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MRI showed L4L5 disc herniation with secondary spinal canal stenosis. Recommended surgery. Guidance

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Spine Surgeon
Practicing since : 2002
Answered : 322 Questions
My mom underwent MRI as recommanded by orthopaedic surgeon as we went for back pain whice c has from a year..for which used to take pain killer tab and physiotherapy in between.last week she did MRI ...and the reports says

L4L5 disc herniation with secondary spinal canal stenosis by thickening of ligament um flavum she requires decompression and screws n rod fixing surgery.her pain scale is only between 5-6,does normal daily I need your valuable opinion about the condition and surgery.dr says spinal canal is occupied nearly 75% at the level.presently no other neurological problem(no numbness weakness )
Dr recommands surgery bcoz MRI shows bad compression and c may prone to cauda equina syndrome in future or anytime.I need your valuable opinion.
Posted Sun, 30 Jun 2013 in Back Pain
Answered by Dr. Rahul D Chaudhari 1 hour later
Thanks for writing to us.
She has severe spinal stenosis at L4-5 level. Need to know more about her disability. How frequently does she take pain medicine? Does she have limitation in walking as compared to last year? Any leg pain is there?
Looking this picture she is a defiantly surgical candidate. Also with increasing the age spine changes will worsen and may result in neurological deficit . Recovery from neurological damage is always unpredicatable. So I would consider doing surgery in this case.
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Follow-up: MRI showed L4L5 disc herniation with secondary spinal canal stenosis. Recommended surgery. Guidance 23 minutes later
Thank u sir.c has only back pain and calf muscle pain left side.back pain at para spinal muscle of L3-L5 mid spine pain.and I'm a physiotherapist sir I give her ultrasound if pain z more and in this 1 year c had 3times consultation with ortho for pain and taken physiotherapy 2weeks and bw.her ECL power and other muscle power r good.reflex is good.
Answered by Dr. Rahul D Chaudhari 3 hours later
I am more interested in knowing her disability due to pain. What is her walking tolerance? how much distance can she walk without leg pain? does she feel any heaviness in legs after walking. Stenosis patients dont have symptoms at rest but whenever they do any exertion such as walking they tend to develop weakness in legs. Is she able to do toe and heel walking for 2-3 min. XXXXXXX weakness in legs is too late sign in stenosis and not good for overall prognosis.
Patient's pain and disability should be the criteria for intervention rather than waiting for neurological symptoms to appear. thanks.
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