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What Causes Severe Back Pain Affecting Gait When Suffering From Disc Prolapse?
Question: Recent MRI reveals L4L5 - where there is slight loss of height of the disc and reduction in disc signal there is substantial right paracentral and posterolateral disc extrusion adjacent to a posterior annular tear and compression on the descending right fifth lumbar nerve root. The Central spinal canal dimensions are reduced at this level as a consequence. At L5-S1 there is a central and left paracentral posterior annular tear and a shallow central and paracentral disc bulge but no evidence of nerve root compression. Clinical correlation advised... Symptoms .. for the past six weeks -suffering back pain amounting to affecting my gait and daily routine moving around..can not stand for more than five minutes... lying down and sitting down are ok but walking is a big problem.. will this need surgery
Brief Answer:
Yes , you need L4-5 Disc removal
Detailed Answer:
Hello Madam,
I have read your case and I think you need to get it operated . L4-5 level disc is showing extrusion which is very advanced stage of disc prolapse and it is compressing nerves so it is causing pain the leg and thigh.
You have already tried all non operative methods so Now only option which is left is removal of all extruded disc fragment. As L5S1 level it is still not compressing any nerves so it does not need an surgery.
Disc removal can be done with endoscopy . It will be a very small incision and you can walk after two to three days.
I hope this answer will be helpful for you. Let me know if there is any other question.
Thanks.
Yes , you need L4-5 Disc removal
Detailed Answer:
Hello Madam,
I have read your case and I think you need to get it operated . L4-5 level disc is showing extrusion which is very advanced stage of disc prolapse and it is compressing nerves so it is causing pain the leg and thigh.
You have already tried all non operative methods so Now only option which is left is removal of all extruded disc fragment. As L5S1 level it is still not compressing any nerves so it does not need an surgery.
Disc removal can be done with endoscopy . It will be a very small incision and you can walk after two to three days.
I hope this answer will be helpful for you. Let me know if there is any other question.
Thanks.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks.. there is no weakness and this is the first major stage of leg problems.. I went for a second opinion last week and a suggestion was made to do a nerve block as it is impinging on the l4l5 nerve route..the pain in the leg is as follows:-I can not weight bear on the right leg..for longer than five minutes... do you think the nerve block is a good idea.. or do you think the epidural as suggested by my original consultant is better..I am due to meet him next week to discuss..both consultants know each other well and are slow to do surgery unless absolutely necessary..i had an epidural before and I don't really think it worked.. it bought on extra pain..in my neck..which turned out to be a bulge in the neck.. there is no leg weakness.. just this pain when I walk or stand on the right ..what would happen if I tried to leave it.. would it fix itself..naturally without surgery or injections or would it get worse...thanks
Brief Answer:
You can try nerve block
Detailed Answer:
Hello,
If I give you my advise according to my experience nerve block and epidural block are not much effective. But you can try them If you are not willing for surgery.
As I pointed out that Disc can be removed by endoscopy so it is not a big procedure. Main indication of disc excision is pain and we can not wait for weakness or numbness to appear as they are marker of irreversible damage to nerves.
If you did not get surgery done you can develop following complications.
1. Your pain can progress.
2. You can develop weakness in foot or ankle.
3. You can develop decrease sensation in leg.
So I would recommend you to think in favor of surgery. Chances of recovery with out it is not possible.
I hope this answer will be helpful for you. Let me know if there is any other question you want to ask.
Thanks.
You can try nerve block
Detailed Answer:
Hello,
If I give you my advise according to my experience nerve block and epidural block are not much effective. But you can try them If you are not willing for surgery.
As I pointed out that Disc can be removed by endoscopy so it is not a big procedure. Main indication of disc excision is pain and we can not wait for weakness or numbness to appear as they are marker of irreversible damage to nerves.
If you did not get surgery done you can develop following complications.
1. Your pain can progress.
2. You can develop weakness in foot or ankle.
3. You can develop decrease sensation in leg.
So I would recommend you to think in favor of surgery. Chances of recovery with out it is not possible.
I hope this answer will be helpful for you. Let me know if there is any other question you want to ask.
Thanks.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks so much for this to the point advice. This is what I am feeling at this stage and I hope that I surgeon agrees to do surgery as he may think that numbness is a sign that surgery is necessary.... i do not want to get to this stage.. i have seen people suffer as a result of leaving their situation to this level and they have suffered... a quick question...do you think i need a laminectomy...and have i spinal stenosis..also.. do you think pursuing a nerve block would elimate a bigger surgery.. as they they will know that the L4L5 nerve root is compressing if i get relief.. my second opinion did a excellent evaluation.. i hope you have read all the other notes i have written to doctors..also do you think my neck problem as anything to do with my back.. is the spinal cord at risk...thanks so much.. XXXX
Brief Answer:
Nerve block can not take care of spinal stenosis
Detailed Answer:
Hello,
Nerve block can take care of root compression for short time but it can not cure spinal canal stenosis. For this you will need surgery . Spinal stenosis can be cured by laminectomy only.
Your neck problem is not the cause of this back pain. There is no risk to your spinal cord.Once treated for canal stenosis , you will be relieved from this pain and you will be able to stand for longer time and your walking distance will improve too.
Thanks.
Nerve block can not take care of spinal stenosis
Detailed Answer:
Hello,
Nerve block can take care of root compression for short time but it can not cure spinal canal stenosis. For this you will need surgery . Spinal stenosis can be cured by laminectomy only.
Your neck problem is not the cause of this back pain. There is no risk to your spinal cord.Once treated for canal stenosis , you will be relieved from this pain and you will be able to stand for longer time and your walking distance will improve too.
Thanks.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
hi .. my consultant reassured me last week that i do not have spinal stenosis.. perhaps the l4l5 disc is causing the spinal demensions to reduce.. why do you think i have spinal stenosis.. this is worrying me.. they are completely different surgeries.. also do you think the Sciatica pain will go away on its own.. thanks so much.. also what do you think of taking medication? thanks so much
Brief Answer:
Sciatica pain will not go by its own
Detailed Answer:
Hello,
I dis not say that you have spinal canal stenosis. You mention that. Single level stenosis can be caused by disc herniation.
Sciatica pain does not go by its own specially when it is caused by extrusion.
Medication like Pregabalin and Methylcobalamine is good for early stages but not much effective in extrusion.
At last I want to say that if you can tolerate pain then you can wait for some time. If pain is not bearable then go ahead with surgery.
Thanks.
Sciatica pain will not go by its own
Detailed Answer:
Hello,
I dis not say that you have spinal canal stenosis. You mention that. Single level stenosis can be caused by disc herniation.
Sciatica pain does not go by its own specially when it is caused by extrusion.
Medication like Pregabalin and Methylcobalamine is good for early stages but not much effective in extrusion.
At last I want to say that if you can tolerate pain then you can wait for some time. If pain is not bearable then go ahead with surgery.
Thanks.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks so much for your honest reply.. I feel this way myself.. just one question.. you mentioned not to wait for it to go numb and get weak etc.. I had physio to day and my physio mentioned that she thought my right leg was definitely getting weaker... she mentioned not to agrivate anything until she my surgeon sees me next Thursday.. do you think I have more chance of success with the operation now in the early stages.. I feel the pain is getting worse..and I would imagine putting pressure on the right leg is not good.. I also have a small neck issue.. small bulge.so this is acting up again as the rest of my body is compensating for my leg issue...not easy. my gait is terrible.. I do hope my surgeon recommends surgery as I don't think nerve blocks etc are really going to work as I have heard it is a bad prolapse...thanks for all your XXXXXXX advice.. XXXX
Brief Answer:
Putting pressure on leg is not a problem
Detailed Answer:
Hello,
I am happy that you are accepting my view. I wish you a speedy recovery. Putting pressure on leg is not going to make any difference. Just avoid any weight lifting or forward bending.
Neck pain and disc herniation is not affected by back issue, but yes you have to cautious that you do not keep your neck in same position for long time.
Your gait is terrible due to weakness in keg, and a early surgery is better.
Thanks.
Putting pressure on leg is not a problem
Detailed Answer:
Hello,
I am happy that you are accepting my view. I wish you a speedy recovery. Putting pressure on leg is not going to make any difference. Just avoid any weight lifting or forward bending.
