Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Severe Leg Pain?
Question: oh thank you.. i am extremely concerned. I have had a scan which reveals at L4L5 where there is slight loss of height of disc and reduction in disc signal there is a substantial right paracentral and posterolateral disc extrusion adjacent to a posterior annular tear and compression on the decending right fifth lumbar root. The central spinal canal dimensions are reduced at this level as a consequence. At L4S1.. there is central and left paracentral posterior annular tear and a shallow central and paracentral disc bulge but no evidence of nerve root compression. My symtoms are severe pain in right leg when i walk more than five minutes.. and pain in the lower back. Intermittent pins and needles...i am seriously concerned and i am seeing my surgeon in three times. i have had the l4l5 protrusion for two and a half years - have had an epidural in february...relief for a while but unfortunately got neck pain and scan read mild angular kyphosis centred at c5c6 where there is disc narrowing, disc dehydration and osteophytosis. Axial scans show right paracentral disc protrusion which impinges on the surface of the cord. There is bony encroachment on the exit foramina bilaterally. I am so concerned .. have had six months of physio. my last scan said there was no evidence of spinal stenosis which was done in december of last year.. why do i have stenosis now.. in circumstances such as this would they operate... my feel so delibated.. no neurological symtoms in right leg just pain upon walking on right leg....is another epidrual going to help this or would they proceed to surgery.. thanks so much
Brief Answer:
Degenerative changes of spine
Detailed Answer:
Hi
You are welcome. I have gone through your query and understand your concern. Let me assure you MRI report alone is never the basis to make a decision regarding surgery. It has to be supplemented by clinical examination and patient symptoms.
Having said that I would like to know are you able to walk on your heels and toes? That will give me some idea of severity of nerve compression.
Now coming back to your queries one by one-
1. What is the duration of severe pain in right leg? For pain you may have the following medicine -: Pregablin, muscle relaxant (thiocolchicoside), oral/inject able form of vitamin B12.These are prescription only medicine so you may talk to your local doctor.
2. Spinal stenosis and disc protrusion are progressive degenerative changes. Hence, If not present in the MRI scan of December they may occur in the latest.
3. If the pain in right leg is of long duration along with muscle weakness not responding to conservative measures like by epidural injection or by drugs like pregablin then the surgeon may decide to operate.
4. You may have second shot of epidural, no harm in it. It may help.
Hope this answer your queries.
Take care
Degenerative changes of spine
Detailed Answer:
Hi
You are welcome. I have gone through your query and understand your concern. Let me assure you MRI report alone is never the basis to make a decision regarding surgery. It has to be supplemented by clinical examination and patient symptoms.
Having said that I would like to know are you able to walk on your heels and toes? That will give me some idea of severity of nerve compression.
Now coming back to your queries one by one-
1. What is the duration of severe pain in right leg? For pain you may have the following medicine -: Pregablin, muscle relaxant (thiocolchicoside), oral/inject able form of vitamin B12.These are prescription only medicine so you may talk to your local doctor.
2. Spinal stenosis and disc protrusion are progressive degenerative changes. Hence, If not present in the MRI scan of December they may occur in the latest.
3. If the pain in right leg is of long duration along with muscle weakness not responding to conservative measures like by epidural injection or by drugs like pregablin then the surgeon may decide to operate.
4. You may have second shot of epidural, no harm in it. It may help.
Hope this answer your queries.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks so much for this wonderful reply
in my last MRI report it said that the lumbar cord is normal. The lumber vertebral heights are all normal. In my last report it said that the central canal was normal.. in my first report when I had problems with this same disc.. it said (2012).. it said that there was a moderate degree of central canal stenosis with the same disc but considerable improvement in the appearance of the focal right posterolateral l4l5 disc protrusion.. (2013).. the last report reported the compression etc. I already gave you this information.
My physio has sent a four page report to my consultant basically stating that I had a flare up and presented with lumbar pain and right lower limb pain which is causing disability and discomfort. She said that I did not present with any lower limb weakness.. she did a test on my feet and got me to stand on my heals etc. She said that at present she did not see aany lower limb weakness or neurologiaal findings. She told the doctor that if there was any change in the strength of the lower limb that I should seek without delay..the pain is the leg is gong into the sixth week now.. basically I have a problem with weight bearing on the right leg..do you think my neck is going to be affected... how about the spinal cord.. I am not in pain all the time.. only when I put pressure on the leg but I can not walk very far.. I am just wondering about the L5 nerve root.. will it settle .. will the stenosis get worse..i need help to manage this.. if the surgeon does decide to operate I do not mind.. I may hold off on the epidural until he returns as I am afraid of side effects.. my neck disc bulge issue came on very quickly after the last epidural..i am an extremely active person and this will really depress me if this is going to stop me from living a full life..my question is .. is the disc causing the stenosis..stenosis can get worse..thanks so much for all you advice and help.. can these things settle on their own
I meant to say when I do weight bear that it causes considerable pain down my right leg.. ankle.. below the knee.. will this cause nerve damage.. straight leg raising is limited to 60 degree on the right and causes increased back pain and leg pain. There is marked tenderness on my right paravertebrals and most notably over L5L5 centrally and the right facet joints at this level.. what is the name of the surgery that they would do for this?..decompression..thoracolumbar range of motion is very restricted and any movement into extension causes increased pain. Side flexion to the right is also very limited and causes increased leg pain. At the moment I am resting and avoiding loading on my right lower limb as much as possible. When I wake in the morning I find it difficult to mobilise initially and keep a flexed posture until back pain and leg pain eases and I can gradually straighten. I have posterolateral buttock pain and thight pain, There is marked reduction in core stability. My hips and pelvis are normal. I never had any neurological symtoms on my upper limbs just pins and needles in my hands but this has levelled out.
in my last MRI report it said that the lumbar cord is normal. The lumber vertebral heights are all normal. In my last report it said that the central canal was normal.. in my first report when I had problems with this same disc.. it said (2012).. it said that there was a moderate degree of central canal stenosis with the same disc but considerable improvement in the appearance of the focal right posterolateral l4l5 disc protrusion.. (2013).. the last report reported the compression etc. I already gave you this information.
My physio has sent a four page report to my consultant basically stating that I had a flare up and presented with lumbar pain and right lower limb pain which is causing disability and discomfort. She said that I did not present with any lower limb weakness.. she did a test on my feet and got me to stand on my heals etc. She said that at present she did not see aany lower limb weakness or neurologiaal findings. She told the doctor that if there was any change in the strength of the lower limb that I should seek without delay..the pain is the leg is gong into the sixth week now.. basically I have a problem with weight bearing on the right leg..do you think my neck is going to be affected... how about the spinal cord.. I am not in pain all the time.. only when I put pressure on the leg but I can not walk very far.. I am just wondering about the L5 nerve root.. will it settle .. will the stenosis get worse..i need help to manage this.. if the surgeon does decide to operate I do not mind.. I may hold off on the epidural until he returns as I am afraid of side effects.. my neck disc bulge issue came on very quickly after the last epidural..i am an extremely active person and this will really depress me if this is going to stop me from living a full life..my question is .. is the disc causing the stenosis..stenosis can get worse..thanks so much for all you advice and help.. can these things settle on their own
I meant to say when I do weight bear that it causes considerable pain down my right leg.. ankle.. below the knee.. will this cause nerve damage.. straight leg raising is limited to 60 degree on the right and causes increased back pain and leg pain. There is marked tenderness on my right paravertebrals and most notably over L5L5 centrally and the right facet joints at this level.. what is the name of the surgery that they would do for this?..decompression..thoracolumbar range of motion is very restricted and any movement into extension causes increased pain. Side flexion to the right is also very limited and causes increased leg pain. At the moment I am resting and avoiding loading on my right lower limb as much as possible. When I wake in the morning I find it difficult to mobilise initially and keep a flexed posture until back pain and leg pain eases and I can gradually straighten. I have posterolateral buttock pain and thight pain, There is marked reduction in core stability. My hips and pelvis are normal. I never had any neurological symtoms on my upper limbs just pins and needles in my hands but this has levelled out.
Brief Answer:
Surgery is called “Decompression laminectomy”.
Detailed Answer:
Hello
You are welcome.
I have gone through the detail reply and there can be variation (Improvement) in MRI report as our body has its own ways to heal or cure a problem.
Based on symptoms it confirms you have pinched nerve on right side (L5 nerve root).In most of the cases without any muscle weakness patient usually show Improvement on drugs like Pregablin,muscle relaxant (thiocolchicoside) and vitamin B12 (oral/Inject able form) after few week of treatment.Stenosis is caused by hypertrophy of ligament, osteophyte (new bone formation) beside slip disc. In maximum number of cases things settle with time and hence one can wait. But one should not wait if there are warning sign like loss of bladder and bowel control.
Walking around does not damage the nerve and you may do gentle exercises. The surgery to correct stenos is called “Decompression laminectomy”.
Hope this answers your query.
Take care
Surgery is called “Decompression laminectomy”.
Detailed Answer:
Hello
You are welcome.
