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What Is The Treatment For Mild Diffuse Disc Bulging At L3-L4?

Posted on Sat, 25 Jan 2014

Question: My MRI shows mild diffuse disc bulging at l3-l4 which extends into the inferior aspects of the neural foramina mild narrowing! I already had a fusion of l4-s1, should the fusion be extended to the above l3-l4, everything above that disc is normal?

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer: No need of fusion at L3-L4 for mild disc bulge Detailed Answer: Hi XXXX, Thanks for writing in to us. There appears to be a mild diffuse disc bulge at level L3-L4 which has been described as extending into the inferior aspects of the neural foramina. This suggests that the situation is mild and not severe enough to demand surgical line of treatment (including fusion). If no mention is made about the other discs (above L3-L4) in your report then we assume there is no disc bulge, protrusion or significant disc disease. But you must take note that the nerve root compression might be happening at L3-L4 level and a little bit of precaution and with medications you do not have to worry. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (18 hours later)

Sorry I should have listed my symptoms. I'm having pain in butt and down right leg also twitching in leg which is progressively getting worse. I have had fusion of lumbar and in my neck due to degenerative disc disease, but disc above l3 are good. Any updated response would be welcomed with this further information, thanks! Also says further support lines and canal stenosis at this level L3-L4

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing in with an update. Lumbar fusion surgery is an extensive procedure and the healing can vary from 3 to 18 months. The main idea behind doing the surgery is to decrease the pain. If you continue to have the same amount of pain or if it worsens then there is no point in getting the surgery done. The spine fusion can change the normal physics in the spine and provide more limited movement at the non fused joints. The L4-L5 and L5 –S1 levels are usually chosen for surgery. It is also important to know that by doing fusion surgery the remaining mobile joints can get stressed out. Right now your symptoms need to be carefully assessed keeping in mind the previous surgery at L4-L5 and the canal stenosis. You may need to try medications for up to 12 months before your doctor is convinced that you need surgical treatment. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (19 minutes later)

Thanks for the information! My fusion in the lumbar was 3 years ago and all pain symptoms then were left side. I have permanent nerve damage in left leg now. Everything in regards to pain has been nonexistent until 2 months ago with the symptoms in my right leg now. And now with the nerve twitching in the right leg starting I just don't want the 24/7 twitching like the left leg permanently! My surgeon will be seeing the MRI tomorrow and then supposed to call I just wanted to be informed before that, I appreciate your your thoughts and opinions!

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer: Welcome Detailed Answer: Hi, Thanks for writing in with an update. It is unfortunate that you have a permanently damaged nerve supply to left leg and that makes your problems with the right leg a greater concern. You are welcome and it was a pleasure communicating with you. Wishing you good health. Should you have any new query to be answered by me, please quote query ID 89078 and I will be glad to answer at the earliest. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar