Brief Answer:
Central canal stenosis

Detailed Answer:

Hi,

Typically in my practice I think it is always a good idea to get an EMG/NCV study for cases of radiculopathy in patients with spinal canal stenosis since often the MRI doesn't tell the whole story...OR...it doesn't tell a completely ACCURATE story. Between 25-40% of positive MRI findings of lower back pathology occur in patients with NO SYMPTOMS of any clinically significance. In other words, things such as "bulging disks, herniated disks, scoliosis, degenerative arthritic disease, etc. etc. etc." end up being seen in patients with no complaints and no abnormal neurological findings on examination.

This means that just because one SEES something on a radiograph does not automatically mean one should act on it...and that is even in the face of HAVING COMPLAINTS as you do. However, when doing electrical studies for cases where patients have specific complaints of pain or weakness (not so much sensory changes) then, EMG/NCV studies can add a layer of improved statistical predictability as to exactly where a lesion on an MRI is that is causing a particular symptom.

In your case, I would consider therefore, obtaining an EMG/NCV looking for paraspinal muscle activity that would then, further substantiate that in fact, it is the spinal canal stenosis causing the pain in the buttock as opposed to some other phenomenon such as a peripheral entrapment syndrome like PIRIFORMIS syndrome which could just as easily give the symptoms you're having and which would never get better on the basis of any type of surgical intervention for the lumbar canal stenosis....make sense?

Also, be aware that the party line on "broad central disc protrusion" that actually results in XXXXXXX symptoms of PAIN, weakness, etc. is that they really don't have much to do with those problems since anatomically they cannot easily come anywhere close to nerve roots to irritate them since the disk is bulging OUTWARD and toward the BACK of your spine whereas nerve roots that would likely be responsible for pain are located to the SIDES of your spinal column and the nerves themselves are traveling more inwardly and in the opposite direction to where the central disc protrusion would be going if were centrally located.

I believe that therapeutically speaking your options are to try some type of neuropathic pain medication such as gabapentin, pregabalin, or even BOTOX injections (off label recommendation) into the muscle distribution served by the L4 nerve root though you didn't really mention anything in the leg that sounds like it's really being bothered by the "moderate" central canal stenosis of the L4 nerve root. Pain in the buttock doesn't really correlate anatomically well to where the L4 nerve root runs. The buttock region is more in the S3 root zone...so here is clearly an example where your symptoms don't match what the image is showing.

Physical therapy and possibly lumbar traction would be reasonable approaches to managing this pain in addition to the medications I've listed above. Aquatherapy and electrical stimulation as well as a TENS unit may provide additional relief. A good solid neurological examination is what I recommend gets the process rolling along with the results of this MRI.

If I've adequately answered your questions then, I'd greatly appreciate your CLOSING the query and assigning a 5 STAR rating to our encounter. Cheers!

60 minutes of professional time were spent in reading, researching, and formulating an analysis on behalf of this patient.

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Brief Answer:
Should avoid alcohol- thank you for your response.

Detailed Answer:

Hi,

In medicine, the general rule of thumb is not to ingest alcohol (either recreationally or medicinally) while also taking prescription medications (no matter whether orally, by injection, or by dermal transfer patch).

Although there is no specific INTERACTION between these 2 agents known to be specific or acutely dangerous... it is true that lidocaine patches can bring on symptoms of dizziness, vertigo, drowsiness, and blurred vision as direct side effects. It is also known that alcohol can and does amplify all such secondary effects of lidocaine and therefore, should be properly avoided.

Therefore, the proper recommendation is that alcohol should be avoided while using lidocaine patches.

If I've adequately answered your question then, I'd greatly appreciate your CLOSING the query and assigning a 5 STAR rating to our encounter. Cheers!

20 minutes of professional time were spent in reading, researching, and formulating an analysis on behalf of this patient.

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