Rush to Surgery

Rush to Surgery

Q:

Age: 45 Sex: F Concern: Spinal cord injury

Bending over a patient (nurse) for an extended period of time resulted in severe pain several days later. MRI shows "an anterior epidural defect impinging on the emerging right L5 nerve root, most consistent with a moderate to large disc fragment originating from the L4-L5 disc." Also have foot drop. Orthopedic says surgery.

Getting 2nd opinion from Neurosurgeon shortly. Still in pain w/foot drop. Nobody seemed to mention conservative treatments. Should I go this route first? Can it really get rid of my pain - logic tells me if there is a fragment pressing against a nerve, the only way to "reverse" that is with surgery, but from what I read, conservative treatments can help as well. Would I damage the nerve by waiting? I would love to hear about alternatives.

-- mfkiely

A:

This is the gray area. There are anecdotal cases of disc sequestration with radiculopathy (your case) that have been managed successfully with epidural injections and exercise program. However, you should be monitored closely for progressive neurologic loss which would require surgery. The traditional and safe treatment is surgery to remove the compression on the nerve root.
Weakness can be due to neuropraxia or "shock to the nerve" or to neurotomesis or "actual nerve injury". If it is the former, over the next several weeks, you might improve drastically. If it is the later, you might not. An EMG/NCS test can delineate the two but it takes 3-4 weeks for the abnormalities to show up.
Question is whether waiting would create further injury to the nerve. No one knows. I might be in the minority in advocating waiting and try conservative route. However, this is highly individualized based on the patient's clinical presentation, pain level, serial exams, EMG test, etc... No one can advise you about this online or over the phone.
I would recommend that you get another opinion from a non-surgeon spine specialist.

-- Sherman Nam Tran, M. D.

to ask Dr. Tran.