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Monday, September 22, 2014
Spine and Back Health
Pain due to a bulge
Thank you so much for your response to the question "L-4 pedicle fracure / treatment" posted on 6/18/08. We stopped fighting with our ortho and went to a spine specialist who now says the MRI is inconclusive regarding the pedicle stress fracture. He says the MRI shows edema and suspicion of stress fracture. He says the pain may be due to an existing bulge. He has ordered a bone scan and a CT scan to see he fracture clearly. In any event, your advice on treatment of a unilateral pedicle fracture via non-invasive surgery was great news. We will certainly look into that if it turns out to be a stress fracture which does not respond to conservative treatment. Do you have any magical treatment if the pain is due to a bulge?
I'm glad the previous post was of some help. As far as the disc bulge, these can be tough problems to treat. Treatment usually starts with pain medication, anti-inflammatory medications (such as ibuprofen, etc.) and physical therapy. If/when that doesn't work, pain management consultation is often helpful, which can lead to more invasive tests and/or treatments, such as discography, cortisone injections, etc. In some cases, surgery is an option, but this is not a good option for many patients and is only considered when all other reasonable treatments have failed. Surgery might consist of a fusion or an artificial disc replacement (also known as total disc arthroplasty). Hopefully it won't come to that. Good luck.
David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University