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Dr. Andrew Rynne

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Having back pain. MRI showed degenerative spondylolisthesis. Not cured by nasid. Do I need surgery?

Answered by
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Dr. Rahul D Chaudhari

Spine Surgeon

Practicing since :2002

Answered : 322 Questions

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Posted on Sat, 22 Dec 2012 in Osteoporosis
Question: I have back pain from the last 3 months. It worsened at the end of October and I went for an MRI. The MRI showed that I have:
a) Spondylo disco degenerative changes in lumbar spine
b) Posterocentral protrusion of L4-L5 intervetebral disc with compression of thecal sac in anterior part with mild bilateral neural canal narrowing along with facet joint arthropathy
c) Protrusion of L5-S1 intervetebral disc with compression of thecal sac in anterior part with bilateral neural canal narrowing more so on the left side along with facet joint arthropathy with bilateral foraminal stenosis
My doctor prescribed NSAIDs and told me to do some exercises and if it does not improve I needed to have surgery. He asked me to take hot pack treatment. I have terrible pain and cannot walk properly. My body is twisting to one side. However with a walker I am able to walk a little more as I donot put presssure on my right leg/ side where the pain is. There is a constant numb pain in the back and it radiates down sometimes below the knee. All my issues are with the right side of the body.
I developed a muscle pull yesterday and could not walk at all and then after I had ice applied and felt relief. I took Voveran SR and the muscle pull seems resolved today. However the excruciating pain remains. My bladder functions are normal my bowel as well today I did not have. I am also having my periods now. Please help? How can I know that my condition is improving? Or when will i know if i need surgery? Is surgery recommended in these cases?
doctor
Answered by Dr. Rahul D Chaudhari 2 hours later
Hi,

Thanks for the query. We usually try to treat conservatively with medicine and physiotherapy. Sometimes nerve root block is preferred. It seems you are still in lot of pain. I would suggest to try nerve root block. It may help you. Surgery is considered last option.

If possible please upload an mri image to know more about your spine. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

Regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 17 hours later
Hello Dr. Chaudhari, thank you so much. I donot have a soft copy and shall try to get one tomorrow. Yesterday was the first day when i rested for better part of the day and i could do some of my work myself. Thereafter again the lain returned and i have to lie down. Some doctors have told me i need to walk and exercise as otherwise i will lose muscle. But i felt better today after i rested well yesterday. Any suggestion you have would be appreciated. Many thanks best regards Sharmistha
doctor
Answered by Dr. Rahul D Chaudhari 3 hours later
Thanks for the information.

Yes, rest does relieve acute pain, however I would also suggest a nerve root block to reduce the pain and make you more mobile. The pain block will fasten the recovery and ultimately you need to do exercise to stay pain free.

At present we need to get you out of this episode and that's why I suggest a nerve root block.

Let me know if there are other concerns.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Rahul D Chaudhari 18 hours later
Dear Doctor, thank you. Does the nerve root block means steroid injections. How many do you think I need to take. Any side effects? I have diabetes but blood sugar is under control. Will this cure me of pain immediately within days and will my body straighten up and I will be able to walk free of pain. Thank you again for being so patient with my questions. Regards Sharmistha
doctor
Answered by Dr. Rahul D Chaudhari 1 hour later
Hi,

Yes, it is a steroid + sensorcaine injection given locally at the site of the nerve, under the guidance of x-ray machine. If you are diabetic, we need to check sugar level one day prior. Risk involving the procedure is minimal, and rarely infection can occur if not done under aseptic precautions. I usually give it in the operation theatre. It should relieve your pain at least 50 % within a day, and effect should last for few weeks. Also, we can repeat it in 4-6 weeks. It can be repeated 4-5 times a year. If your pain is reduced to a tolerable level, then will try to take you on regular physiotherapy.

Hope I had been able to clear all your concerns. Let me know if I can assist you further.

Thanks.

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 8 hours later
Thank you so much doctor. I am afraid of injections and hence the hesitancy. Will I never improve if I don't take these injections? Are there oral steroids I can take. You have already seen the medicines I am taking, any others you think are more effective and I can request for those. Also I was also told to add glucosamine chrondrotin sulfate supplement which is effective and was told about Glutin. but am not sure if I should take it? Is it safe? Finally how will I know i am improving, I took rest for most of the day and my pain is in the back and legs. What are the signs of improvement --- relief from pain, how will I know the disc is healing -- xray? Thank you for your patience? regards
doctor
Answered by Dr. Rahul D Chaudhari 3 hours later
Hi
thanks for writing back.
you may improve without injections. however it may take quite a few weeks. Improvement means gradual reduction in pain and you would also become more mobile and also need to take less and less medication. our ultimate aim is to make you pain free with no dependency on medicine. glucosamine is of no help and is not indicated. definitely you can try rest, medicine such as myospaz forte and physiotherapy modalities like IFT or TENS for 4-6 weeks. I need to see your MRI images to know more about the disc condition.
thanks.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Rahul D Chaudhari 3 days later
Dear Doctor, Unfortunately I was not able to load the messages. However, I came to AIIMS in Delhi and they told me that the pain which is specifically in my buttocks is due to the piriformis muscle syndrome. Its an excruciating pain and it makes sense in terms of diagnosis. Can you please advise what I need to do to alleviate the pain in this muscle and cure it? What kind of therapies are recommended? I have been recommended microwave therapy, can i do that at home? What kind of physiotherapy is recommended? Or Do i need to rest the muscle and no aggravate it by doing exercise etc thank you
doctor
Answered by Dr. Rahul D Chaudhari 21 hours later
This is relatively rare to happen. A program of exercises and stretches involving the pyriformis muscle is initially suggested to help reduce sciatic nerve compression. Other recommendations such as anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anesthetic can be tried. Other therapies such as iontophoresis, which uses a mild electric current, and injection with botulinum toxin may be used. Surgery may be recommended as a last resort. I would still consider lumbar spine pathology as the main concern while treating you.

Thanks.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 1 hour later
Thank you doctor. I shall keep a note of that. The medicines that have been prescribed are Mobicox, Rabekind, Dolenix gel for a week and Disperzyme, Mgalin, Calcitrate + micriwave therapy and exercises. I must say the excruciating pain has reduced significantly and I can walk for longer distances and my body is slightly straighter. I still have some pain in the buttocks and leg. Do you advise I take traction? I am wearing a belt though. I am still concerned with the lumbar spine pathology but I have absolutely no pain in the back. Since I have diabetes I did not want to be treated with steriods. Bow that the pain has reduced significantly does that indicate healing? Kindly advise, Thanks
doctor
Answered by Dr. Rahul D Chaudhari 12 hours later
Definitely if pain is reduced then you are on a right path. This is usually episodic and once the episode is over then you may not get similar problem for years. Continue the pain medicines and gradually start doing physiotherapy.

Traction for few hours a day may help.

Thanks and Regards

Above answer was peer-reviewed by : Dr. Prasad
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