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What Causes Pain In The Back And Leg Radiating To The Foot?

Posted on Fri, 22 Jul 2016

Question: I am a 45 yr old male with back and leg pain radiating into my left foot and a burning sensation in my left thigh, my MRI revealed a degenerative appearance of the intervertebral disc space at l5 s1 with end plate irregularities, also at l5 s1 there is bilateral facet arthrosis with a broad based disc bulge which contacts exiting l5 nerve roots bilaterally, there is a further protrusion inferiority which abuts the descending s1 nerve root, I can't seem to get a straight answer explanation as to the correct treatment, I have steroid injections in my hip joint and a nerve block at the disc but nothing has worked, can you please tell me how serious this is as the pain is constant although not yet completely debilitating, also what is my prognosis. Thank you XXXXXXX

Answered by Dr. Neeraj Kumar (12 minutes later)

Brief Answer:
Take treatment as advised

Detailed Answer:
Hello XXXXXXX
I have gone through your question and understand your concerns.

Back pain with radiation to left lower limb is due to compression and irritation of nerve root.
The management includes precautions like avoiding stooping forward, lifting heavy objects, squatting position.
Regular physiotherapy under guidance of a physiotherapist will help in strengthening back muscles.
Pain killers with muscle relaxant like etoricoxib or Aceclofenac with thiocholchicoside or tizanidine can be taken for relief.
Pain modulator medication like pregabalin or amitryptiline or gabapentin can be used for pain relief.
Unresponsive cases or with motor deficit require surgical intervention.
Nerve block and steroid may give some transient benefit.
Visit a neurologist or neurosurgeon for evaluation and guidance.

Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Neeraj Kumar (1 hour later)

Thanks Dr XXXXXXX I just have a couple of follow up questions, firstly do you think the facet arthrosis and end plate irregularities are a contributing factor to my pain ?

Also i am currently taking Lyrica and codapaine forte, which does take the edge off the pain, my condition is entering its 3rd month now with little relief from injections or PT, i have visited a neurosurgeon but he is currently away on holidays and didn't provide any feedback on the mri before he left.

Given the time frame and the lack of improvement with conservative treatment would surgical intervention be reasonable ?

Answered by Dr. Neeraj Kumar (1 hour later)

Brief Answer:
Wait for surgery

Detailed Answer:
Hello,
Facet arthrosis, end plate changes and disc prolapse are all related.
The treatment should be continued and dose of lyrica may be increased if needed.
If response to medications and physiotherapy is not adequate, severe pain persists even after 3 months or some motor weakness or urinary complains occurs then surgical intervention may be required.
At present you can wait for a month with focus on physiotherapy and precautions.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj