I have chronic back pain with tingling and numbness in my left leg. What to do?

Question

Hi doctor,

I am 34 years old. I have chronic back pain. I would like to have a second opinion about my last MRI scan. I have chronic back pain for the past five years. I have tingling and numbness in my left leg with pain on my big toe for the past three months.

My report has the following features. The L5-S1 disc shows a subtle asymmetric diffuse posterior bulge but without neural compromise. Mild facet hypertrophy is also seen but without significant neural net compromise. End plate degenerative changes with sclerosis are also seen at this level with marrow edema on the left.

The L4-5 disc shows an asymmetric diffuse posterior bulge, which along with facet hypertrophy causes mild narrowing of the lateral recesses, left greater than right. Significant central canal compromise is however not seen. End plate degenerative changes with sclerosis are also seen at this level with marrow edema on the left. The rest of the intervertebral discs appear grossly normal. The rest of the visualized vertebrae are also normal with normal marrow signal. The conus is normal. The perivertebral soft tissues appear grossly normal. The sagittal bony canal dimensions are within normal limits. The L4-5 and L5-S1 end plates show degenerative changes with a combination of type 1 and type 2 Modic changes, more on the left. Both discs show degeneration. Asymmetric disc bulge with facet hypertrophy is seen at L5/S1 without neural compromise. Asymmetric disc bulge with facet hypertrophy is also seen at the L4-5 causes mild narrowing of the lateral recesses, left greater than right.

Kindly help.

Answer 1

Hello,

Ideally I would have like to see the films myself as the interpretation of an opinion without clinical examination findings had a limited value. It is obvious from the report that the Neves care not being compressed either in the canal or in the lateral recess. The problem is it does not explain the recent onset of tingling in your left leg and pain in the toe.

The disc Bulge is more on the left though and the only explanation is that the punching of the nerve is dynamic with certain positions bringing about the symptoms while the MRI done in a straight posture and lying down does not replicate the offending posture. The way to go about will be to try root injections as if the symptoms are relieved temporarily it will help by pinpointing the exact nerve which is the source of symptoms and help direct surgery or will rule out the spine as the source of your symptoms and you may then have to try to do the nerve conduction studies to get to find out the exact cause Hope this helps

Thank you.

Answer 2

Hello,

The MRI report describes the findings appropriately and it seems that your symptoms may be arising from L4/5 with the L 5 nerve root being irritated but not truly compressed as the lateral recess is narrowed on the axial cuts. You have enough changes to explain the back pain but the leg pain may more positional as I had explained earlier. The way to go about is to try left sided L5 nerve root injection. If you are not keen on the injection then try a course of Pregabalin 75 mg twice a day for 4-6 weeks and mind you will feel a bit sleepy during the day but this side effect wears of rapidly and you should see the response 3rd week onwards with lessened leg symptoms, though back pain may persist. What did your doc discuss with you and did he not ask you to try pregabalin.

Hope this helps.

Thank you.