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Suggest Treatment For Severe Stenosis And Slight Bulge
Question: If I have severe stenosis and L2/L3 with a slight bulge. I have seen chiropractors and done PT. Myelogram was done confirming stenosis yet I'm told my pains are more consistent with L4/L5 which has no stenosis. I am facing Discetomy/forminotomy but am concerned that since my lower body sciatic pains are inconsistent with L1/L2 that it may not solve the problem. should I be concerned
Brief Answer:
no need for surgical decompression
Detailed Answer:
Hello. I have been through your question and understand your concern.
As I see your situation your clinical symptoms do not relate to your radiological features. As your main complain are due to sciatica and more precisely due to L4/5 root, there is no confirmation on the myelogram which instead shows severe stenosis in upper levels.
Spinal stenosis causes neurogenic claudication which is a back pain precipitated by walking or prolonged standing. In severe cases urinary problems appear with saddle anesthesia which is numbness around the genital area.
If you have these signs, then there would be a CLINICAL-RADIOLOGICAL correlation. This is the only condition where there is surgical indication.
In your case I do not see such correlation, thus no surgery is needed.
I recommend an MRI after some months.
Hope this helps. Please feel free for further questions
no need for surgical decompression
Detailed Answer:
Hello. I have been through your question and understand your concern.
As I see your situation your clinical symptoms do not relate to your radiological features. As your main complain are due to sciatica and more precisely due to L4/5 root, there is no confirmation on the myelogram which instead shows severe stenosis in upper levels.
Spinal stenosis causes neurogenic claudication which is a back pain precipitated by walking or prolonged standing. In severe cases urinary problems appear with saddle anesthesia which is numbness around the genital area.
If you have these signs, then there would be a CLINICAL-RADIOLOGICAL correlation. This is the only condition where there is surgical indication.
In your case I do not see such correlation, thus no surgery is needed.
I recommend an MRI after some months.
Hope this helps. Please feel free for further questions
Above answer was peer-reviewed by :
Dr. Prasad
My condition has gone on for over a year. In addition i have atrophy in my calf and cannot stand on my toe producing a limp. uninary problems occur if I am unable to get to the restroom before an urgent state. In addition I have severe sciatica on both sides buttocks and legs with severe cramping when I walk extended periods of time. the proposed surgery is Lumbar Discectomy/Formaninotomy. Do you still see this as unnecessary?
Brief Answer:
see detailed answer below
Detailed Answer:
Hello again. Atrophy and not being able standing on your toes is a sign of sciatica while urinary urgency is a very common condition and not necessarily connected to spinal problem. The cramping sensation after long distance may be a sign of stenosis.
It is very important a neurological exam to see the sensation, motor strength and deep tendon reflexes of each dermatome (spinal root) and see for correlation with the radiologic findings.
I still do not understand at which intervertebral disc level do they propose for discectomy/foraminotomy.
As I understood from your first question the myelogram did not show any other spine problem beside the stenosis. And stenosis is not treated by discectomy but by bilateral laminectomy. Unless they have seen a herniated disc at L4/5 level which would explain the symptoms and the proposed surgery.
see detailed answer below
Detailed Answer:
Hello again. Atrophy and not being able standing on your toes is a sign of sciatica while urinary urgency is a very common condition and not necessarily connected to spinal problem. The cramping sensation after long distance may be a sign of stenosis.
It is very important a neurological exam to see the sensation, motor strength and deep tendon reflexes of each dermatome (spinal root) and see for correlation with the radiologic findings.
I still do not understand at which intervertebral disc level do they propose for discectomy/foraminotomy.
As I understood from your first question the myelogram did not show any other spine problem beside the stenosis. And stenosis is not treated by discectomy but by bilateral laminectomy. Unless they have seen a herniated disc at L4/5 level which would explain the symptoms and the proposed surgery.
Above answer was peer-reviewed by :
Dr. Yogesh D
Stenosis and bulge both l2/l3. They are saying this is the only problem area and alrhough they too thought it woud be l4/l5 this woukd be our only hope in addressing since we've done emg nerve testing and myelogram
Brief Answer:
no surgery indication
Detailed Answer:
In these terms I dont see how surgery can work on relieving your complains. I would wait and have an MRI scheduled to better see the nerve roots raport with the foramina and the stenosis.
After all this is my opinion. Hipe this helps somehow on taking your decision.
Wish you the best health
no surgery indication
Detailed Answer:
In these terms I dont see how surgery can work on relieving your complains. I would wait and have an MRI scheduled to better see the nerve roots raport with the foramina and the stenosis.
After all this is my opinion. Hipe this helps somehow on taking your decision.
Wish you the best health
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
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