Concluded Case

L 5- S1 IV disc ,with migration to S1 vertebral level

New case. 46 yr,M, Attended the OPD with back pain 9 months,aggravation of pain with pain radiating to both lower limbs since 2 months,unable to stand and walk properly for 1 month.Took steroids,analgesics and oiling and massage but with out any relief . H/ O fall 4 yrs ago from 12 feet hight tree. On exam vitals stable.Motor systemgr 5/5 power DTRs normal knee jerks ankle absent left side ,hypoactive rt side,dulling of sensation L5 s1 bilaterally. After the MRI ,he was ref to spinal surgeon. Diagnosis and management?

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Concluded answer

Thanks for all answeres. MRI Lumbosacral spine shows Desiccation,asymmetrical annular bulge,left posterior paracentral extrusion and inferior migration of L5-S1 IV disc,causing moderate stenosis of left central recess and left inferior neuroforamin . Extruded disc has migrated to the infrapedicular level of S1 vertebra, is likely compressing the L5 exiting nerve root and leftS1 traversing nerve root. Extruded disc is causing severe focal spinal canal stenosis at S1 level and compression of cauda equina nerve roots. Endoscopic microdiscectomy done under GA. patient became better and discharged.

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Thanks for all answeres. MRI Lumbosacral spine shows Desiccation,asymmetrical annular bulge,left posterior paracentral extrusion and inferior migration of L5-S1 IV disc,causing moderate stenosis of left central recess and left inferior neuroforamin . Extruded disc has migrated to the infrapedicular level of S1 vertebra, is likely compressing the L5 exiting nerve root and leftS1 traversing nerve root. Extruded disc is causing severe focal spinal canal stenosis at S1 level and compression of cauda equina nerve roots. Endoscopic microdiscectomy done under GA. patient became better and discharged.

if a ring is stuck on a finger and it pains, do we think of giving pain killers/ steroids/ exercise/ traction on the finger/ or injecting finger with anaesthetic to relieve pain??? it sounds nonsense isn't it? and harmful too! first and only remedy is to remove the ring ASAP by anymeans..similarly if a nerve is compressed by a large disc fragment or osteophyte or all.....sure and only treatment to be done is surgery to remove comoression... it's a very straight forward safe and rewarding surgery, now microscopic or endoscopic... except surgery no treatments can remove the disease or the cause and delaying surgery or surgery as a last resort is a false practice which induces permanent damage to the compressed nerve and medical fraternity should aggressively shun that.

Look like L5/S1 disc herniation with caudal migration Correlates with symptoms Will benefit from discectomy Rare possibility of some other extradural cystic lesion

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What i do not like in curofy is ayurvedic&homiopthy docs taking scans&asking questions

it's also seen in practice
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You are great for showing interesting cases madam

Thank you doctor
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L5-si disc advised discectomy now.

On MRI large extruded disc at L5/S1 is seen Diagnosis is Prolapsed intervertebral disc I.e. PID at L5/S1 Management will be Discectomy at L5/S1

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