[Expat98]

#6181

I recently had an MRi which shows that I have spinal stenosis, spondylolithesis, degenerative disk, and evidence of an old fracture (there must be a medical term for that!). All ‘problems’ showing at the L5 – S1 area.

I have moderate lower back pain on occasion, but the main issue is severe pain which radiates down my left leg. Symptoms as follows:

a) Hip pain
b) Knee pain
c) ‘Cramp’ in calf area
d) Ankle pain
e) Intermittent numbness across the top of my foot into big toe
f) Intermittent numbness in front thigh and hip
g) Pain in groin area

At times, I get ALL of these symptoms at once. In addition, most of the time that I am walking my legs feel very weak as though I am struggling to stand up. My knee has ‘given way’ a couple of times. I take Vicodin, Gabapentin and Methocarbamol (which take the edge off, but do not get rid of the pain), but no other medications at all (well, maybe Tylenol for headache). My job involves standing for extended lengths of time, and right now I cannot do that…I cannot even get from my bedroom to the bathroom without getting leg pain!

Is surgery the way to go?

Thanks

Ep98

[Donald Corenman, MD, DC]

#6183

To summarize your diagnosis, you have at L5-S1, spondylolisthesis associated with a degenerative disc, spinal stenosis and evidence of “an old fracture”. This all adds up to an isthmic spondylolisthesis at L5-S1 (See website). You probably misunderstood the presence of spinal stenosis as this occurs in the center of the canal and isthmic spondylolisthesis actually enlarges the center of the canal. You probably have foraminal stenosis (see website under isthmic spondylolisthesis to understand this disorder).

I assume that the rest of your spine is normal.

Your leg pain is most likely from foraminal stenosis caused by collapse of the L5-S1 segment and a spur that forms off the “old fracture” region called an osteophyte. If this is true, your pain is worse with standing and walking and somewhat improved with sitting or bending forward.

You have a classic presentation of an L5 radiculopathy (the L5 nerve is getting pinched). If you have had the pain for greater than three months and have failed therapy, then most likely you are a candidate for TLIF surgery (see website for details). You need a good history and physical examination as well as a thorough review of your imaging to make sure the diagnosis is appropriate.

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.

[Expat98]

#6184

Many thanks, Dr. Corenman. Yay. Surgery! if it makes the pain go away, I’m good with that!

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