I have gone through the detail reply and there can be variation (Improvement) in MRI report as our body has its own ways to heal or cure a problem.
Based on symptoms it confirms you have pinched nerve on right side (L5 nerve root).In most of the cases without any muscle weakness patient usually show Improvement on drugs like Pregablin,muscle relaxant (thiocolchicoside) and vitamin B12 (oral/Inject able form) after few week of treatment.Stenosis is caused by hypertrophy of ligament, osteophyte (new bone formation) beside slip disc. In maximum number of cases things settle with time and hence one can wait. But one should not wait if there are warning sign like loss of bladder and bowel control.
Walking around does not damage the nerve and you may do gentle exercises. The surgery to correct stenos is called “Decompression laminectomy”.
Hope this answers your query.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks.. does my neck condition have anything to do with this..I am concerned as i am afraid the condition will not get better.could i have stenosis of the spine..will this condition effect the spinal cord.. today i tried to walk and i have to sit after five minutes.. would a nerve root injection help.. or the epidural.. how will i prevent stenosis continuing... i have read dreadful situations in relation to this condition..i am a very active person and if walking becomes a difficulty for me.. this would be dreadful..i personally would prefer to have an operation than go through this..i documented the details in relation to my neck.. the last time an epidural. my neck pain came straight afterwards so i am very wary of these injections...are you telling me this nerve root pinch could heal itself...? thanks so much for your great support.. also should i be seeing a neurosurgeon for this condition.. i am due to see my orthopaedic consultant in three weeks.. also i had a brain scan and this was totally normal so my consultant said no underlying pathology..thanks so much
i meant to say how do the consultants see if i have stenosis..of the spine...was i born with it or is it has a result of this disc generation
i meant to say how do the consultants see if i have stenosis..of the spine...was i born with it or is it has a result of this disc generation
Brief Answer:
Do not wait much If walking distance decreases
Detailed Answer:
Hi
You are welcome.
I have gone through your reply and have following suggestion for you-
1. Slip disc at neck region give symptoms of radiating pain in upper limb.But, if there is canal stenosis at neck then it may produce symptoms in all 4 limbs. You already have the experience of epidural and as far as root block injection are concerned they do help may be temporary.
2.If spinal cord get compressed for a prolong period with decreasing walking distance then I am afraid it may lead to permanent damage to spinal cord (myelomalacia).So If you do not have Improvement on conservative measure then surgery is recommended.
3There is no sure way to prevent stenosis but exercises may help. Yes lots of patient show Improvement on conservative measure alone.
4. Stenosis is diagnosed by Neurosurgeon/Orthopaedic surgeon by clinical examination (decreasing walking distance) along with help of MRI.
5. Most of the time stenosis occurs as a part of degenerative process but some patient has tight spinal canal since birth known as congenital spinal canal stenosis.
Hope this helps.
Take care
Do not wait much If walking distance decreases
Detailed Answer:
Hi
You are welcome.
I have gone through your reply and have following suggestion for you-
1. Slip disc at neck region give symptoms of radiating pain in upper limb.But, if there is canal stenosis at neck then it may produce symptoms in all 4 limbs. You already have the experience of epidural and as far as root block injection are concerned they do help may be temporary.
2.If spinal cord get compressed for a prolong period with decreasing walking distance then I am afraid it may lead to permanent damage to spinal cord (myelomalacia).So If you do not have Improvement on conservative measure then surgery is recommended.
3There is no sure way to prevent stenosis but exercises may help. Yes lots of patient show Improvement on conservative measure alone.
4. Stenosis is diagnosed by Neurosurgeon/Orthopaedic surgeon by clinical examination (decreasing walking distance) along with help of MRI.
5. Most of the time stenosis occurs as a part of degenerative process but some patient has tight spinal canal since birth known as congenital spinal canal stenosis.
Hope this helps.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much for your reply. .. last scan for neck read mild angular kyphosis centred at c5c6 where there is disc narrowing, disc dehydration and osteophytes. Axial scan show a small right paracentral disc protrusion which impinges on the surface of the cord. There is bony encroachment on the exit foramina bilaterally. Significant spondylosis demonstrated at c5c6 with a small right paracentral disc abutting the anterior cord and bilateral osteophytosis. I had treatment for four four and half months for this.. at first there was significant stiffness at both neck and thoracolumbar spine. I had ntermittent pins and needles in both hands, At this stage the cerivical spine has settled. There were never any neurological signs in the upper limb. In this scan .. does it state stenosis? My consultant is not back until the 28th of August.. do you think I can wait out till then.. how would I know if my spinal cord is in trouble.. that is very here the L5 nerve root..stenosis was not mentioned in my neck scan. just narrowing..concerned..that the spinal cord could be in trouble.. thoracolumbar range of movement is very restricted.. thanks so much for all your help
Brief Answer:
Cervical canal stenosis at C5-C6
Detailed Answer:
Hello
You are welcome. I have gone through the MRI report of cervical spine. Yes, it is suggestive of stenosis at C5-C6 level but again if you are comfortable which you said you are; this is more important than going by the MRI finding.
