What Are The Findings From The MRI Report And Is It Necessary To Go For Surgery For Nerve Compression At L4 And L5?

Posted on Sat, 11 Jan 2014

Question: This is behalf of my mother, since 1month she was feeling pain in left leg then we went to physician and carried out all the test and did MRI too, the Impression of the report mentioned below. IMPRESSION. LUMBAR SPONDYLOSIS MINIMAL LUMBAR SCOLIOSISWITH CONVEXITY TOWARDS RIGHT DIFFUSE BULGE OF L4/5 DISC LEFT POSTEROLATERAL ANNULARTEAR OF L5/S1 DISC ARTHROPATHY OF L5/S1 FACETELJOINT ON LEFT SIDE NO OTHER SIGNIFICANT ABNORMALITY IS SEEN ON THE STUDY. the local neurologist prescribe some pain killer we tried for a month found no change in the pain then we went to neuro surgeon as per his analysis the nerve at L4 and L5 is getting compressed and suggested for immediate operation. Kindly give me your expert view on this case,

Answered by Dr. Praveen K Nath (10 hours later)

Brief Answer: LUMBAR SPONDYLOSIS Detailed Answer: DEAR SIR HELLO WISHING A SPEEDY RECOVERY TO YOUR MOTHER I have gone through your mother,s medical history in detail . Lumbar spondylosis with PIVD L4/5 IS NORMALLY MANAGED CONSERVATIVELY . SURGICAL decompression is reserved for cases which do not respond to medical treatment . or which develop some neurological deficit . May i suggest you to 1 Give her some ANALGESIC like aceclofenac+paracetamol combination / and MUSCLE RELAXANT for about 2 weeks . 2 Add some CHLORDIAZEPOXIDE +AMYTRIPTYLLIN combination 3 Add some METHYLCOBALAMIN 4 GIVE HER COMPLETE BED REST for about 2 weeks 5 If still pain persists , get herself examined by neurosurgeon /orthopedic surgeon . If neurological deficit is present /progressing , then go for surgery . Thanx DR XXXXXXX K XXXXXXX DIRECTOR DEPTT. OF NEUROSURGERY

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen K Nath (1 hour later)

Thank you for your kind reply Dr. Saab on 18/11 all of sudden at night the pain started on her left leg we went to physician, then they carried out all blood tests and fast sugar test , the blood test found to be normal but sugar was 294 then Doc prescribed NUCOXIA-NR and muscle relaxant GEL for ten days, found no improvement in ten days then he prescribe for MRI and referred to neurologist then neuro doctor prescribe medicine Numin gb10, VERSIDOL 200MG , ANXIT 0.25MG for 15 days after this medicine the pain is intermittent not regular Then we went to neuro surgeon on 18/12 as per his analysis the nerves is getting compressed and need operation and he prescribed some medicine mentioned below PAN-B ULTRACET PHIOACT D4MG MAXGLAIN M 75MG Kindly suggest us Doctor because my mother is type 2 diabetic, and we are not in the favor of operation and the pain is not tolerable

Answered by Dr. Praveen K Nath (12 minutes later)

Brief Answer: LUMBAR SPONDYLOSIS Detailed Answer: DEAR SIR HELLO MY BEST WISHES ALWAYS FOR YOU I have gone through the details . Continue with all the prescribed medications . If pain is still persisting you may increase the dose of MAXGALIN . Check with your neurosurgeon if she has any neurological deficit . Add some CHLORDIAZEPOXIDE+AMYTRIPTYLLINE COMBINATION after discussing with your doctor . THANX DR XXXXXXX K XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Praveen K Nath (2 days later)

GOOD EVENING DR. SAAB my mother is taking prescribe medicine since 2 days but still pain is persist, we have taken one more opinion of Orthopedic surgeon as per his observation the lifting of left leg is as equal to right leg and no pain is found while lifting so he recommend for traction, not operation. so kindly suggest me Doc. whether traction will be help full for in this case.

Answered by Dr. Praveen K Nath (18 hours later)

Brief Answer: LUMBAR SPONDYLOSIS Detailed Answer: DEAR SIR HELLO MY BEST WISHES ALWAYS . If on examination by a doctor there is no any neurological deficit , you can very well continue with conservative management ,. You can go for TRACTION , it might give some relief . But traction should be under medical supervision ,especially during initial days . THANX DR XXXXXXX K XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar