Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Pelvic, Groin And Thigh Pain
Question: I would very much appreciate if you review this scan..i have an appointment with my consultant on Thursday..i had an epidural three weeks ago..i have pain inbetween my legs, in front of my legs, and the thight and buttocks...very painful.. this has been going on for the last twelve weeks...is there lateral recess stenosis.. are you seen compression..any suggestions.. is this stenosis or is it the disc causing the problem..there are a few discs involved..any suggestions on other treatments or tests that should be carried out to get to the bottom of this...which level is causing the problem..i am taking lyrica for the last week...could this be caused by the neck..you will see from previous reports that there are other neck issues..stiffness around right side groin area not pleasant..i am attaching a more recent scan also and could be greatful if you could comment on the difference.. do you think that this will require surgery
Brief Answer:
Get operative advice from a neurosurgeon
Detailed Answer:
Hi XXXXXXX
I have gone through your question and understand your concerns.
I have reviewed the scan .
There is definitely nerve root compression due to canal stenosis.
The epidural procedure is to decrease the pain but if disc prolapse remains the changes of nerve damage increases.
Previous scan is also showing similar findings.
You should get evaluated by a neurosurgeon for requirement of surgical options at present after clinically examining you.
In meantime you can do regular physiotherapy, pain modulator drugs like pregabalin, gabapentin and amitriptyline.
Pain killers with or without muscle relaxants may be required.
Hope you found the answer helpful. Please get back for further queries.
Wishing you good health.
Regards
Dr Neeraj Kumar
Neurologist
Get operative advice from a neurosurgeon
Detailed Answer:
Hi XXXXXXX
I have gone through your question and understand your concerns.
I have reviewed the scan .
There is definitely nerve root compression due to canal stenosis.
The epidural procedure is to decrease the pain but if disc prolapse remains the changes of nerve damage increases.
Previous scan is also showing similar findings.
You should get evaluated by a neurosurgeon for requirement of surgical options at present after clinically examining you.
In meantime you can do regular physiotherapy, pain modulator drugs like pregabalin, gabapentin and amitriptyline.
Pain killers with or without muscle relaxants may be required.
Hope you found the answer helpful. Please get back for further queries.
Wishing you good health.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks. .what disc ate causing the problem. .what is lateral recess stenosis. .is the scan worse than previous. .is L3L4AFFECTED. THANKS AVMILLIIN
Brief Answer:
New Mri looks better as compared to old
Detailed Answer:
Hello XXXXXXX
Lateral recess or foramina of spine is the area from which the exiting nerve root passes.
In your case disc prolapse in canal is causing narrowing of lateral recess at L3-4 and L4-5 region.
Mild improvement in disc prolapse is there in new Mri as compared to old.
You can continue with physiotherapy and medication if no neurological deficit present.
Regards
Dr Neeraj Kumar
Neurologist
New Mri looks better as compared to old
Detailed Answer:
Hello XXXXXXX
Lateral recess or foramina of spine is the area from which the exiting nerve root passes.
In your case disc prolapse in canal is causing narrowing of lateral recess at L3-4 and L4-5 region.
Mild improvement in disc prolapse is there in new Mri as compared to old.
You can continue with physiotherapy and medication if no neurological deficit present.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
thanks...it is extremely painful...which surgery would you suggest and do you have any other questions that I could ask my surgeon in relation to further tests..is surgery an option with this type of problem.. I would be concerned about the pain thanks
Brief Answer:
Consult a neurosurgeon for operative advice
Detailed Answer:
Hello XXXXXXX
If the pain is not bearable and unresponsive to medication then you may consult your neurosurgeon for definite operative advice.
The procedure may be endoscopic or open as finally decided by neurosurgeon after completely evaluating your case.
Regards
Dr Neeraj Kumar
Neurologist
Consult a neurosurgeon for operative advice
Detailed Answer:
Hello XXXXXXX
If the pain is not bearable and unresponsive to medication then you may consult your neurosurgeon for definite operative advice.
The procedure may be endoscopic or open as finally decided by neurosurgeon after completely evaluating your case.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
thanks.. do you see any nerve root compression at l5S1
Brief Answer:
Mild non significant compression
Detailed Answer:
Hello XXXXXXX
Nerve root compression at L5-S1 is mild and seems not to be significant.
It's better visualised on Mri machines with facilities of zooming and continous images visualisation in multiple windows.
Regards
Dr Neeraj Kumar
Neurologist
Mild non significant compression
Detailed Answer:
Hello XXXXXXX
Nerve root compression at L5-S1 is mild and seems not to be significant.