Yes definitely you can wait for your consultant to come back.
The warning signs are Increasing muscle weakness that is weakness of grip, loss of power in legs and loss of bladder and bowel control. At L5 level you have only nerves and spinal cord ends much above this level that is at L1.
In the operation we remove the tissue leading to pressure over nerve and spinal cord (decompression laminectomy).
Hope this helps.
Take care
Cervical canal stenosis at C5-C6
Detailed Answer:
Hello
You are welcome. I have gone through the MRI report of cervical spine. Yes, it is suggestive of stenosis at C5-C6 level but again if you are comfortable which you said you are; this is more important than going by the MRI finding.
Yes definitely you can wait for your consultant to come back.
The warning signs are Increasing muscle weakness that is weakness of grip, loss of power in legs and loss of bladder and bowel control. At L5 level you have only nerves and spinal cord ends much above this level that is at L1.
In the operation we remove the tissue leading to pressure over nerve and spinal cord (decompression laminectomy).
Hope this helps.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for this reply. a few questions..
I just want to clarify.. I actually had the epidural for the back in February.. my neck issue only became a problem two weeks after the epidural...
a few extra points..i got assessed by my physio and had him look at the recent scan which took place three weeks ago.. the scan is really bad.. that is the back scan.. he advised me to go seek another consultant straight away so I will not end up in an emergency situation..there has been a XXXXXXX difference in the most recent scan..deterioration since December..again the gait is very poor..i do not want to get the epidural again.. bad experience and felt the neck issue came on very quickly afterwards...how would a surgeon tell if you have stenosis all over the spine... perhaps the neck area is as a result of the c5c6 small bulge issue..when you mentioned an operation. I assume you meant the lower back.. laminectomy... this is not spinal fusion is it..i assume they will leave my neck area alone as this has improved hughly.. thanks so much. XXXXXXX
I just want to clarify.. I actually had the epidural for the back in February.. my neck issue only became a problem two weeks after the epidural...
a few extra points..i got assessed by my physio and had him look at the recent scan which took place three weeks ago.. the scan is really bad.. that is the back scan.. he advised me to go seek another consultant straight away so I will not end up in an emergency situation..there has been a XXXXXXX difference in the most recent scan..deterioration since December..again the gait is very poor..i do not want to get the epidural again.. bad experience and felt the neck issue came on very quickly afterwards...how would a surgeon tell if you have stenosis all over the spine... perhaps the neck area is as a result of the c5c6 small bulge issue..when you mentioned an operation. I assume you meant the lower back.. laminectomy... this is not spinal fusion is it..i assume they will leave my neck area alone as this has improved hughly.. thanks so much. XXXXXXX
Brief Answer:
As follows
Detailed Answer:
Hello
You are welcome.
Going to your queries one by one-
1. Its unfortunate to have neck issues following lumbar epidural. It is uncommon.
2. MRI Images are very sensitive and specific to pickup stenosis anywhere in the spine. As rightly said MRI is the Non-Invasive way to see the Inside of spinal cord.
3. In the operation “decompression laminectomy” at lower back I do not prefer spine fusion. At present you need attention to lower back as this is the major site of fault leading to symptoms in lower limb.
Take care
Regards
As follows
Detailed Answer:
Hello
You are welcome.
Going to your queries one by one-
1. Its unfortunate to have neck issues following lumbar epidural. It is uncommon.
2. MRI Images are very sensitive and specific to pickup stenosis anywhere in the spine. As rightly said MRI is the Non-Invasive way to see the Inside of spinal cord.
3. In the operation “decompression laminectomy” at lower back I do not prefer spine fusion. At present you need attention to lower back as this is the major site of fault leading to symptoms in lower limb.
Take care
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks so much for this information.. today i made a decision to take up on a cancellation of a consultant visit.. (Orthopaedic guy). He was excellent. He knows my own consultant very well so all was above board. He did a test on me and he suggested it was my l5 nerve root. to be absolute sure he is suggesting i do a nerve block injection next week for the l4l5. What is your opinion on this approach? He said that will answer alot of questions to the sourcce of the problem. Are Nerve root injections dangerous. thanks so much .. he did a test on all other nerves etc. the neck area was fine.. he said that this was not the issue..the back was the problem..he said if the nerve root injection did not work well then we would proceed to surgery. Thanks so much Orla
Brief Answer:
Nerve root Injection are safe
Detailed Answer:
Hello
You are welcome.