Neck pain and disc herniation is not affected by back issue, but yes you have to cautious that you do not keep your neck in same position for long time.
Your gait is terrible due to weakness in keg, and a early surgery is better.
Thanks.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi.. I would appreciate if you could answer the following question..this is my neck scan.. it gives me trouble from time to time.. any suggestions on how i should mind this... no nuerological symtoms just pins and needles and a bit of numbness from time to time and flare up s.. had have had some great physio to ease symtoms.. by the way when you mentioned putting pressure on the leg is not going to make any difference.. does this mean that is will get worse..the last thing i want is nerve damage.. thanks so much.XXXX see neck scan below
Medical History there is mild angular kyphosis centred centred at C5C6 where there is disc narrowing, disc dehydration and osteophytosis. Axial scans show right paracentral disc protrusion which impinges on the surface of the cord. There is bony encroachment on the exit foramina bilaterally. No other finding
Medical History there is mild angular kyphosis centred centred at C5C6 where there is disc narrowing, disc dehydration and osteophytosis. Axial scans show right paracentral disc protrusion which impinges on the surface of the cord. There is bony encroachment on the exit foramina bilaterally. No other finding
Brief Answer:
Cervical spondylitis also needs continuous physio
Detailed Answer:
Hello madam,
I have studied your neck scan and your clinical history and I think you just need physiotherapy in form of cervical traction and Muscle strengthening exercises. Same medicines like Pregabalin and Methylcobal which you are using for back pain is also useful here. If pain is severe then you can apply cervical collar also. As oppose to your back MRI there is no need for surgery here.
When I said that weight bearing on leg will not affect any thing I mean this thing will not going to make matter worse. So you can safely walk normally.
Let me know if there is any other query.
Thanks.
Cervical spondylitis also needs continuous physio
Detailed Answer:
Hello madam,
I have studied your neck scan and your clinical history and I think you just need physiotherapy in form of cervical traction and Muscle strengthening exercises. Same medicines like Pregabalin and Methylcobal which you are using for back pain is also useful here. If pain is severe then you can apply cervical collar also. As oppose to your back MRI there is no need for surgery here.
When I said that weight bearing on leg will not affect any thing I mean this thing will not going to make matter worse. So you can safely walk normally.
Let me know if there is any other query.
Thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thanks so much.. you are very to the point which I really appreciate..
It this the same as cervical stenosis?
also when you talk about stenosis in the lumber spine.. do you mean central, lateral, unilateral..how will my surgeon know if my condition is been caused by stenosis or the herniated disc.. will they have to do further tests.. is this neurogenic claudication..also is there a major difference between epidurals and nerve roots.. surely the epidurals give more pain relief to all the nerves..which injection is safer...? thanks so much
I meant to ask.. is it possible for surgeons to go ahead and do surgery without pins and needles symtoms and numbness in legs..also which type of decompression surgery do you think they will have to do.. there are various different types.. is there a long recovery period and is there a chance of having to get spinal fusion at a later stage
It this the same as cervical stenosis?
also when you talk about stenosis in the lumber spine.. do you mean central, lateral, unilateral..how will my surgeon know if my condition is been caused by stenosis or the herniated disc.. will they have to do further tests.. is this neurogenic claudication..also is there a major difference between epidurals and nerve roots.. surely the epidurals give more pain relief to all the nerves..which injection is safer...? thanks so much
I meant to ask.. is it possible for surgeons to go ahead and do surgery without pins and needles symtoms and numbness in legs..also which type of decompression surgery do you think they will have to do.. there are various different types.. is there a long recovery period and is there a chance of having to get spinal fusion at a later stage
Brief Answer:
Stenosis is diagnosed on MRI
Detailed Answer:
Hello,
Here are the answers of your questions.
1. Stenosis is diagnosed on the basis of MRI, and in report diameter in mentioned. If it is less then 9 mm then it is known as critical diameter and need surgery.
2.Your surgeon has to study MRI report to see if it is stenosis or disc. Also in stenosis there is no rest pain and it appears only when patient walks. Where as in Disc pain is present all the time.
