Hello and thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the symptoms you are experiencing.

Regarding the severe low back pain I feel it could be due to severe degenerative spondylosis which can cause focal weakness either of the toe or the foot. However weakness of both with tremulousness of the legs. Rarely lumbar canal stenosis due to multiple slip disc can cause problems like this. I would like to consider the possibility of anxiety neurosis also in you.

Regarding the MRI findings I would say you have severe form of spondylosis with facet atrophy and bilateral recess stenosis. However there is no mention of compression of the spinal nerves or narrowing of the spinal canal in this description. I am interested to know these details. In the absence of nerve compression and Lumbar canal stenosis, surgery is not an option and you will not benefit from it.

My recommendation would be for you to see a Neurologist for a good physical examination and consultation. If the weakness and tremulousness is found to be due to compression of the spinal nerves from degenerative disc disease we can consider the option of surgery, only if benefit is more than the surgical risk. Do provide me the additional MRI details to see if there is canal stenosis & neural compression.

I thank you again for submitting your question. I hope you have found my response to be helpful.

If you have additional concerns I would be happy to discuss them with you.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.

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Hello

Thanks for the additional information.

Regarding the moderate canal stenosis and compression of the nerve roots, I feel if on examination the neurological signs are suggestive of neurogenic claudication and root disease you will be a candidate for spine surgery.

Neurogenic claudication is characterized by pain begin or worsen with the onset of ambulation or by standing, and are promptly relieved by sitting or lying down. Thigh or leg pain typically precedes the onset of numbness and motor weakness. Often people complain of difficulty walking even short distances and do so with a characteristic stooped posture in more advanced cases.

So I personally feel a good neurological examination before and immediately after symptoms appear following a short period of ambulation is important to confirm the diagnosis. If signs of canal stenosis are present, you would require decompressive laminotomy for pain relief. Since many of them are severely limited by pain, early surgery is the best way to return them to full activity and independent living. You need to see a spine specialist for confirmation of the same and discuss the options of surgery with him.

Wishing you good health.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist

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Hello and thank you for follow up query

From the symptoms described to me it is not clear to me about the kind of movement disorder. However loss of speech is very unusual and I feel you need an evaluation from the Neurologist to know the reason for speech loss. Stroke as well as focal seizures needs to be excluded in you at this point of time.

Wishing you good health.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.

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