Question: 32/m
complains:
paraesthesia, right leg.
mostly involving the sole, involving the lateral aspect of sole. (lateral planter nerve territory)
right calf tenderness.
pain around the right buttock: along the S1 distribution.
no bladder/bowel issues.


question: would i need surgery ?
The CT Lumbar spine follows





Findings:
There is normal vertebral alignment
Vertebral body height is maintained
There is mild disc space loss posteriorly at the L5/S1 level.
There is associated osteophyte formation. This indents and partially compresses the thecal sac.
There is moderate spinal canal stenosis related to this, and also mild facet joint arthropathy
There is bilateral sunarticular recess stenosis, and likely S1 nerve root impingment.
There is no impingment of the L5 nerve roots at the neuro foramina.

There is mild disc bulging at the L4/L5 level, but no spinal canal stenosis or nerve root impingment is identified.
There L2/3 and L3/4 disc contours posteriorly are normal.
There is mild facet joint arthropathy at the remaining lumbar levels.

Comment:
1. There is disc octeophyte complex posteriorly at the L5/S1 level with evidence of disc protrusion/extrusion.
This is causing moderate narrowing of the spinal canal and impingement if the S1 nerve roots within the subarticular recesses.
2. Mild facet joint arthropathy.
3. Mild bulging of the L4/L5 disc, but without nerve root compromise.