Diagnosis
Lumbar intervertebral disc herniation. Acute lower back and radiating leg pain. Bilateral foot numbness.
Patient:
Female, 34 years old, Kazakhstan
Physician:
Dr. med. Andrey Bitter, Neuwerk Clinic
Patient’s Inquiries & Medical History:
"I had been experiencing intermittent back pain for two years. In May, the pain intensified, so I completed a course of massage therapy. While it provided lasting relief for my lower back, I soon developed pain in my right buttock. At first, I suspected a hip joint issue, as the therapist had attempted to adjust my pelvis. However, X-rays confirmed my hip joints were completely healthy.
Gradually, the pain radiated down my leg to the calf. In October, I started physical therapy at the Bubnovsky Center and received conservative treatment from a neurologist, which yielded only temporary relief. After New Year's, the pain worsened significantly, radiating into both legs. I can sleep peacefully through the night, but the pain sets in toward morning. Getting out of bed is the most challenging part of my day due to severe pain in my legs and lower back. Over the past week, I developed numbness along the outer sides of both feet. Bending forward is impossible and extremely painful, making putting on shoes and dressing very difficult.
Despite this, I continue to do housework to the best of my ability and go to work—I am not bedridden. In fact, lying down for extended periods seems to make it worse. Doctors in Kazakhstan strongly recommend surgery. If surgery is indeed necessary, what treatment options would you propose?"
Expert Opinion by Spine Specialist Dr. Andrey Bitter:
"The lumbar MRI scans reveal a very pronounced, if not massive, disc herniation. Just 1–2 millimeters more could lead to cauda equina compression, impairing bladder and bowel control. Therefore, an urgent surgical intervention is clearly indicated to prevent the need for an emergency nighttime procedure under critical conditions.
Regarding surgical techniques: given the size of the herniation, a microsurgical discectomy is the safest option. This approach minimizes the risk of damaging the dural sac and surrounding nerve roots, which are already under severe compression. In my clinical assessment, an endoscopic approach in this specific case carries a higher risk of complications."
Treatment Rendered:
Following Dr. Bitter's urgent recommendation, the patient underwent immediate emergency surgery for intervertebral disc removal at her place of residence.