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Have osteoarthritis in back. Earlier MRI shows stenosis. Surgery required?

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
Greetings. My 54 year old wife has been suffering from symptoms related to osteoarthritis in her lower back for years. Fortunately the symptoms have not significantly worsened over the years. We are concerned, however, whether the indications in the attached MRI from 3 years ago portend a future of worse symptoms as she ages. You will notice the special concern about deterioration in L4 an L5 and "moderate" stenosis. Is she likely to face the need for surgery to repair these problems, and could there be alternative remedies for them?
Posted Sat, 10 Aug 2013 in Bones, Muscles and Joints
Answered by Dr. K. Naga Ravi Prasad 44 minutes later
Hi, thanks for writing to XXXXXXX

I have gone through the attached MRI report. It is dating back 2010.

All those findings are suggestive of LUMBAR DISC DISEASE with DEGENERATIVE CHANGES.

Generally the degenerative changes in the spine tend to get worse with age.

Majority of the patients (around 80%) with lumbar disc disease will get significant improvement in their symptoms with conservative management. The following are the steps needed -

* avoid lifting heavy weights as it puts more strain on facet joints
* avoid forward bending activities as this may worsen the Listhesis of L4 over L5
* Use a lumbosacral back support
* Intermittent pelvic traction to cause a regression of the bulging discs
* Maintain optimum body weight,if you are obese
* Physiotherapy to strengthen your back muscles. Physiotherapy has to be done only after the acute pain has subsided.
* Judicious use of analgesics and muscle relaxants.

If your symptoms fail to improve after the above measures, or if radicular pain (shooting pain in the leg along with tingling and numbness) is increasing, then an EPIDURAL STEROID INJECTION may be helpful.

There are a few latest entries to manage these problems which are worth trying

If all the above measures fail, then the last option is SURGERY.

Hope I have addressed your issues. Happy to help for any more clarifications.

Above answer was peer-reviewed by
Follow-up: Have osteoarthritis in back. Earlier MRI shows stenosis. Surgery required? 12 minutes later
Thank you very much for your reply, Dr. XXXXXXX My wife has told me that because she has some mild scoliosis of the spine and some discomfort in her knees (she had meniscus surgery 2 years ago on her left knee) she feels somewhat better bending from the waist. She does try to be careful not to life heavy weight however.

What kind of lumbosacral support would you recommend, and would you recommend decompression as traction for the bulging disk? She has looked into this, but not pursued it because she does not have any acute pain: WWW.WWWW.WW
When she has occasional pain (including her basal thumb) she uses Tramadol. Are there concerns of side effects of tramadol as opposed to Advil? Should he worry, however, that eventually she WILL develop acute pain, and will the bulging disk situation inevitably worsen? Thank you.
Answered by Dr. K. Naga Ravi Prasad 27 minutes later
Hi, nice to see your prompt response.

Any brace or support that has an ANATOMICAL contour of the Lumbosacral spine will work.

Intermittant and prolonged pelvic traction will ASSIST in causing the protruded disc to regress to some extent by way of distracting the disc spaces thereby relieving pressure on the spinal cord and nerve root providing pain relief.

I personally prefer TRAMADOL over Advil(Ibuprofen) because of relatively lesser side effects and more potent. Infact, any pain killer medicine will lead to side effects used over a prolonged period of time.

There is a possibility that she may develop acute pain as the condition worsens with age. Bulging discs always gets worse with age because the disc loses its water content with age (degeneration). As a result they become "inelastic" and the protruded disc will only elongate during loading and will never regress back.

Hope this information is helpful. Good day

Above answer was peer-reviewed by
Follow-up: Have osteoarthritis in back. Earlier MRI shows stenosis. Surgery required? 30 minutes later
Many thanks......and what are the prospects in relation to the moderate stenosis issue? That was also rather worrisome.
Answered by Dr. K. Naga Ravi Prasad 9 minutes later
Hi, Prospects are always better with MILD or MODERATE stenosis. Whereas in SEVERE stenosis, the outcome with conservative (non-surgical) management is not good and a surgical decompression may be needed then.

I wish her a quick recovery.
Above answer was peer-reviewed by
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