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Dr. Andrew Rynne

Family Physician

Exp 50 years

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MRI done. What treatment should be done to get cure?

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Dr. Rahul D Chaudhari

Spine Surgeon

Practicing since :2002

Answered : 322 Questions

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Posted on Thu, 14 Feb 2013 in Osteoporosis
Question: Please find attached MRI result
- please explain in plain language that can be understood by an ordinary person the result of ths MRI
- what is the best treament to reverse this illness if an operation is not an option
- wil this heal by itself of requires treatment by whom ( neurosurgeon, physiotherapist)
- what are the chance of complete healing or aggravation of this type of lumbar illness
doctor
Answered by Dr. Rahul D Chaudhari 5 hours later
Hi,

Thanks for the query.

- You have listhesis and spinal stenosis. In simple words, your L4 vertebra is slipping over the L5 vertebra, due to the the disc (which lies in between the vertebrae) and the facet joint pathology. Back pain is due to this slippage. Leg pains can occur due to pinching of the nerve at that level. Gradual slippage compromise the space for the nerves, which leads to pinching.

- Treatment usually is decided on the patient's symptoms. How bad is the back pain? Do you get leg pains? Does it bother you daily? Can you perform your activities without pain? What treatment have you taken so far? Definitive treatment is surgery and stabilization of the spine.

- This is an irreversible problem. It is going to worsen over a period. We can not reverse the situation. We can control patient symptoms with medicine and physiotherapy. But can not change the pathology.
If patient is having significant problem and affecting his daily routine, then I would go ahead with the the spinal fusion. So it requires treatment from a Spine surgeon and supportive treatment with physiotherapy.

- Chances are bright after surgery and patient will be back pain and leg pain free. On the other hand, if we leave it, then it may cause more slippage and nerve pinching which makes the surgery more difficult and risky. I think timely intervention gives the best result.

Hope I have answered all your queries. Let me know if I need to clarify.

Thanks.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 37 minutes later
back pain is not that much, but the leg pain is sometimes unbearable
physical mobility is quite painful
I have been treated by a physio 3 times, without success
What other possible conservative treatment for nerve pinching
In the morning, my right leg is weak and could not stand up straight away, but
after a while I could walk, but still feeling the pain
This is going on for almost 2 months now.
How long does it take for the nerve to calm down
Is disc slippage heals by itself? (just heard about it)
My other physical activity is ballroom dancing (with a bit of hoping for the jive)
Will this aggravate the situation? We are doing this twice a week

doctor
Answered by Dr. Rahul D Chaudhari 50 minutes later
Hi,

Thanks for the follow up.

Its good that you don't have much back pain which indicates auto-stabilization of the slippage by the body. Once its slipped, it will always be. Either it worsens or remain as it is by auto-stabilization by the body. However during the process of auto-stabilization, its quite possible that the space for the nerve root may get compromised further.

Coming to conservative measures, you can try nerve root block or epidural block which is a spine injection treatment. Weakness in the legs again indicate alarming situation which can not be ignored.

Talking about nerve calm down, there is no specific period and it differs in every patient. Sometimes it may take 6 months or more. In your case, its a chronic problem and may take longer period.

Ballroom dancing should be fine and it will keep you active.
After seeing the Xray and MRI, we may decide if you need simple decompression surgery or fusion surgery.

Thanks.
Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Rahul D Chaudhari 15 hours later
Thanks Dr
Aside from nerve pinching, what are the possible causes of leg weakness in the morning. A few steps tend to recover to normal, still with the pain due to nerve pinching.
What is the best possible scan and or xray to give me an accurate answer
to this weak leg (only right...one affected by pinch nerved)
As I mentioned before, we do ballroom dancing. In the morning after the night
of the dancing...weakness in the leg is worst
Body flexibility is another problem. I have a hard time lifting my right leg
to the normal flexible and leaning back on the right side is painful
What is decompression surgery or fusion surgery?
doctor
Answered by Dr. Rahul D Chaudhari 31 hours later
Hi,

You problem is already diagnosed as L4-5 listhesis. The L4 / L5 nerve root pinching is giving you these issues. I do not think there is any other cause here.

Conservative treatment includes medicine physion and nerve root block; but definitive treatment will be surgery.

Decompression surgery is only freeing your nerve to give them more space in the spine while fusion refers to fusing the two vertebrae by putting screws in the spine.

Hope I have answered all your queries. Yet, I will be glad to assist any other concerns that you might have.

Regards

Above answer was peer-reviewed by : Dr. Prasad
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