It's better visualised on Mri machines with facilities of zooming and continous images visualisation in multiple windows.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Hi
I attended my Surgeon today. He said that he could do what was called a laminotmy on the L4L5 disc and the L3L4 disc. There is no nerve damage as yet. The only risk he thought in relation to surgery was the annular tears..this could be causing the pain.. surgery could make my situation worse. Is there any other cure for anular tears. Also he examined my neck.. he mentioned that there was muscle wasting in the hands...
is this dangerous...thanks.. also can you explain what a lamintotomy is
I attended my Surgeon today. He said that he could do what was called a laminotmy on the L4L5 disc and the L3L4 disc. There is no nerve damage as yet. The only risk he thought in relation to surgery was the annular tears..this could be causing the pain.. surgery could make my situation worse. Is there any other cure for anular tears. Also he examined my neck.. he mentioned that there was muscle wasting in the hands...
is this dangerous...thanks.. also can you explain what a lamintotomy is
Brief Answer:
No other treatment for annular tear
Detailed Answer:
Hello XXXXXXX
Laminotomy is a procedure to remove the lamina of vertebra and make a way into spinal canal for operative procedures.
Annular tear is tearing of tight covering around the disc. It may be teared by injury or uncommonly during procedure.
In case with no neurological deficit there is risk of root injury during surgery .
But at good centre , it could be done well.
No other method of repair.
Consult some endoscopic spine surgery expert for minimally invasive surgery.
Wasting in hands may be due to cervical radiculopathy due to compression at cervical level or some neuropathy. Its evaluation requires detailed examination by neurologist, MRI of cervical spine and routine blood investigations and may be nerve conduction studies.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
No other treatment for annular tear
Detailed Answer:
Hello XXXXXXX
Laminotomy is a procedure to remove the lamina of vertebra and make a way into spinal canal for operative procedures.
Annular tear is tearing of tight covering around the disc. It may be teared by injury or uncommonly during procedure.
In case with no neurological deficit there is risk of root injury during surgery .
But at good centre , it could be done well.
No other method of repair.
Consult some endoscopic spine surgery expert for minimally invasive surgery.
Wasting in hands may be due to cervical radiculopathy due to compression at cervical level or some neuropathy. Its evaluation requires detailed examination by neurologist, MRI of cervical spine and routine blood investigations and may be nerve conduction studies.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
thanks you...do you suggest that I have actually spinal stenosis...is there a real need for this surgery.. can I suvive on phsiotherphy..the epidural did not work..i am resultant having a consultant operatio on L4L5 and L3L4..all seens a bit invasive with no success rate promised as I could be left from pain from the annual tears..do yo u think these tears are bad,,can this go away with time.how many of them are there..
Brief Answer:
Surgical treatment to be considered if pain unresponsive
Detailed Answer:
Hello XXXXXXX
In many cases conservative treatment like physiotherapy, hydrotherapy, ultrasound therapy, epidural injections helps .
In most cases with time and adequate steps the pain reduces in intensity.
In cases with unresponsive pain the treatment may be surgical.
Tear in annulus may be a risk for disc prolapse if undue pressure occurs.
Regards
Dr Neeraj Kumar
Neurologist
Surgical treatment to be considered if pain unresponsive
Detailed Answer:
Hello XXXXXXX
In many cases conservative treatment like physiotherapy, hydrotherapy, ultrasound therapy, epidural injections helps .
In most cases with time and adequate steps the pain reduces in intensity.
In cases with unresponsive pain the treatment may be surgical.
Tear in annulus may be a risk for disc prolapse if undue pressure occurs.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
thanks .. the surgeon explained the risks..when you say tear in athe annulus may be a risk for disc prolapse if undue pressure occurs...
not sure I understood this..do you mean during surgery..also do you think that a surgical procedure with such an annular tear is safe.. can you see the annular tear..i do not have any nerve damage..just pain and cramping which could..also is this stenosis as such...I heard that this could lead you to not been able to walk in the long term..surely my problem is not thid dangerous.. this intense pain has only really got worse after the epidual....do you think I should give surgery more time...I would be nervous with no nerve damage..thanks
not sure I understood this..do you mean during surgery..also do you think that a surgical procedure with such an annular tear is safe.. can you see the annular tear..i do not have any nerve damage..just pain and cramping which could..also is this stenosis as such...I heard that this could lead you to not been able to walk in the long term..surely my problem is not thid dangerous.. this intense pain has only really got worse after the epidual....do you think I should give surgery more time...I would be nervous with no nerve damage..thanks
Brief Answer:
Wait if pain is bearable with medications.
Detailed Answer:
Hello XXXXXXX
You can wait if you want and the pain is bearable with medications. In absence of any nerve damage , only indication for surgery is unbearable pain not responding to drugs .
Surgery is always the second step and is associated with some risk. I don't think there will be any problem in operating but its a routine to explain the rare/uncommon procedural risk in every patient.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Wait if pain is bearable with medications.
Detailed Answer:
Hello XXXXXXX
You can wait if you want and the pain is bearable with medications. In absence of any nerve damage , only indication for surgery is unbearable pain not responding to drugs .
Surgery is always the second step and is associated with some risk. I don't think there will be any problem in operating but its a routine to explain the rare/uncommon procedural risk in every patient.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
