Need advice please...

Need advice please...

Q:

Sex: F Concern: spine

my mom is 54 yrs old , she is diabetic and had undergone a open heart surgery 11 yrs back and renal angioplasty last year..

She also has diabetic peripheral neuropathy and is on Neurontin.

The biggest problem with her right now is she cannot even walk or 3-5 mins. As soon as she starts walking she gets a pain from her back which goes upto her legs. When she sits down she is fine and as soon as she walks the pain starts. She cannot stand straight for even 3-5 mins, when she bents she feels better. We did her Lumbar spine MRI and here are the details:

Clinical Profile

C/O backache with pain radiating to the BLE with parasthesias.

Examination

M.R.I of the Lumbo-sacral spine was performed using the following parameters:

5 mm thick T1 weighted and T2 Weighted sagittal images.
5 mm thick T1 weighted and T2 weighted axial images.

Observation:

There is a sacralizaion of the L5 Vertebra and the L4 Vertebra is as marked on he film. Please correlate with pain radiographs.

There is mild retroplacement of the L4 vertebra over the L5 vertebra.

The L4-L5 intervertebral disc shows loss of water content.

Posterior and left far lateral disc herniation with peridiscal osteophytes is seen at the L4-L5 level with anterior indentation of the thecal sac, mild left neural foraminal narrowing and indentation upon the extraforaminal segment of the existing left l4 nerve root. Hypertrophic factel arthropathy with facet joint effusion is noted at the L4-L5 level. Ligamentum flavum hypertrophy is also noted at this level.

Posterior and bilateral far lateral disc bulges are noted at the L3-L4 level.

The rest of the lumbar articular facets show mild degenerative changes.

The lumbar vertebral bodies and the remaining intervertebral discs show normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12 level and the thecal sac terminates
at the S1 level.

After application of stress there is marginal increase in the degree of disc herniation at the L4-L5 level.

The antero-posterior dimensions of the Lumbar canal at the level of the intervertebral discs are as follows:

17.0mm at L1-L2
15.0mm at L2-L3
16.0mm at L3-L4
15.0mm at L4-L5
06.0mm at L5-S1

Incidental note is made of splenomegaly.

Impression

The MRI features are suggestive of:
1. Sacralization of the L5 vertebra. Please correlate with plain radiographs.
2. Posterior and left far lateral disc herniation with peridiscal osteophytes is seen at the L4-L5 level with anterior indentation of the thecal sac, mild left neural foraminal narrowing and indentation upon the extraforaminal segment of the existing left l4 nerve root. Hypertrophic factel arthropathy with facet joint effusion is noted at the L4-L5 level. Ligamentum flavum hypertrophy is also noted at this level.
3. After application of stress there is marginal increase in the degree of disc herniation at the L4-L5 level.

any advice will be greatful as she resides in India..

-- manishab

A:

If she has left leg pain, she probably would benefit from a left transforaminal epidural. Try one or two injections. If that doesn't work, I would have her see a spine surgeon.

-- Sherman Nam Tran, M. D.

to ask Dr. Tran.