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Suggest Treatment For Painful Stiffness In Hip And Numbness Throughout Right Leg
Question: Hello Doctor,
This is regarding my mother. She is a patient of prolap disc from last 13 years. Undergone a surgery called as Fenestration disectomy for L$-L5 but over time the condition has aggravated and another surgery is advised.
Current symptoms are-
Pain and stiffness in hip region
Numbness in right leg radiating down till feet.
Cannot stand for more than 5 mins.
Tingling in fingers of the feet.
Frequent urination, cannot control the bladder, have to go the toilet even if the urine is less.
We consulted a spine surgeon, he suggested fusion laminectomy.
We consulted a interventional pain management doctor, he suggested adhesiolysis where the entrapped nerve roots can be released and so will the pain.
I am attaching the MRI scan and Nerve Conduction reports.
Can TENS also give relief in some way?
Kindly advice me on the same
Thanks
XXXX
This is regarding my mother. She is a patient of prolap disc from last 13 years. Undergone a surgery called as Fenestration disectomy for L$-L5 but over time the condition has aggravated and another surgery is advised.
Current symptoms are-
Pain and stiffness in hip region
Numbness in right leg radiating down till feet.
Cannot stand for more than 5 mins.
Tingling in fingers of the feet.
Frequent urination, cannot control the bladder, have to go the toilet even if the urine is less.
We consulted a spine surgeon, he suggested fusion laminectomy.
We consulted a interventional pain management doctor, he suggested adhesiolysis where the entrapped nerve roots can be released and so will the pain.
I am attaching the MRI scan and Nerve Conduction reports.
Can TENS also give relief in some way?
Kindly advice me on the same
Thanks
XXXX
Brief Answer:
Consult a neurologist
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Your mother's Mri is showing significant narrowing of foramina at L4 level and also central canal stenosis.
The decision to operate depends upon neurodeficit in terms of motor weakness, sensory loss, reflex loss and unbearable pain.
Non surgical treatment can be tried for few weeks if above surgical indications are not present.
You can try physiotherapy and pregabalin, amitryptiline or gabapentin drugs according to need.
It's difficult to comment about improvement on adhesionolysis.
Surgical procedure adviced by spine surgeon is OK.
TENS may give some benefit but actually pathology will remain unchanged.
But as a neurologist, I am concerned about Nerve conduction finding showing length dependent symmetrical axonal neuropathy and also bladder symptoms.
I will advise you to consult a neurologist before any operative intervention to investigate regarding these symptoms and reports.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Consult a neurologist
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Your mother's Mri is showing significant narrowing of foramina at L4 level and also central canal stenosis.
The decision to operate depends upon neurodeficit in terms of motor weakness, sensory loss, reflex loss and unbearable pain.
Non surgical treatment can be tried for few weeks if above surgical indications are not present.
You can try physiotherapy and pregabalin, amitryptiline or gabapentin drugs according to need.
It's difficult to comment about improvement on adhesionolysis.
Surgical procedure adviced by spine surgeon is OK.
TENS may give some benefit but actually pathology will remain unchanged.
But as a neurologist, I am concerned about Nerve conduction finding showing length dependent symmetrical axonal neuropathy and also bladder symptoms.
I will advise you to consult a neurologist before any operative intervention to investigate regarding these symptoms and reports.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
Thank you doctor for your reply.
As you have mentioned in your reply that
"...as a neurologist, I am concerned about Nerve conduction finding showing length dependent symmetrical axonal neuropathy and also bladder symptoms."
So as per you, is it a neurological problem or it is because of the MRI findings?
We have shown the neurologist the NCV report, he suggested Pregabalin SR75 and Neurobion; but she hasn't got much relief.
I also would like to know- can Gabamax/Pregabalin be taken life long or will it have any side effects over a period of time? She is on the tablet for 6 months now.
My mother is weak health wise so she won't be able to bear the surgery. Can you advice on any treatment or alternative method to get at least 50% relief for the current symptoms which are mainly are-
Heaviness in legs on standing for long
Tingling or less sensation in feet fingers
Urine problem
Await reply
Regards n Thanks
XXXX
As you have mentioned in your reply that
"...as a neurologist, I am concerned about Nerve conduction finding showing length dependent symmetrical axonal neuropathy and also bladder symptoms."
So as per you, is it a neurological problem or it is because of the MRI findings?
We have shown the neurologist the NCV report, he suggested Pregabalin SR75 and Neurobion; but she hasn't got much relief.
