Extrusion from one level to another!

[mmglobal]

Shit

My wife Diane has had some minor back pain for a few months. During the last month, it became bad enough to take days off of work. (She's and RN... big suprise that RN's have back problems.) While I was on my last trip, she told me that she had numbness around outside L calf and across the top of L foot. "Sounds just like my L4-5" I said.

Treatment by her local GP and his messed up office is like a primer on how to get screwed up by the 'standard protocol'. GP refused to do MRI... insisted on PT.... wrote note for 2 days off work. (Great for someone in a high-risk job.) PT made things much worse... actually provoked the numbness. Return to work was impossible... she tried, but had to leave work.

We insisted on an MRI which was done on Wednesday. We still have not heard from doctors office even though we have been calling and we know that the report was there Wednesday afternoon. (Sunday now.) If we followed the protocol, she would be trying to work now and do more PT. Good thing we know better.

MRI showed GIANT protrusion at L5-S1. We picked the films up on and by Thursday morning, Regan and Bertagnoli had already reviewed them and checked in. By Saturday, Zeegers and Yeung and reviewed them and checked in. (Nice to have connections.)

Protrusion is so large that extruded nucleus from L5-S1 has traveled up the canal area and is causing compression of the exiting nerve root at L4-5. Bulge, protrusion shows on every saggital slice across the back of the disc... I worry about how severely compromised the disc is. If surgery is necessary (it's hard to imagine that we won't get there), will a discectomy be successful?

The good news is that her symptoms are not that bad considering how bad the films look. Some of the docs have expressed concern about cauda equina syndrome being a possibility based on how substantial the cord compression is. We are well tuned into those symptoms and will consider her case emergent if those symptoms. I have seen too many cases of permanent CES that could have been avoided if treated on a timely manner. It's a shame to watch the recipe for such a disaster occurring in the treatment she's receiving. Again... her symptoms do not rise to that level of concern, but based on her films we should be hearing concern from the docs involved in the normal channels.

We'll know more on Tuesday when we see the local ortho surgeon that we went directly to based on recomendations from other RN's. His office is very nice and he'd reviewed her online profile / films and called us within a day of my presentation.

I don't know what the future brings for Diane... hopefully she'll get some epidirals, the protrusion will resorb and this will be a minor blip in our lives... we'll see in the next few weeks.

Mark