[asengupta]

#10146

Hello Sir,

My mother aged 63 years is suffering from left knee pain and numbness of legs due to which MRI of Lumosacral Spine and Both Knee Joints were prescribed by the Doctor. The MRI report gives the following impression –

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The findings are suggestive of degenerative changes in lumbosacral spine with scoliosis & grade I degenrative spondylolisthesis at L5-S1. Postero-lateral disc herniations at L2-L3, L3-L4 & L4-L5 are indenting the thecal sac & both neural foramina with encroachment on exiting nerve roots & indentation on cauda equina nerve roots at L4-L5. Postero-lateral disc herniation, articular facets and vertebral displacement at L5-S1 are causing indentation on both neural foramina without nerve root compression. There is no secondary central canal stenosis.

Marked osteoarthritic changes are seen in both knee joints with marrow oedema in femoral and tibial condyles and involvement of tibiofemoral and patellofemoral joints with thinning of medial femoral & tibial articular cartilages on both sides. There is also effusion in both knee joints and suprapatellar bursa with plicae along with distension of semimembranosus semitendinosus bursa on left side. Partial tear of left anterior cruciate ligament is seen with degenerative change in body of left medical meniscus. There is compression of anterior limb of right lateral meniscus by tibial osteophyte.

Suggested clinical correlation & further investigations if clinically indicated.

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Request you to help understand the main problem and what should be the best course of treatment (medicine / physiotherapy / surgery)?

Thanks and Regards,

Arunabha Sengupta

[Donald Corenman, MD, DC]

#10148

Your mother’s knee pain most likely stems from severe degenerative changes of the knee joints. You can try injections (steroids or hyalgan) but it appears that she will eventually need joint replacements.

You mother’s leg numbness could be originating from the degeneration of the lumbar spine with nerve root compression: “encroachment on exiting nerve roots & indentation on cauda equina nerve roots at L4-L5”. This is not descriptive enough to tell me how severe the compression is but lateral recess stenosis sounds like a potential diagnosis (see website for description).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
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.

[asengupta]

#10150

Hello Dr. Corenman,

Thanks a lot for your prompt response. Further to my earlier communication, please find below the findings of the Lumbosacral spine from the MRI report, which may give you additional insight into the problem (Unfortunately I don’t know how to send the MRI images of the spine, so sending you the report findings) –

Case History: Low back pain with parasthesia in both lower limbs. Pain in both knee joints.
Findings of Lumbosacral spine :
There are degenerative changes in lumbosacral endplates with anterior osteophytes and focal fatty changes in the marrow. Scoliosis is seen in lumbosacral spine with convexity to left. Associated scoliosis is seen in dorsal spine with convexity to right, There is degenerative facet joint arthropathy in both facet joints at L5-S1 and in right facet joint at L2-L3 & L3-L4 with grade I spondylolisthesis at L5-S1.
Inter-vertebral discs show dessication with anterior disc bulges. Postero-lateral disc herniations at L2-L3, L3-L4 & L4-L5 are indenting the thecal sac & both neural foramina with encroachment on exiting nerve roots. Postero-lateral disc herniation, articular facets and vertebral displacement at L5-S1 are causing indentation on the thecal sac & both neural formaina without significant nerve root compression. There is mild indentation on cauda equina nerve roots at L4-L5. Thecal sac & cauda equina nerve roots otherwise show normal signal intensity.
No pre-vertebral or para-vertebral soft tissue mass is seen. AP diameters of the lumbar spinal canal at the level of inter vertebral discs are:
D12-L1 – 1.9 cm.
L1-L2 – 2.0 cm.
L2-L3 – 2.1 cm.
L3-L4 – 1.9 cm.
L4-L5 – 1.6 cm.
L5-S1 – 1.1 cm.

Incidentally, degenrative changes are seen in cervical & lumbosacral spine with mild compression of D3 vertebral body.

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Hope that the above findings will help you to investigate further on the case. Awaiting your response on the treatment options available and whether any non surgical option can be availed to address the neuro problem.

Thanks and Regards,
Arunabha Sengupta

[Donald Corenman, MD, DC]

#10156

This MRI reading notes compression of nerve roots. “Postero-lateral disc herniations at L2-L3, L3-L4 & L4-L5 are indenting the thecal sac & both neural foramina with encroachment on exiting nerve roots”.

This means that the nerves are at least somewhat compressed which can cause your mother’s leg “numbness”. If your mother has stenosis, symptoms will increase with standing and walking. See “lateral recess stenosis” on the website.

If that is the case, symptoms can be controlled with physical therapy and epidural steroid injections.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
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.

[Donald Corenman, MD, DC]

#10166

The image report does not note central stenosis which can cause neurogenic claudication (see website). However, as I stated before, your mother can have lateral recess stenosis or foraminal stenosis which can cause standing and walking numbness in the legs. This numbness is normally relieved with leaning on a counter or sitting, lying down.

Non-surgical option (if that diagnosis is correct) is a physical therapy flat back program. Your mother is taught to hold the pelvis “flat” (posteriorly rotated) to reduce the lumbar lordosis (see website for that understanding) which reduces compression on the nerve roots.

In addition, I have found that epidural steroid injections are effective in many cases to reduce pain and numbness.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
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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