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Bilateral foraminal stenosis,pain in calf,low blood pressure.Surgery?

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Neurologist, Surgical
Practicing since : 1996
Answered : 146 Questions
I am 52 yo. I have been diagnosed with bilateral foraminal stenosis in the L5 S1. My symptoms are pain in the calves which increases as the day progresses. I am with Kaiser Permanente in Southern California. The neurosurgeon still is hesitant about surgery. I am all for it and if I'm reading the statistics on this diagnosis, surgery for leg pain caused by stenosis is often successful. Why would the doctor be so hesitant when the success rate is so high and I'm in good health otherwise, low blood pressure, no heart problems etc. ? The pain is so annoying all the time.
Posted Mon, 16 Apr 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen K Nath 10 hours later

Thanks for the query.

I have gone through your detailed history .

L5-S1 foraminal stenosis does not always mandate a surgical treatment.

Surgical treatment indications depend on severity of stenosis , presence / absence of disc prolapse , osteophytes , thickened ligamentum flavum & lot of other factors - like weakness , absent reflexes etc .

Only pain is mostly not an indication for surgery as surgery carries about 5 - 10 % risk of neurological deterioration .

I suggest you to ask your doctor to put you on medications like analgesics , muscle relaxants , pregabalin /gabapentine , amytryptyline etc .

I wish you could send me the scanned MRI spine films to my attention at doctor@healthcaremagic .
This will help me to provide you with more information.

Thanks again and Regards
Above answer was peer-reviewed by
Follow-up: Bilateral foraminal stenosis,pain in calf,low blood pressure.Surgery? 4 hours later
I probably can't send you the film. But I forgot to add to you that they did find osteophytes at that l5s1. The rest of the spine L1-L4 were all fine. Thank you for your answer. I also had lumber epidural injections twice now, the second helped a bit. I am bicycle riding on a road bike and that is helping also. I understand all doctors reluctance for surgery. But on my side, pain has effected my whole life and if someone can fix it by opening up that area, I'm all for it. I'll have to wait it out and in the meantime keep exercising with the bike and keep seeing the pain specialist. Whatever it takes to be out of pain I'm for. I tried those drugs you mentioned and they came with nausea and fogginess constantly so I went back to tramadol three times a night and hydrocodone once or twice a night.

Thank you for your helpful explanation.

God bless
Answered by Dr. Praveen K Nath 16 hours later

Good to hear from you again.

Lumbar Epidural injections of steroids are not always helpful in these cases.
Pure foraminal stenosis at L5 S1 rarely causes a pain in calf due to different area of segmental distribution.

Please get your Electromyography(EMG)/NCV(Nerve Conduction Velocity) of lower limbs to check exact location of MRI then you may opt for surgery, otherwise you need to continue medical management & physiotherapy/bed rest.

Hope this answers your query.

Thanks and regards,
Dr Praveen K Nath.
Above answer was peer-reviewed by
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