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Dr. Andrew Rynne

Family Physician

Exp 50 years

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

Answered by
Dr. S K Mishra

Spine Surgeon

Practicing since :1998

Answered : 116 Questions

Posted on Thu, 10 Jan 2013 in Osteoporosis
Question: 32/m
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

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.

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.
Answered by Dr. S K Mishra 25 minutes later

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.

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

The User accepted the expert's answer

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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.

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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.

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