Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

122 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Have paraesthesia in leg and pain around buttock. Do I need surgery?

Answered by
Dr.
Dr. S K Mishra

Spine Surgeon

Practicing since :1998

Answered : 116 Questions

default
Posted on Thu, 10 Jan 2013 in Osteoporosis
Question: 32/m
complains:
paraesthesia, right leg.
mostly involving the sole, involving the lateral aspect of sole. (lateral planter nerve territory)
right calf tenderness.
pain around the right buttock: along the S1 distribution.
no bladder/bowel issues.


question: would i need surgery ?
The CT Lumbar spine follows





Findings:
There is normal vertebral alignment
Vertebral body height is maintained
There is mild disc space loss posteriorly at the L5/S1 level.
There is associated osteophyte formation. This indents and partially compresses the thecal sac.
There is moderate spinal canal stenosis related to this, and also mild facet joint arthropathy
There is bilateral sunarticular recess stenosis, and likely S1 nerve root impingment.
There is no impingment of the L5 nerve roots at the neuro foramina.

There is mild disc bulging at the L4/L5 level, but no spinal canal stenosis or nerve root impingment is identified.
There L2/3 and L3/4 disc contours posteriorly are normal.
There is mild facet joint arthropathy at the remaining lumbar levels.

Comment:
1. There is disc octeophyte complex posteriorly at the L5/S1 level with evidence of disc protrusion/extrusion.
This is causing moderate narrowing of the spinal canal and impingement if the S1 nerve roots within the subarticular recesses.
2. Mild facet joint arthropathy.
3. Mild bulging of the L4/L5 disc, but without nerve root compromise.
doctor
Answered by Dr. S K Mishra 25 minutes later
Hi,

Thanks for the query. I had carefully gone through the details that you have provided.

There is disc osteophyte complex posteriorly at the L5/S1 level with evidence of disc protrusion/extrusion. This is causing moderate narrowing of the spinal canal and impingement of the S1 nerve roots within the sub articular recesses. Mild facet joint arthropathy.

You may need surgery if any of the following is 'yes'.

1. Get an NCV of both lower limbs done. If it shows radiculopathy.
2. If the pain is disturbing your routine life.
3. If you have tried conservative measures.
4. If symptoms are getting worse.
5. Ultimate decision to be taken by you treating doctor and if your examining spine surgeon is advising surgery.

Hope I have answered your query. Let me know if I can help you further.

Regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Medical Topics ,   ,   ,  

Recent questions on  Geriatrics

doctor1 MD

Hi, I m a 62yr caucasian male. A recent US showed 4 benign cysts. 6.8cm,2.4cm.1.6cn on interpolar left and 1.7cm on parapelvic right. All have grown since my last US 2 years ago. My creatinine is 1.69. I have had 3 episodes of PE s, 4 episodes of DVT s in 4 years. I am now on warfarin with INR 2.9. I have spinal stenosis from an old L1 burst fracture. I have lower back leg pain and muscle cramps. I m concerned about complications if I have the cysts aspirated. Managing the pain requires quite a bit of narcotic pain meds which cause constipation and then additional pain. Could the aspiration reduce the pain level? What other concerns could the procedure cause?

doctor1 MD

i have central protrusions at T2-3 and T3-4 abutting the ventral throacic cord... asymmetric left-sided facet degenerative changes at T1-2... at C6-7 broad-based left central disc protrusion w/left-sided uncovertebral joint hypertrophy causing left neural foraminal stenosis same at C4-5 ... mild disc bulge at C3-4 w/ incovertal joint hypertrophic changes causing left neural foraminal stenosis.......no curvature in neck... lots of neck pain... some days i feel a need a neck brace just to hold my head up and lots of left sided migranes, dizziness, nausea, left arm and hand and shoulder is always pain and tingling... if i lean head back to look up long... major pain fro several days. HELP

doctor1 MD

MRI OF LUMBOSACRAL SPINE: -

PROTOCOL:

-     SE T1W & TSE T2W SEQUENCES IN SAGITTAL PLANE.
-     TSE T2 W SEQUENCE IN AXIAL PLANE.
-     STIR SEQUENCE IN CORONAL PLANE.
-     MR MYELOGRAPHY USING HEAVILY T2W SEQUENCE IN SAGITTAL AND CORONAL PLANES ON A 1.5 TESLA SCANNER.

There is some degree of straightening of lumbar lordotic curvature. Vertebrae are normal in height, alignment and marrow signal intensity.
Dessicative disc changes and anterior osteophytes are noted at multiple levels. Disc height is reduced at L4-5 with degenerative endplate changes at this level.

There is diffuse disc bulge, thickened ligamentum flavum & facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R). The mid sagittal diameter and area of spinal canal are 0.8cm and 0.75cm² (lower normal limits are 1.0cm and 1.5cm² respectively. Effusion is detected in the facet joints.
Annular tear, diffuse disc bulge and facet joint arthropathy are visualized at L3-4 indenting the thecal sac.
Diffuse disc bulge is observed at L5-S1 mildly compromising the neural canals bilaterally.

Cord ends at L1 vertebral level and shows normal signal intensity. No abnormal pre or paraspinal soft tissue mass is seen. MR myelography confirms the above findings.

Impression      :     MR findings reveal lumbar spondylotic changes with
     -     Diffuse disc bulge, thickened ligamentum flavum and facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R).
     -     Annular tear, diffuse disc bulge and facet joint arthropathy at L3-4 indenting the thecal sac.
     -     Diffuse disc bulge at L5-S1 mildly compromising the neural canals bilaterally.

-     To be correlated clinically.

doctor1 MD

I suffer from spinal stenosis lorodisis , spondylitis , chronic pain headaches, nerve damage in left foot, dysphasia due to cervical fusion, nerve damage at the c6-7level, lumbar fusion 2 lumbar surgeries. Degenerative disc disease, and now dealing with thickened bursa, tiny tear rotator cuff, labrum tear of right arm. Constant pain all over everyday. On cymbalta and anti-inflammatories. Not helping any suggestions

doctor1 MD

I have a small case of alziemers does klonopin have any bad affects to it

doctor1 MD

Thank you. I have fibromyalgia and have issues with medications so I really don t take anything for the pain other than 3 Advil every AM for arthritis and the fibro. My doctor recently gave me a RX for Gabapentin for the fibro. The first RX was...

doctor1 MD

90 years old with 4 bad heart valves, 2 very bad. Don't want to get heart operation. Laying flat or even in a recliner I cough a lot. Can't sleep. Do best when leaning forward on a table. Wondering if their is anything that would allow leaning...