As an army man, should I get surgery for PIVD?

Question

Hi doctor,

I am an army man. I am having PIVD L4-L5 and neural compression at L5-S1. I have a little numbness in my left leg, and I do not have any control over my left big toe. As of now, my doctor has recommended surgery. I need your opinion on this case.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

The MRI films that you have sent show only the L5-S1 level, and I will pass that as normal (attachment removed to protect patient identity). The MRI report, however, talks about an L4-L5 extruded disc, which could be significant, but I need to see the films and will appreciate long sagittal cuts too.

EHL (great toe dorsiflexion - extensor hallucis longus) weakness is a result of L5 nerve root pressure, either from a L4-L5 disc prolapse or a far lateral L5-S1 disc prolapse. Being an army man may need to be made fit to return to duty as soon as possible, and here the indications for surgery are more liberal. I agree with your surgeon, but I need to see the MRI or magnetic resonance imaging films to be sure of the radiologist's report.

Now, the recovery of the weakness of the great toe is iffy, and I must point out to you that it may not recover despite surgery, too, but at least surgery will help you in two ways. Best recovery chance provided by surgery. Persistent pressure and an extruded disc are more likely to cause local scarring and take longer to resolve if treated conservatively.

I hope this helps.

Please revert in case of further queries.

Thank you.