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Treatment for slip of L4 on L5 in MRI with pain.

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Female: 33years old.
Crippling lumbar back pain brought on by a cough, spreading to left buttock (Oct 2014, lasting 2 weeks, towards the end of which pain levels improved considerably). Episodic mild pain ever since.

Lumbar MRI on March 23rd 2015 showed near normal alignment with slight slip of L4 on L5 and L5 on S1. Conus at T12 with normal cord signal. Loss of disc signal and height at L5S1, with an annular tear at this level. Diffuse facet joint degenerative change with slight foramina narrowing on right at L5S1, though "no definite root compression was seen"

4 days ago, strong back pain began again in the lumbar region, spreading down left buttock, thigh, and calf, following an hour's light exercise (walking). Pain worsens while getting up or sown from seated position. Pain is virtually eliminated after a night in bed, but begins again upon standing up. Also upon standing up first thing in the day, a tingling sensation in left foot begins. Left foot feels weak, though no obvious loss in strength. Some minor loss of sensation on the top of the foot with associated sense of partial (slight) numbness over the top of the foot and towards the top of the big toe.

I am concerned that I may have experienced a worsening of the back condition since the lumbar MRI, and that the tingling and mild loss of sensation may indicate compression which could ultimately lead to possible nerve damage. How probable does this sound from the information given, and what would be the appropriate course of action in these circumstances?

Category: Neurosurgeon

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Dr. Goutham Cugati
Category: Spine Surgeon
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Expert:  Dr. Goutham Cugati
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Hello,
Thank you for your query at DoctorSpring.com

I could help you out by right suggestions if I have some more details. Your weight
Your lifestyle ( work, lifting weight, frequent long travels)
Treatment taken in Oct 2014 after the first consult and after MRI.
Have you taken any physical therapy
What is your current pain scale 0-10.
Also, can you send a scanned copy of your MRI?


With regards


Patient replied :

Hello.
My weight is currently 103 kilograms
My lifestyle prior to october 2014 involved a lot of sport (roller derby - a contact sport played on roller skates), but has become quite senentary since. I do lot travel long journeys frequently.
No treatment has been taken since my Oct 2014 consult, though as of my most recent consult I have been referred to physiotherapy (though none has yet been undertaken) and given naproxen to deal with the pain in the short term. The doctor did not perform a physical examination in this most recent consult.
On a scale of one to 10, pain in this most recent episode rose sharply over the course of a day to around 7/10, falling to 5/10 over the course of a few days, and is now settled at around 4/10 upon standing, and 3/10 after the initial movements - it is currently sufficient to cause a limp while walking and to restrict range of movement.
I am afraid that the Lumbar MRI was performed and interpreted at an outpatient clinic, and that textual interpretation was sent to my doctor. No image from that MRI is available to either myself or my doctor, and I have given you full findings as reported to my doctor (they are pretty much quoted verbatim from the letter sent to my doctor. The only information I have failed to relay to yourself from that which is available to me is that the diffuse facet joint degeneration was observed on axial imaging
I hope this helps.


Expert:  Dr. Goutham Cugati
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Hello The reason I asked for your weight and lifestyle is because the MRI report is suggestive of significant degeneration which is not usually seen in a 33 year old. And as I expected you are overweight and the lifestyle mandates an early degeneration.
A picture is worth a thousand words. I would have been fully convinced if I had a chance to look at the MRI images. But in any case I hope your doctor has discussed your condition with the specialist (neurosurgeon). If not please request to refer you to a neurosurgeon. As there are other points one has to make a note like the weakness in your foot, sensory blunting in your legs or foot, the leg raising test and others.
The report if I have to interpret, I would say there is no immediate need for surgery. But u need stronger analgesics and a physical therapy is a must. Slight slip at L4L5 and L5S1 raises a suspicion that if that means what is called a listhesis (which I can say only if I see the films) will require surgery. So I strongly feel that you should see a specialist with an MRI.

Regards,

Dr. Goutham Cugati
Category: Spine Surgeon
Experience: 
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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