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MRI showing diffuse disc bulge indenting nerve roots with bilateral moderate degree neural foraminal narrowing. Anything serious?

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Orthopaedic Surgeon
Practicing since : 1994
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My father fail down one month before and recently again he got pain. The x ray shows a small fracture on bone. when we have done MRI the report says. L3-L4:Diffuse disc bulge indenting nerve roots with bilateral moderate degree neural foraminal narrowing, epidural lipomatosis in posterior aspect of cord indenting posterior thecal sac and nerve roots. l4-L5:Diffuse disc bulge indenting nerve roots with significant neural foraminal narrowing, bilateral facetal arthopathy noted with peripherally enhancing paraspinal synovial cysts. l5-S1:Diffuse disc bulge indenting anterior thecal sac moderately with bilateral significant neural foraminal narrowing. In 2009 he has gone for a spinal surgery . Please suggest how serious is the matter and what is your suggestion?
Posted Mon, 2 Dec 2013 in Back Pain
Answered by Dr. Praveen Tayal 19 minutes later
Brief Answer: Depends on the symptoms. Detailed Answer: Hello, Thanks for posting your query. Your father is having a disc prolapse at multiple levels with stenosis of the foramina from which nerves come out causing the nerve compression. These are age related degenerative changes of the spine. There is also a wedge fracture of L4 vertebra. The treatment is done according to the severity of symptoms. If he has only one symptom- back pain with no nerve related symptoms like limb weakness, numbness, urinary incontinence, etc then medicines along with bed rest are the first line treatment along with physiotherapy. If the patient responds well with medicines then physiotherapy helps in preventing further progression of the problem. Surgery is kept as a last resort to improve the quality of life. He needs to be assessed by a neurosurgeon for the severity of the symptoms and an appropriate treatment can be planned depending on the response to medical drugs. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal.
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Follow-up: MRI showing diffuse disc bulge indenting nerve roots with bilateral moderate degree neural foraminal narrowing. Anything serious? 1 hour later
Dear Sir, Thank you very much. Your kind advice is enlightning and I am grateful for it. The x ray shows that Bones are osteopenia. Central wedging of L4 vertebral body noted with mild anterior listhesis of L4 over L5. Reduce L5-S1 disc space with endplate sclerosis. Anterior marginal osteophytes at L4,l5 and S1 levels. Rest of the vertebral bod heights and intervertebral disc spaces are normal. Posterior elements are normal. pervertebral soft tissues are normal. AFter he fail down he had pain for 7 days and then he got relived by taking medicines. He travellied for few days after than one. He is getting pain in between.My father has started feeling numbness in his left leg two days before. The doctor at the Hyderabad XXXXXXX hospital told to go for immediate surgery. Please advice how critical it is to go for surgery. Thanks for advice once more. Regards, Niroj
Answered by Dr. Praveen Tayal 16 hours later
Brief Answer: If the numbness increases, surgery is needed. Detailed Answer: Hello. Thanks for writing again. Development of numbness in the leg is suggestive of a gradually increasing nerve compression. If the numbness subsides in 5-7 days with rest, physiotherapy and methylcobalamin supplements then surgery can be avoided for few months. If there is a progressive increase in the numbness then immediate surgery is recommended. Hope my answer is helpful. If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health. Regards
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