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  #1  
Old 10-12-2011
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Rheumatology/Orthopedics Disc Herniation, Best next step!

I Decided to do Kaplan Qbook 2009 & ran into a question that they gave a weird answer for.
The question clearly giving all the clues for disc herniation like +ve straight leg elevation and all & asks for the best next step in management, so I thought it was definitely MRI to confirm the diagnosis as management of herniated disc is mainly surgical , but kaplan said NSAIDs and rest for 2 days as MRI will not change the next step in management anyway , so what do you guys think ? hope somone ran into that question before me cause it doesn't make any sense.
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Old 10-12-2011
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I didn't go through that question in Q book, but...it does make sense & kaplan is right as > from the given case, it's clear that person is suffering from herniated disc so why need to spend time over MRI to re-confirm it.... just give the NSAID's...let the patient feel better. MRI is not going to change the management.
ya,one thing more regarding to disk herniation, NSAID's along with the continuation of ordinary daily activities is superior than that of treatment along with bed rest. yoga exrcises r the best bet compared to formal back exercises programs .
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Old 10-12-2011
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well , I can see the sense in that , but it also make a good sense doing MRI to see the extent of the herniation since there is clearly neurological symptoms along with the herniation and you know what ? Kaplan notes said that the management of the herniated disc is mainly surgical to decrease the compression on the nerve root & I think bed it would be better to do MRI first to see what the damage is.
Plus as far as I remember, NSAIDs and early ambulation is the management of Lumbosacral strain not Disc Herniation.
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Old 10-12-2011
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Well, if the case with disc herniation describe progressive or severe neurological deficits such as paralysis , weakness then MRI should be done ... imaging is required for epidural abscesses n cauda equina syndrome etc.
And regarding the treatment, it's just clear that have to start with NSAID's n if not relieved then next step to improve the condition > may give steroid injection into epidural space to get rapid benefit.
Surgical compression is the only answer when case describes progressive focal neurological deficits n cauda equina syndrome !!!
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Old 10-12-2011
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agree with you buddy but I still think MRI is a must anyway , it just makes a good sense.
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Old 10-14-2011
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yup,diagnosis is clear so hit the treatment. Me totally agree with dryogi
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Old 10-14-2011
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Quote:
Originally Posted by younissmed View Post
I Decided to do Kaplan Qbook 2009 & ran into a question that they gave a weird answer for.
The question clearly giving all the clues for disc herniation like +ve straight leg elevation and all & asks for the best next step in management, so I thought it was definitely MRI to confirm the diagnosis as management of herniated disc is mainly surgical , but kaplan said NSAIDs and rest for 2 days as MRI will not change the next step in management anyway , so what do you guys think ? hope somone ran into that question before me cause it doesn't make any sense.
DISC HERNIATION - from MTB

In a classic case of disc herniation, the next step in management is # IBUPROFEN and BRIEF BED REST.
It also says do not answer MRI in a classic disc herniation case.
Trial of anti-inflammatory is he first step in management.

hope it helps.
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Old 10-15-2011
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Quote:
Originally Posted by younissmed View Post
I Decided to do Kaplan Qbook 2009 & ran into a question that they gave a weird answer for.
The question clearly giving all the clues for disc herniation like +ve straight leg elevation and all & asks for the best next step in management, so I thought it was definitely MRI to confirm the diagnosis as management of herniated disc is mainly surgical , but kaplan said NSAIDs and rest for 2 days as MRI will not change the next step in management anyway , so what do you guys think ? hope somone ran into that question before me cause it doesn't make any sense.
Thanks for raising this important point.
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Old 10-16-2011
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Quote:
Originally Posted by road2success View Post
DISC HERNIATION - from MTB

In a classic case of disc herniation, the next step in management is # IBUPROFEN and BRIEF BED REST.
It also says do not answer MRI in a classic disc herniation case.
Trial of anti-inflammatory is he first step in management.

hope it helps.


I guess that the patient does not have any sign of acute compression such as weakness or numbness. However, as road2success wrote, the FIRST step is giving NSAIDs as an attempt to make the patient feel better, AFTER that you can get an MRI.

Just think how you will feel with back pain and no painkiller inside the MRI machine. An MRI can take 30 - 60 minutes to be taken. Using this reasoning you can find the correct answers for some questions in this exam

Good luck.
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Old 03-22-2014
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MTB 2 says bed rest is the most common wrong answer.
MTB 3 says if SLT +, then go for NSAID and bed rest.
Kaplan surgery says treatment for most patient is bed rest for 3 weeks.

confused
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Old 03-23-2014
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Bed rest and some NSAIDs used to be the treatment of choice but recent studies have shown that bed rest actually worsens the outcome. At my med school, we were taught to recommend against bed rest and encourage normal daily activities.
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