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  • morgan1
    Post count: 1

    I am a 68 year old male and in the last 5 weeks I have been experiencing severe cramps in my hamstrings & calf muscles when I walk for more than a few feet. I can however work on the eliptical machine for sometime and get a lessing of the pain. I had a MRI in March of 2010 and another September 19 & 20 2011. The results are:
    L2-3 Mild spondylosis with a bulging disc with mild flattening of the anterior sac. This progressed minimally from previous study, probably not causing significant stenosis.
    l3-4 There is a diffusely-bulging disc which causes mass effect on the anterior thecal sac and loss of fat in the upper right lateral recess accentuated by enlarged ligaments and milder arthritic change involving the facet joints. Bulging disk and spur extends lterally and in near-apposition to the right third nerve root at the foramen. This is unchanged from previous study and is causing mild to moderate canal stenosis and borderline right foraminal encroachment.
    L4-5 Bulging degenerative disc with mass effect on thecal sac, enlarged ligaments. Disc also extends laterally on the right and in opposition to the right forth nerve root at the foramen and could effect it. Certainly this is causing moderate central and lateral stenosis. This is fairly similar to previous study.
    L5-S1 Shows no herination or encroachment on the thecal sac. Small spur extending laterally, only in near-apposition to the right fifth nerve root in the mid foramen. This is simllar to previous study. No mass effect on the S1 nerve roots or thecal sac. Minimal arthritic change involving facet joints.

    Based on this I have been told I am not a good canidate for surgery. However, I am still having significant pain. In your openion, what should the treatment be?

    Donald Corenman, MD, DC
    Post count: 8660

    First- let’s establish the symptoms you suffer from. You have cramping in your hamstrings and calf muscles with walking a short distance. Are the symptoms bilaterally equal or is there much more on one side than the other? Can you walk the exact same distance every time or are there days you can walk further and others that you can’t? If you sit or lie down, do your symptoms go away? If you are at a supermarket and hold onto a shopping cart, can you walk further comfortably?

    Are these symptoms actually muscle cramps or pain that feels like muscle cramping? Do you get this cramping in any other muscle groups, especially in your arms? You note that you can work out on an elliptical machine and do not get onset of symptoms- at least for a longer time. Are you bent forward when you work out?

    Has someone looked at your feet to see if there are pulses present? Are your feet discolored or swollen? Do you have ankle swelling? Have you lost hair on your feet and are your toenails thickened?

    All these questions differentiate vascular claudication from neurogenic claudication (see web site). You very well might have spinal stenosis which leads to neurogenic claudication but your differential is still not established (again- see website).

    Assuming neurogenic claudication, a great test and treatment is an epidural steroid injection. If you get good relief, even for a short period of time, this might confirm the diagnosis. You might even get long term relief (3 months or more). Now- if we assume the presence of neurogenic claudication, you might be a candidate for surgical decompression but that depends upon many factors including the spinal stability and your ability to undergo the surgery.

    Your MRI does note the presence of central stenosis which certainly can cause your symptoms, especially at L4-L5.

    Dr. Corenman

    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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