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MRI showed mild spinal stenosis, 3 bulging discs, one is pressing on spinal cord. Surgery needed?

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Spine Surgeon
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Recent mri shows mild spinal stenosis, 3 bulging discs, one is pressing on spinal cord. Chronic back pain, lose feeling in one leg standing/walking for more than a few minutes. Surgery necessary?
Posted Fri, 9 Nov 2012 in Osteoporosis
Answered by Dr. Rahul D Chaudhari 9 hours later
Thanks for writing to us.
Spinal stenosis represents age related changes in spine and it varies with patient to patient. Clinical correlation between MRI findings and your symptoms is very important. Bulging discs and facetal arthropathy usually give rise to back pain. When nerves get compressed then you start getting leg complaints. In your case, symptoms described by you are related to spinal stenosis.
But you are saying that you have mild stenosis.
In order to be able to help you better, I would need a little more information from you.

Is there any nerve root compression? Any foraminal stenosis?
Please let me know more about leg complaints.....what is the exact location? how frequently do you get these symptoms? Is there any night pain?
What aggravates the pain and what relieves it?
Does the pain travel anywhere?
Does one leg hurt more than the other?
What is your walking tolerance before getting leg pain, numbness?
Can you upload your MRI images?
Are you diabetic?
In case of mild stenosis we usually try physiotherapy and medicines to relieve the symptoms. Surgery is considered as the last option when all other measures failed.
Above answer was peer-reviewed by
Follow-up: MRI showed mild spinal stenosis, 3 bulging discs, one is pressing on spinal cord. Surgery needed? 3 hours later
Thank you, I will ask GP for copy of mri report.
All pain is in lower back, of the 3 bulging discs the lowest one is the worst one, causing my symptoms. Lower back pain chronic. Of 3 bulging discs lowest one is apparently the worst (S1/L5 maybe??).
Standing maybe 5/10 mins same walking, get spasm type pain L buttock, then pins/needles L foot, sometimes L calf, Numb feeling R front thigh with sharp pins/needles, continued standing/walking causes loss of feeling L leg, have to drag it along, have fallen over when trying to continue walking. This is a daily problem, although deliberately don't stand/ walk to avoid the situation.
Never have pain in legs.
Above symptoms are relieved by sitting down and bending forward to stretch back.
Only L leg goes numb.
Not diabetic.
Had multiple physio for back pain, but above symptoms only started 18 months ago. GP then said, nothing could be done, just physio and keep taking Diclofenac. Only asked another GP for mri scan after advice from physio I am acquainted with, but haven't been treated by, who suggested that these symptoms need further investigation. This GP feels I need urgent surgery, nhs appt with neurosurgeon not til December, of course I am very concerned meantime.
To add, sitting painful and starting to get pins/needles L foot while sitting, spend most of my time lying on sofa, that relieves the symptoms apart from some back pain, again sleep well, no real discomfort overnight, but do suffer from bad cramps L leg mainly during night but also during day, mainly if I bend L knee, ie getting out of car, these cramps are very painful.
Answered by Dr. Rahul D Chaudhari 40 minutes later
Thanks for the information.
It seems you have quite a severe problem. These are definitely neurogenic symptoms due to nerve compression. When other measures fail and there is associated weakness in the leg (dragging the leg), it indicates that you are a surgical candidate. In this scenario I would definitely suggest surgery after seeing your MRI report and images. Below knee problem suggest L4-5 / L5-S1 level stenosis and thigh problem indicates L2-3 / L3-4 stenosis.
Again, I need to see the MRI to comment more about surgery.
Above answer was peer-reviewed by
Follow-up: MRI showed mild spinal stenosis, 3 bulging discs, one is pressing on spinal cord. Surgery needed? 2 days later
Hi Doctor, I now have my mri report as follows;
Shallow lumbar spine scoliosis concave on R. Straightening of the lumbar spine.
Normal distal cord signal. Normal conus.
L2/3 Shallow broad based disc bulge, extending to L side. No canal or root compromise.
L3/4 Shallow broad based disc bulge flattening the anterior aspect of the thecal sac and slightly narrowing the R exit foramen. No canal/root compromise. Facet joint degeneration.
L4/5 Shallow broad based disc bulge. Ligamentum flavum hypertrophy. Facet joint degeneration. Moderate spinal stenosis. Disc touches both exiting L4 roots in the exit foramena but no confirmed displacement.
L5/S1 Shallow broad based disc bulge. Narrowing of the L exit foramen. Disc compresses the L L5 root in the exit foramen and touches the L S1 root in the lateral recess.
Normal abdominal aorta.

Lower lumber spine degenerative disc disease.
L4/5 moderate spinal stenosis.
L5/S1 disc compromises the left L5 root in the exit foramen.

Your comments appreciated, in order that I understand the implications of these findings when I attend my appt. with neurosurgeon in December.
With thanks
Answered by Dr. Rahul D Chaudhari 14 hours later
Thanks for the information.

Looking at the report there is definite compression on left side at L4-5 and L5-S1 level. Needs decompression at those levels. We may have to consider doing disc spacers to maintain the disc height so as to keep foraminal height. You have to discuss with the neurosurgeon about decompression surgery and spinal fusion surgery if required.

Above answer was peer-reviewed by
Follow-up: MRI showed mild spinal stenosis, 3 bulging discs, one is pressing on spinal cord. Surgery needed? 1 hour later
One final question, Doctor.
Would you regard this surgery as best done in the near future, is the
situation likely to deteriorate further if nothing was done?
I have no other health problems re heart/lungs etc and apart from
increasing weight due to inability to walk, would consider myself a healthy
63 year old. Thank you for your comments, I can now attend the neurosurgeon's
appt. with a better understanding of my condition.
Thanks again.
Answered by Dr. Rahul D Chaudhari 3 hours later
Hi and thanks again,

Considering the severity of your problem, I would suggest you to get operate as early as possible.

In deterioration conditions or severe nerve root compression it is always better to decompress the nerve root earlier for the good results.

Hope I have clarified all your doubts.
If you have no other follow ups, please close this discussion.

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