3. Neurogenic claudiacation is pain on walking due to nerve compression so yes it can be neurogenic claudiacation.
4. Epidural is given in a space between cord and membrane so it get diffused effect, where as block is more focused on one nerve or root. Both are effective . Epidural is more safe.
5.Surgeon can do surgery on the basis of pain and no need to wait for complication to arise.
6.Again choice of procedure depends on surgeon. Now a days most common procedure in dissectomy.
7.When you remove disc then you need at least a month for recovery and again it depends on method of surgery.
8. Spinal fusion is not needed for single level disccectomy.
I hope i have answered all your queries. Let me know if I missed some thing.
Thanks.
Stenosis is diagnosed on MRI
Detailed Answer:
Hello,
Here are the answers of your questions.
1. Stenosis is diagnosed on the basis of MRI, and in report diameter in mentioned. If it is less then 9 mm then it is known as critical diameter and need surgery.
2.Your surgeon has to study MRI report to see if it is stenosis or disc. Also in stenosis there is no rest pain and it appears only when patient walks. Where as in Disc pain is present all the time.
3. Neurogenic claudiacation is pain on walking due to nerve compression so yes it can be neurogenic claudiacation.
4. Epidural is given in a space between cord and membrane so it get diffused effect, where as block is more focused on one nerve or root. Both are effective . Epidural is more safe.
5.Surgeon can do surgery on the basis of pain and no need to wait for complication to arise.
6.Again choice of procedure depends on surgeon. Now a days most common procedure in dissectomy.
7.When you remove disc then you need at least a month for recovery and again it depends on method of surgery.
8. Spinal fusion is not needed for single level disccectomy.
I hope i have answered all your queries. Let me know if I missed some thing.
Thanks.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thanks so much for your help. Just a question.. is stenosis the same as spondolytis? when it states spondoloytis of the neck.. does this mean stenosis? just wondering... on my neck scan it read significant spondolytis c5c6..i notice my neck is acting up but I think this is due to my gait.. postural issues do not help. Another question:- can the dissectomy be done non invasively..and also can my leg develop numbness and weakness..? My leg pain is decribed now as pins and needles, and severe pain around the Sciatic nerve area..pinching right down my ankle.. my ankle gets very sore...one sided only.. I am hoping this is not stenosis.. I guess the extruded parts could be in the spinal canal..my physio mentioned the other day that this could settle.. but from what you think it won't..i am just hoping the surgeon will not leave me the way I am..this has been going on two and half years..there was a resolution of a disc protusion in the same disc before which resolved in the last scan but has come back.. this is the worse case of leg pain...strangely.. in the very first scan it stated central canal stenosis and when it resolved the neck scan last Christmas read no evidence of central stenosis is shown... thanks for all your great advice.. also do I need to worry about the small disc bulge in the neck..my consultant said the last time I did not and this is normal for someone of my age.. I am 49.. he is very good
Brief Answer:
Stenosis is a type of spondylitis
Detailed Answer:
Hello ,
here are your answers.
1.Spondylitis is degenerative changes in cervical spine. It can be stenosis or can be disc herniation.
2. your pain in leg is due to nerve compression and I do not think it can improve without intervention.
3.I hope your surgeon will also have same view like me.
4.As far as neck bulge is concerned I also think that it will need surgery. It will improve by physiotherapy and medicines.
I hope this answers all your query. Let me know if there is any thing left.
Thanks
Stenosis is a type of spondylitis
Detailed Answer:
Hello ,
here are your answers.
1.Spondylitis is degenerative changes in cervical spine. It can be stenosis or can be disc herniation.
2. your pain in leg is due to nerve compression and I do not think it can improve without intervention.
3.I hope your surgeon will also have same view like me.
4.As far as neck bulge is concerned I also think that it will need surgery. It will improve by physiotherapy and medicines.
I hope this answers all your query. Let me know if there is any thing left.
Thanks
Above answer was peer-reviewed by :
Dr. Yogesh D
thanks.. I am shocked to hear that you think that my neck bulge will need surgery...gosh. this is not good... would an injection help.. my surgeon said he was not concerned about surgery for my neck at this time..i am getting physioand it has helped up to now.. it has flared up recently but I think this is due to my gait issue and no exercise.. I would hate to have an operation for my neck.. I believe it is not successful... is this true?
