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Fallen off ladder, degenerative disc, spondylotic disease, pain and weakness in legs, numbness. Surgery is best solution?

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Orthopaedic Surgeon
Practicing since : 1994
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I recently feel off of a 12 foot ladder onto a concrete pool deck 4 weeks ago. My mri is long but the most serious area is l4-l5. degenerative disk and spondylotic disease, most prominent at l4, l5 with posterior annular fissure and central intervertebral disk extrusion resulting in severe canal compromise with residual thecal sac diameter reduced to 5mm. there is encroachment of the right and left lateral zones at this level, likely with impingement upon the descending bilateral l5 nerve roots, additionally , there is abutment of the extraforaminal exiting bilateral l4 nerve roots by the intevertabral disk bulge, possibly with impingement. I am experiencing exterme pain bilaterally down my glutes to my hanstrings and weakness in my right leg with numbness. I have actually fallen a couple of times due to this. Does it look like surgery will be my best solution?
Posted Fri, 21 Sep 2012 in Brain and Spine
Answered by Dr. Praveen Tayal 9 hours later
Thanks for posting your query.
Your MRI report is suggestive of considerable degenerative changes of the spine with nerve impingement at L4 and L5.
The treatment is done according to the severity of symptoms. Medicines are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life.
The main treatment of such problem is bed rest along with pain killers and muscle relaxants. Muscle relaxants can help with your symptoms if used in appropriate dosage in combination with a potent analgesic. You can get these prescribed from your orthopedician.
Local analgesic gels and hot fomentation may provide a short term relief. You can use analgesic gels like Volini gel. Exercise is not advisable in the times of acute pain.
Using an LS contour belt of appropriate size might be helpful in providing support to back muscles.
Physiotherapy also plays a major role in treating such conditions. Epidural steroid injections have been used if oral pain killers are not very effective.
Regarding the need of surgery, it depends on your symptoms and how far you are relieved after taking the proper medicines. If the conservative treatment decreases the muscle weakness then surgery can be avoided for a few weeks.
In this case surgery is not an emergency. The disease process will not be reversed with any medicines but the symptoms can be taken care of.
It depends on the assessment of your orthopaedician when will you need surgery.

I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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