It's either a tingling or pin-prick pain in my left calf or my left-buttocks hurts(basically a pain in my butt, literally). Also, my left hamstring is wound up pretty tight. I can lay down and lift my right leg to about an 80degree angle before it hurts. My left leg can only get up to about a 40 degree angle from the floor before it hurts.
I am looking for ways to help cope with this. I sit at a computer all day so I know proper posture should help. I've heard that a bulging disk can repair itself if taking care of but don't know if this is correct or not.
It does not stop me from doing day-to-day things but my wife and I are having are first baby in July 2005 and I really would like to get a handle on this so I can enjoy fatherhood without having to think about this.
Can a bulging disk heal itself and go back to its proper position releaving the inflammation on the nerve or is this something that I will need to deal with the rest of my life? If it is something I will have to deal, what are some ways to minimize the pain?

Thanks for any input, appreciate it.
 Dr. A. Saif - Sun Jan 16, 2005 5:48 am

User avatar Dear Hole-n-one,

I am sorry to hear of your discomfort. I will try to help.

Lets what makes up your back skeleton first, to help understand what is going on here. Your spine made of small "blocks" of bones called your vertebrae and is able bend and twist because of the specialised joints and ligaments between these bones. The disc is one such kind of joint. it is like a bag of jelly, and sits between the bodies of two vertebrae. Behind the disc, the rest of the vertebra forms an channel (the spinal canal) through which the spinal cord, and the nerves leaving the spinal cord lie. The vertebrae are numbered in your neck from C1-C7, in the back of chest from T1 to T12, in your lower back from L1 to L5, then comes your sacrum which is lots of vertebrae fused as one bone without discs between them, and then is your coccyx...your "tail bone". Your lesion is probably between L5 and S1 (rather than T1 and S5)

These discs are made of a fibrous bag containing jelly like material, and a weakness in the bag wall can make a part of the disk bulge. This bulge can irritate a nerve in the spinal canal, and cause the sysmptoms your describe, sometimes also called "sciatica". Irritation around the nerev is contributed to by inflammation (swelling) around the bulging disc, arthritis in other joints in you spinal column (the facet joints if you want to know), or the ligmants being thickened. Muscle spasm in you back may increase the stiffness and pain. Essentially the canal in which the nerves lie is a finite space and a number of things contribute to there being less room for your nerve. Your bulging disc is just one cause identified on MRI, other contributory factors exist. A prolapsed disc is when the jelly "pops out" of the bag, and lies in the canal, and is usually much more serious. Becuase there are multiple contributing factors, not everyone with bulging discs have symptoms that you describe, and vice versa.

An irritated nerve gives you pain and pins and needles, and reduction in your ability to straight leg raise. Nerve function is compromised when you have numbness or weakness, and if this is persistent, then nerve damage is occuring. (Severe compromise of nerve roots can cause a situation when the nerves to your bladder and bowel sphincters get compromised and this is called cauda equina syndrome...but lets not worry about that for now, apart from saying that if these occur, you should seek formal medical advice immediately.)

Having said that thee are many contributary factors, it means that just because you have a bulging disc, you don't have to deal with the disc itself. It does sometimes shrink, by itself, so often the pain is self limitting. Just as often it is possible that the inflammation in this region is the easiest factor to treat. Anti-inflammatory medication, epidural injections as well as rest help reduce this inflammation, and symptoms may subside until your body gets its act together and the disc dehydrates a little, and reduces in size. Treating disc bulges themselves is not recommended, as the risks from surgery can be quite serious. However if nerve damage is occuring, or cauda equina is present, surgery is mandatory. In answer to your question, I myself don't believe that buging discs become normal again, as a dehydrated disc while certainly may not have as big a bulge, functions less well. This is is not noticable in the majority of situations, but may contribute to degenerative processes in the future.

Treatments follows a ladder of therapeutic options, with each step up the ladder being more aggressive, and therefore with greater side effects and potential complications. So the management should be rest, analgesia, anti-inflammatories and occassional muscle relaxants (to help reduce the muscle spasm ) intially. gentle exercises after this intial rest, with a physio. Epidurals if the nerve irritation persists despite these treatments, and as a last resort surgery...unless there is a reason to bypass these less aggressive steps.

Hope this helps, and take care

Saif
 godolphins1985 - Wed Dec 21, 2005 4:33 pm

i recently in october got hurt at work and had an MRI done...the impressions listed: At L5-S1 there is 2mm Anterolisthesis with bilateral L5 pars defects....there is biforaminal stenosis at this level impinging the L5 nerve roots. There is mild broad based disc bulge......Mild disc bulge with chronic focal extrusion at L4-5 ...there is borederline canal stenosis without signifant nerve compresse.....what does this mean for me
 godolphins1985 - Wed Dec 21, 2005 4:35 pm

also ive already been threw 3 weeks of physical therapy until they told me to stop going because it was prob. making it worse..i was put on several medication that did nothing ..

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