You may have the nerve block treatment.It is a diagnostic and also pain relieving (temporary) procedure.Most of the time these are safe.
Wishing you early recovery.
God bless you.
Nerve root Injection are safe
Detailed Answer:
Hello
You are welcome.
You may have the nerve block treatment.It is a diagnostic and also pain relieving (temporary) procedure.Most of the time these are safe.
Wishing you early recovery.
God bless you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
which is safer nerve block or epidural.. I have read up on the nerve block injections.. they seem to be better in detecting the source of the problems as I have a few disc issues in the lower spine.. thanks so much
Brief Answer:
Nerve block is safe and precise
Detailed Answer:
Hello
It's good to see you.
I would advice for nerve block as it is precise, diagnostic, and ttherapeutic.
All the best.
God bless you
Nerve block is safe and precise
Detailed Answer:
Hello
It's good to see you.
I would advice for nerve block as it is precise, diagnostic, and ttherapeutic.
All the best.
God bless you
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
It is me again.. thanks so much for your reply. Well I was due to have the nerve block injection today and my consultant reviewed the letter that the other consultant and did not agree. He wanted to do an caudal epidural. He has not seen me since the last scan as he has been away. The other consultant did and I felt he did a very good investigation. I do not want to go against my own consultant as he is the best in this country. I made a decision to hold off completely until the other consultant returned. The consultant that I met on Monday did not think that my neck scan was bad and he said I did not have stenosis...just wear and tear.. unfortunately it has acted up again this week.. woke up with numbness in fingers..twice.. he tested my strength in upper limbandsaid there was nothing to worry about..do you think he is right..also it isonly eight weeks since the leg pain started. do you think it could heal on its onw given what I have told you instead of going down the nerve root/epidural route.. thanks.. you are so helpful to me.. Orla
It is me again.. thanks so much for your reply. Well I was due to have the nerve block injection today and my consultant reviewed the letter that the other consultant and did not agree. He wanted to do an caudal epidural. He has not seen me since the last scan as he has been away. The other consultant did and I felt he did a very good investigation. I do not want to go against my own consultant as he is the best in this country. I made a decision to hold off completely until the other consultant returned. The consultant that I met on Monday did not think that my neck scan was bad and he said I did not have stenosis...just wear and tear.. unfortunately it has acted up again this week.. woke up with numbness in fingers..twice.. he tested my strength in upper limbandsaid there was nothing to worry about..do you think he is right..also it isonly eight weeks since the leg pain started. do you think it could heal on its onw given what I have told you instead of going down the nerve root/epidural route.. thanks.. you are so helpful to me.. Orla
Brief Answer:
Wait for the consultant to have nerve block
Detailed Answer:
Hi
It’s good to see you again
You are welcome. After going through your reply it’s the right decision to wait for the consultant to have nerve block Injection. The diagnosis of stenosis is basically clinical that is based on the symptoms patient have and is supplemented by MRI report.So,I think he is right as far cervical stenosis is concern, you should be happy with that. For numbness you may vitamin B12, B6 tablet/Injection along with prescription only drug like pregablin.This drug (pregablin) also helps in pain of lower leg.
Most of the cases of sciatica (slip disc/spine stenosis) do respond favourably to pregablin along with short course of cortisone (defza 6 mg). You may have the above treatment.
Take care and do not hesitate to ask further.
Regards
Wait for the consultant to have nerve block
Detailed Answer:
Hi
It’s good to see you again
You are welcome. After going through your reply it’s the right decision to wait for the consultant to have nerve block Injection. The diagnosis of stenosis is basically clinical that is based on the symptoms patient have and is supplemented by MRI report.So,I think he is right as far cervical stenosis is concern, you should be happy with that. For numbness you may vitamin B12, B6 tablet/Injection along with prescription only drug like pregablin.This drug (pregablin) also helps in pain of lower leg.
Most of the cases of sciatica (slip disc/spine stenosis) do respond favourably to pregablin along with short course of cortisone (defza 6 mg). You may have the above treatment.
Take care and do not hesitate to ask further.
Regards
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Dr. Mukesh Chugh
Orthopaedic Surgeon, Joint Replacement
Practicing since :1997
Answered : 1619 Questions
Get personalised answers from verified doctor in minutes across 80+ specialties
