Brief Answer:
L4-L5/L5-S1

Detailed Answer:
Hi XXXXXXX
Thanks for being again here on HCM.
I am Dr.Ajay Panwar,here to answer your query again.

As we previously had large discussion about your symptoms and MRI scan,I would like to impress here that you have significant L4-L5 and L5-S1 disk changes which are causing nerve radicles compression from the exiting foramina, and this compression is the likely cause of your pain on the top of buttock.Pain can be well referred in between the cheeks of buttocks in this case,as you mentioned.

L3-L4 disk bulge is less likely cause for the same.
Further,we did not have a discussion about your fistula previously.What fistula are you talking about?Is it an anal fistula that you are having?

I shall be glad to have you in follow-up with further questions.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
What bowel issues do you have?Nerve radicles compression can cause them.

Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.

I have gone through the details of neurological examination case sheet you have attached.Your consultant neurosurgeon somehow does not appear to be in agreement of the disk changes at L5-S1 level.Though,he mentioned clearly about L3-L4 and L4-L5 level changes.

Bowel issues can occur in lumbosacral radiculopathy,especially with the involvement of sacral roots.Please tell me what are the bowel issues that you are currently having so that I can answer this question appropriately.

Fistula can also be causing pain at the buttocks site you mentioned.I hope that your fistula treatment should improvement in the pain at this site.Though,nerve radicles compression can also contribute towards the pain at this site but how much role it is playing,can be told only if the pain persists even after the treatment of fistula.

I shall be glad to answer your further questions.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Yes,you can go for implant surgery.

Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.

If the symptoms are not getting stabilised on medicines and physiotherapy,then of course you can go according to the treatment plan as Dr.Zulfiqar XXXXXXX has formulated. Foraminal injections will help to know if the surgery will benefit.

Interspinous implant is good option,if you have a mechanical component to your pain,as explained by Dr.Zulfiqar.

Regarding sacral roots involvement,I suggest you to get your scans,evaluated reported by a consultant in Radiodiagnosis.Let us have his opinion on L5-S1 involvement.

Sacral roots may cause constipation or fecal incontinence.Are bowel symptoms still persisting?If they have improved after a few days,then they are less likely to be due to sacral roots.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Disc protrusions at C5-C6 and C6-C7.

Detailed Answer:


Hi XXXXXXX
Thanks for being in follow-up.

I already reviewed your neck scan in the previous query.I already mentioned-
Diffuse osteophytes are seen.
Disc protrusions at C5-C6 and C6-C7.More prominent at C5-C6 with significant thecal compression.It is impinging on the surface of spinal cord.Also appears to narrow the nerve root exiting foramina.
Overall,it is a DEGENERATIVE SPINE DISEASE.Surgery for neck symptoms should be considered only if symptoms are not controlled even on medicines and are rendering you occupationally impaired.
Once your symptoms are explained by spine disease,one should not go to alternative diagnosis like fibromyalgia or rheumatism.

Foraminal injections will help reduce inflammation in the foraminas and thus reduce the pressure on the exiting nerve radicles,which will likely improve the symptoms.

Interspinous implant surgery can be done if there is a significant mechanical component to the pain. Regarding laminotomy and interspinous implant details,I suggest you to consult a neurosurgeon as I am a clinical neurologist and this is not a part of my domain.

Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Please get back to me in case you have any query in future.
You can also put up a query directly to me on HCM address- http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69273

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Please tell the details.

Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.

I need to know a few details about this symptom-
1)Where in the arms you have this burning pain-proximal or distal or around shoulders?Please specifically tell that in which part of the arm, do you have this pain?
2)Similarly,please tell the distribution of this pain in legs?
3)Is it persistent or intermittent?
4)Does posture improves or worsens it?
5)What are the aggravating and improving factors?

I shall be looking forward to your follow-up query with above details.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Likely due to nerve compression.

Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up and providing further details.

Though,a few of the characteristics of pain(like the pain starts in upper arms,when you sit in the same position for too long)do not apply to radicular compression,but considering the distribution of pain and its character(burning,needles like),most likely cause still remains the same-Nerve radicle compression due to the disk disease.
Significant disk bulges in the cervical as well as lumbar spine further strengthens the causal reasoning.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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