Mri results-broad based disc protusion at L4-L5 level with effacement of the thecal sac?

The thecal sac is a sack full of fluid that surrounds and cushions the nerves going from the brain down the spine. Right near L4 and L5 (two vertebrae in the small of the back), the main nerves break away from the spinal column and travel towards each hip where they then turn and go down across the thighs and down the legs to the feet.

What is seen in the MRI is a broadly protruding (well out of its normal position) intervertebral disk which cushions the L4 vertebra from the L5 vertebra. (This disk and the one below are the most common bad actors in the human spinal column.) It is being squished out and pushed aggressively into (effacing) the thecal sac. This causes pressure on the nerves and is likely an important component in his severe pain. Pressure on nerves like that can cause low back and lower extremity numbness, tingling, pain which can be severe, even loss of bowel, bladder, or coordinated leg function. It can get worse than now.

When a disk is slightly out of position, it can be treated with rest, anti-inflammatories (either more powerful than you can buy over-the-counter and corticosteroid-based, like an oral Medrol Dosepak, or by injection of corticosteroids), and/or physical therapy. If they have already tried these treatments with your son and there has been no improvement in his symptoms, surgery may be the best option. The other option is giving up and just trying to manage the pain, which carries its own risks including tolerance of and dependence upon narcotics and possible progressive worsening of symptoms.

If he were my son, I would seriously consider surgery after conservative management had been tried and had failed. There are different surgical techniques which you can discuss with the spinal surgeon. Of course you need to have a long talk with this spinal surgeon including detailed discussion of risks vs. benefits before deciding. Another key variable not addressed in your question is the condition of the vertebrae. Are they deteriorating, badly out-of-position themselves, or intact? Is there anything else known to be contributing to his pain? (If there is, and that is not addressed as well, the benefit of spinal surgery may not be worth the risk.)

Getting a second opinion from another spinal surgeon is also worth doing. Get copies of images. The second surgeon may need to repeat an in-person exam of your son if possible.

I’m so sorry it has come to this. Your son and family will be in my thoughts and prayers.

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Mri results-broad based disc protusion at L4-L5 level with effacement of the thecal sac?

My son has been having severe lower back pain and the MRI results showed broad based disc protusion at L4-L5 level with effacement of the thecal sac. Could someone explain what the effacement of the thecal sac means. Also, what kind of treatment options would be available besides surgery. I got the…

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Thecal Sac Compression

The effacement basically means it is coming into contact with spinal discs in this case L4 and L5. Spinal injections, Physical Therapy/Physiotherapy exercises can help aid realignment, manual therapy (joint manipulation of bones) of the spine can also be used..

You would be best to speak to your doctor and they can advise the most suitable treatment for your son.

Best of luck!

Sorry to hear he is having back issues at his age. I am also the same way. I am 25. Had neck surgery when I was 23. I still go to pain management. Mine was not from an accident either. He should get some steroid injections and do physical therapy. The longer the wait before surgery the higher possibility that the nerve pain won’t go away after the operation.