Brief Answer:
You do not need surgery for neck
Detailed Answer:
Hello,
I think I was not able to convey my message. I want to say that at present you do not need any surgery and medicines and physio is sufficient for neck problem. It is is very early stage. Surgery for neck is not as simple as it is in case of back. Neck surgery is needed only when a person has severe weakness of shoulder and hand. So right now you just need traction and medicines.
Neck surgery is successful but complications are too common so we want to keep it as very last option.
Thanks
You do not need surgery for neck
Detailed Answer:
Hello,
I think I was not able to convey my message. I want to say that at present you do not need any surgery and medicines and physio is sufficient for neck problem. It is is very early stage. Surgery for neck is not as simple as it is in case of back. Neck surgery is needed only when a person has severe weakness of shoulder and hand. So right now you just need traction and medicines.
Neck surgery is successful but complications are too common so we want to keep it as very last option.
Thanks
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for this information. Just a question - i note that i have been suffering with my l4l5 disc for almost two and half a year with approximately a year of relapse and the most severe case as been this right leg nerve compression.. i attend my consultant on thursday.. in your experience do you think that this compression will progress further in terms of canal stenosis..and will the leg pain get worse. .. also it appears to be that from reviewing all the scans that this has prolapsed once in 2012 and subsided..a sequestered fragment and that there was central canal stenosis as a result of this disc fragment..this disappeared in 2013 and in the 2013 report.. there was no central canal stenosis .. now it has appeared back again with another extrusion.. can these extrusions sometimes reabsorb and settle.. i have done alot of reading stating that sometimes they do..also what is the success rate of surgery and also do you think i need to see a neurosurgeon.. how will my surgeon know that i have stenosis right throughout my spine...he already did a brain scan in 2012 and there is no underlying pathology in my case.. brain scan was perfect...thanks.. also is the back surgery successful?
Brief Answer:
Spine surgery are very successful
Detailed Answer:
hello,
Disc prolapse can some time get reduced but most of the time they always progressed. Specially it is not possible to reduced once they developed extrusion.
Disc surgery are very successful and patient almost get complete pain relief. Some time there can be mild back pain but neurogenic claudication does improve always.
Neurosurgeon can also do this surgery but results are better with orthopaedic surgeons.
Bone scan is not a test to look for canal stenosis. Canal stenosis is measured at different level. So it is not present through out spine. It is measured by MRI.
Let me know if there is any other question.
Thanks
Spine surgery are very successful
Detailed Answer:
hello,
Disc prolapse can some time get reduced but most of the time they always progressed. Specially it is not possible to reduced once they developed extrusion.
Disc surgery are very successful and patient almost get complete pain relief. Some time there can be mild back pain but neurogenic claudication does improve always.
Neurosurgeon can also do this surgery but results are better with orthopaedic surgeons.
Bone scan is not a test to look for canal stenosis. Canal stenosis is measured at different level. So it is not present through out spine. It is measured by MRI.
Let me know if there is any other question.
Thanks
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
can I get one of the doctors that has been dealing with me already.
Brief Answer:
Yes, My name is Dr. Naveen
Detailed Answer:
Hello,
I have answered your questions in the past. If you want,you can ask any other query, I can also give you my bitly link so you can ask direct questions from me .http://bit.ly/orthonaveen
Yes, My name is Dr. Naveen
Detailed Answer:
Hello,
I have answered your questions in the past. If you want,you can ask any other query, I can also give you my bitly link so you can ask direct questions from me .http://bit.ly/orthonaveen
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi, I have provided some attachments. Please review them.
Brief Answer:
Brief Answer
Detailed Answer:
Please provide the report of the scan you attached here, as it has only one image. A single image cannot be commented on.
Brief Answer
Detailed Answer:
Please provide the report of the scan you attached here, as it has only one image. A single image cannot be commented on.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Dr. Dr. Naveen Kumar Sharma
Orthopaedic Surgeon, Joint Replacement
Practicing since :2002
Answered : 4486 Questions
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