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Does MRI indicate surgery necessary to prevent paralysis? Is the facet arthrosis or lumbar stenosis causing pain?

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Spine Surgeon
Practicing since : 2002
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Does my MRI indicate surgery is necessary to prevent paralysis?
I am trying to determine if my MRI findings indicate possible paralysis if I do not have surgery. Currently I am managing pain with Oxycodone 10 325, am daily doing physical therapy, and try to fit in exercise in the pool at least twice a week.

Here is what my recent MRI had:

T12-L1: Moderate loss of disk height and disk desiccation without spinal canal stenosis or foraminal narrowing.

L1-2: Broad-based disk bulge noted. This finding narrows the thecal sac to 5 mm consistent with a least moderate stenosis. There is also secondary bilateral at least mild foraminal narrowing. Mild facet arthrosis.

L2-3: Mild loss of disk height and disk desiccation without spinal canal stenosis or foraminal narrowing. Mild facet arthrosis.

L3-4: Grade 1 anterolisthesis of L3 on 4 with broad-based disk bulge again noted. Finding does again cause severe spinal canal stenosis, narrowing the thecal sac to 4 mm and displacing it to the left. Severe facet hypertropic arthrosis is noted. There is significant right-sided foraminal narrowing also noted.

L4-5: Severe facet arthrosis. No evidence of spinal canal stenosis noted, although there does appear to significant left-sided foraminal narrowinng.

L5:S1: Bilateral L5 pars defects with at least grade 1 anterolisthesis of L5 on S1. There is broad-based disk bulge with annular tear again noted. There is secondary significant bilateral formaninal narrowing.

I have back pain 24/7, and am beginning to develop numbness in my left thigh, and nerve pain in my buttocks and going down the back of my legs. Obviously my conditions did not develop overnight, but over a course of several years.

Is it the foraminal narrowing, the facet arthrosis, or the lumbar stenosis causing the pain? I do not want to become paralyzed because I need the surgery and I refuse to do so thinking that "Conservative Treatment" is preferred no matter what. I, however, am quite content to leave well enough alone if that is possible.
Posted Tue, 22 May 2012 in Osteoporosis
Answered by Dr. Krishna Kumar 5 hours later
thanks for the query.
You have severe spinal stenosis at various levels in the lumbar region. Usually even with so much stenosis people do not become paralysed. They may have some weakness of bigtoe, ankle etc and pain and numbness while walking.
Yes pain is due to facetal arthritis, foraminal narrowing and stenosis..
You may try epidural steroids/ transforaminal root bloc to reduce your symptoms. Many people survive without surgery accepting the pain and I am certain you wouldnot become paralyzed , but you may have to live with the pain without surgery.
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