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Having spinal Stenosis. Treatment?

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Spine Surgeon
Practicing since : 2002
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Spinal Stenosis- What would you recommend as treatment option. Here are the details. Thanks in advance

MRI - l4-l5, there are degenerative changes. There is facet hypertrophy and severe ligamentum flavum thickening with severe canal stenosis. The AP diameter is approximately 4.5 mm. There is diffuse disk bulging. There is a left formaminal disk extrusion with significant left foraminal narrowing and impingement on the nerve root with left neural foramen. There is moderate to severe right foraminal narrowing with impingement upon the nerve root.

l5-s1, there is degenerative changes. There is severe facet hypertrophy and ligamentum flavum thickening. There is central canal stenosis. The diameter is 7mm. The diffuse disk is bulging with a central annular tear. The disk is seen to slightly extruded inferiorly. The disk is also seen to protrude into the neuroforamina bilaterally. There is severe right foraminal narrowing with significant impingement upon the nerve root within the right neural foramen. There is moderate to severe neuroforamial narrowing with mild impingement on the nerve root.

There is diffuse thickening and clumping of the nerve roots extending from the cauda equina. These nerve roots appear to be fixed on the vertebral posteriorly. Findings are compatible with diffuse arachnoiditis.

I have tingle and numbness, I can exercise and do activities but I have problems walking and standing. I have to stop and stretch, if I continue legs become weak and rubbery. There is no pain.
One orthopedic checked my stability and wants to do a laminectomy and can not explain why I went from no symptoms to severe systems without an in between and can not explain why I have compatible arachnoiditis findings. Another didn't check my stability and wants to do a laminectomy and fusion. He said my problem is congenital and the small spinal opening creates the compatible arachnoiditis symptoms.

I am 65, physically fit (exercise 2-3 times per week), problem surfaced about four years ago. Numbness occurs about 2-4 times per day but quickly subsides. I do not take any medication for problem. Tried chiropractor, accupuncture, and will now begin stretching exercises with a professional trainer.

Aside from this I have always been healthy, no health problems, and I am extremely apprehensive when it comes to surgery operation.
Posted Sun, 9 Jun 2013 in Osteoporosis
Answered by Dr. Rahul D Chaudhari 13 hours later
Thanks for the detailed information.
You have severe stenosis at L4-5 and L5-S1 level with arachnoiditis along several lumbar levels from cauda. Multiple reasons for the arachnoiditis such as previous spinal surgery, spinal trauma, spinal injections or myelography and rarely disc herniation or stenosis. Patient with arachnoiditis usually have significant back pain (almost 100% patients). Do you have back pain? how bad is it?
To what extent your activities are restricted due to leg problems? Do you feel weakness in legs after walking certain distance. Do you get leg pains in the night?
If possible please upload your MRI pictures.
Coming to treatment, with this MRI findings you are a surgical candidate and your disability due to this problem will indicate the urgency for the surgery. If you have significant limitations while walking then you need to consider surgical option. This problem will worsen with increasing age and stretching exercise wont work at the spinal level or they will make any space for the nerves. You have to go there and decompress those nerves. Whether you need laminectomy or fusion depends on your back symptoms. If significant back pain then you need fusion surgery otherwise decompression surgery should suffice.
Please upload the xray and MRI pictures to know more about your spine. Thanks.
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