Expert: Dr. Paul Newhart - 3/31/2008

Question
I just received the analysis of the MRI that was performed on me last Friday.  

Basically, my L5 disc protrudes 16mm to the right and is causing me the horrible pain that I am experiencing.  I have never heard of a protrusion so large.  What am I facing?  Any comment is appreciated since I am very worried and concerned.

Below is the complete report:

History: Lumbosacral neuritis.

Technique: Multiplanar multi-weighted pre- and post-infusion MRI images of
the lumbar spine.

Findings: At L5-S1, there is a large right disc protrusion/extrusion. This
measures up to about 16 mm obliquely. This moderately deforms the right
aspect of the thecal sac at this level without high-grade central canal
stenosis. This severely compromises the lateral recess with apparent
significant compression of the proximal right S1 nerve root. Lateral to the
disc herniation, the right neural foramen is patent. The left neural foramen
is patent.

At L4-L5, there is disc desiccation. High signal in the posterior annular
fibers suggests annular tear, but no focal protrusion or extrusion. No
significant generalized disc bulge. No canal compromise. Neural foramina are
patent.

Discs higher in the lumbar spine have a normal appearance with preserved
signal and no significant bulge or focal protrusion. No canal or neural
foraminal compromise.

No suspicious marrow signal. Paraspinous tissues are unremarkable. Alignment
is normal.

Impression:

Large right paracentral disc protrusion/extrusion at L5-S1 as detailed.

Answer
Unfortunately, with a herniation that large, your only recourse may be a surgery.  They may try a round of physical therapy to see if it helps; it probably won't unless you luck upon a practitioner of the McKenzie method.  This may or may not help with a herniation of that extent.  If you can find one in your area ( a google search for the McKenzie institute will take you to their site, and their practitioners are listed in a directory), you may want to give it a try before anything less conservative.