I also would like to know- can Gabamax/Pregabalin be taken life long or will it have any side effects over a period of time? She is on the tablet for 6 months now.
My mother is weak health wise so she won't be able to bear the surgery. Can you advice on any treatment or alternative method to get at least 50% relief for the current symptoms which are mainly are-
Heaviness in legs on standing for long
Tingling or less sensation in feet fingers
Urine problem
Await reply
Regards n Thanks
XXXX
Brief Answer:
Increase the drug dose if tolerating well
Detailed Answer:
Hello XXXX,
Findings of nerve conduction study in your mother is not related to Mri problem. You need to get some test for neuropathy like vitamin B12, folic acid, Thyroid profile, urea, creatinine, blood sugar fasting and post prandial. Also serum electrophoresis may be required for evaluation regarding myeloma.
She can try physiotherapy and increased dose of pregabalin upto 150 mg for improvement.
This can be taken safely for many years.
Surgery may be required if not benefitted by these steps.
Avoid standing for prolonged periods, stooping forward, lifting heavy objects, squatting position and carrying heavy objects overhead.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Increase the drug dose if tolerating well
Detailed Answer:
Hello XXXX,
Findings of nerve conduction study in your mother is not related to Mri problem. You need to get some test for neuropathy like vitamin B12, folic acid, Thyroid profile, urea, creatinine, blood sugar fasting and post prandial. Also serum electrophoresis may be required for evaluation regarding myeloma.
She can try physiotherapy and increased dose of pregabalin upto 150 mg for improvement.
This can be taken safely for many years.
Surgery may be required if not benefitted by these steps.
Avoid standing for prolonged periods, stooping forward, lifting heavy objects, squatting position and carrying heavy objects overhead.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you doctor for the detailed reply.
Have done all the tests and they are in normal limits.
Should we try Tens as part of the physiotherapy, also suggest some other exercises if available.
Why do you suspect of myeloma?
The symptoms which she is complaining about; are those in some way related to the nerve findings in NCV or is it purely due to MRI findings?
Symptoms-
Heaviness in legs on standing for even 5 mins
Tingling or less sensation in feet fingers
Urine problem
Also do you suspect of GBS in anyway in such a case?
She had got severe malaria a year back followed by a shoot out in BP to upto 180/100 where she was given oral Depin capsule to bring it down quickly.
Do you think Depin could play a role in nerve complications. She has been given Depin 2 times over a period of 10 days.
Can you suggest a good neurologist in XXXXXXX who can in actual study this case and give good treatment?
Await reply for all the queries.
Regards n Thanks
XXXX
Have done all the tests and they are in normal limits.
Should we try Tens as part of the physiotherapy, also suggest some other exercises if available.
Why do you suspect of myeloma?
The symptoms which she is complaining about; are those in some way related to the nerve findings in NCV or is it purely due to MRI findings?
Symptoms-
Heaviness in legs on standing for even 5 mins
Tingling or less sensation in feet fingers
Urine problem
Also do you suspect of GBS in anyway in such a case?
She had got severe malaria a year back followed by a shoot out in BP to upto 180/100 where she was given oral Depin capsule to bring it down quickly.
Do you think Depin could play a role in nerve complications. She has been given Depin 2 times over a period of 10 days.
Can you suggest a good neurologist in XXXXXXX who can in actual study this case and give good treatment?
Await reply for all the queries.
Regards n Thanks
XXXX
Brief Answer:
Detailed answer below
Detailed Answer:
Hello XXXX,
The symptoms of your mother is due to involvement of lumbosacral nerves secondary to disc prolapse.
The nerve involvement as neuropathy is also present in nerve conduction study. Myeloma with other dysimmune diseases is one the cause of neuropathy.
It is not due to GBS or drug related.
You can consult good hospitals like seven hills, Apollo.
Physiotherapy should be done under proper guidance of a physiotherapist.
TENS can be tried for some benefits.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Detailed answer below
Detailed Answer:
Hello XXXX,
The symptoms of your mother is due to involvement of lumbosacral nerves secondary to disc prolapse.
The nerve involvement as neuropathy is also present in nerve conduction study. Myeloma with other dysimmune diseases is one the cause of neuropathy.
It is not due to GBS or drug related.
You can consult good hospitals like seven hills, Apollo.
Physiotherapy should be done under proper guidance of a physiotherapist.
TENS can be tried for some benefits.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
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Above answer was peer-reviewed by :
Dr. Prasad
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