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I Have Spinal Stenosis . Last Three Months, Having Pain
Question: I have spinal stenosis. Last three months, having pain in my right butt. MRI showed moderate central canal stenosis at the L4-5 level due to a new small broad central disc protrusion and moderate to severe bilateral facet hypertrophy.Slowly I am also getting pain in my right hamstring and calf area. I had a course of 5 day oral steroid. It did not do much. Physical therapy is helping but pain is still there. I apply one lidocaine patch daily. How should I proceed.
Brief Answer:
Further examinations are necessary for a correct diagnosis.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Before to conclude for the best treatment way in cases of lumbar spine degenerative disease, a exact correlation between imaging studies findings and distribution of the symptoms ( i.e. affected nerve roots ) is necessary.
MRI findings of stenosis at L4-L5 may justify symptoms on the calf, buttock pain is attributed usually to other nerve roots being irritated.
It is okay to continue the physical therapy, but, other evaluation tests are necessary to get a correct diagnosis.
First of all, a careful neurological examination is necessary and results should be compared with MRI findings.
Nerve conduction study and EMG ( to identify the affected nerve roots and the site of irritation), lumbosacral spine dynamic x-rays ( neutral, flexed and extended position to evaluate spondylolysthesis ) are necessary examinations for this purpose.
If the stenosis at L4-L5 will result the culprit after such extended examinations, decompressesive surgery may be considered since the condition is progressing.
Hope you found the answer helpful.
Let me know if I can assist you further.
Further examinations are necessary for a correct diagnosis.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Before to conclude for the best treatment way in cases of lumbar spine degenerative disease, a exact correlation between imaging studies findings and distribution of the symptoms ( i.e. affected nerve roots ) is necessary.
MRI findings of stenosis at L4-L5 may justify symptoms on the calf, buttock pain is attributed usually to other nerve roots being irritated.
It is okay to continue the physical therapy, but, other evaluation tests are necessary to get a correct diagnosis.
First of all, a careful neurological examination is necessary and results should be compared with MRI findings.
Nerve conduction study and EMG ( to identify the affected nerve roots and the site of irritation), lumbosacral spine dynamic x-rays ( neutral, flexed and extended position to evaluate spondylolysthesis ) are necessary examinations for this purpose.
If the stenosis at L4-L5 will result the culprit after such extended examinations, decompressesive surgery may be considered since the condition is progressing.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your answer.
I will talk to my doctor about nerve conduction study and EMG.
I have pain on the calf as well as ham string area. You are saying that is due to stenosis at L4 L5. Does the herniated disc at L4 L5 also contributing to it? Should I try epidural injection at L4 L5 for it? Is there any serious risk with epidural injections. Thanks.
I will talk to my doctor about nerve conduction study and EMG.
I have pain on the calf as well as ham string area. You are saying that is due to stenosis at L4 L5. Does the herniated disc at L4 L5 also contributing to it? Should I try epidural injection at L4 L5 for it? Is there any serious risk with epidural injections. Thanks.
Brief Answer:
Herniated disc may contribute to your symptoms.
Detailed Answer:
Welcome back.
It is possible that hamstring and calf pain may be related to the L5 nerve root being pinched by the stenosis, or the herniated disc.
Epidural injections actually are one possible treatment way for the symptoms with possible long-term results (months).
Adverse effects and complications may happen very rarely.
Hope this helps.
Take care.
Herniated disc may contribute to your symptoms.
Detailed Answer:
Welcome back.
It is possible that hamstring and calf pain may be related to the L5 nerve root being pinched by the stenosis, or the herniated disc.
Epidural injections actually are one possible treatment way for the symptoms with possible long-term results (months).
Adverse effects and complications may happen very rarely.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
My doctor mentioned epidural injection at the L4 L5 level. Does that fix the place of the injection or are there any other details that should be kept in mind. For example my pain is on right side - so give the injection on right side? Also does bilateral facet hypertrophy affect the exact location within L4 L5 level. Thanks a lot.
Brief Answer:
Epidural injection at right L4-L5 seems okay.
Detailed Answer:
Hello again.
The epidural injection aims to improve the affected area, so, that's why the L4-L5 level found in MRI to be the culprit, is selected for the injection.
Since the pain is more on the right side, it is better for the injection to be performed at that side.
Facet hypertrophy contributes more to back pain than in radicular pain.
Hope this helps.
Greetings.
Epidural injection at right L4-L5 seems okay.
Detailed Answer:
Hello again.
The epidural injection aims to improve the affected area, so, that's why the L4-L5 level found in MRI to be the culprit, is selected for the injection.
Since the pain is more on the right side, it is better for the injection to be performed at that side.
Facet hypertrophy contributes more to back pain than in radicular pain.
Hope this helps.
Greetings.
Above answer was peer-reviewed by :
Dr. Yogesh D
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