spinal stenosis

I am at the moment seeing a patient whose major complain is inability to walk… he actually presents with paraplegia secondary to back pain. He reported for physiotherapy after haven undergone continuous spinal traction for 2 weeks. I was hoping if I could get some suggestions on his line of management especially after reviewing his lumbar CT scan result- please note that the CT scan was taken after the spinal traction was removed. I have included a summary of the result. The patient is a male 51years old African. Married with children and runs an advert outfit.

Thanks, Therapy C
:D
CT scan Report

1. Grade I/II central disc prolapsed at L5/4 and similar extrinsic thetical compression by bulging annulus fibrosus at L5
2. Apparent central canal stenosis at L4 with thetical compression
3. Posterior osteophytosis also at L4
4. Facetal degenerative changes at L3/2, narrowing ipsilateral neuroforamen
5. vertebral body lesion at T12

I don't think there is much you can do. check posture and movment patterns and correct i possible. Your main job is probably going to be chronic pain management.

good luck

liase with P&O,get appropriate calipers,strenghthen upper body,trunk and ULs,and start gait education on callipers and crutches probly.get him to be as ambulatory as you can...unless you know a way of taking pressure of the spinal cord itself,then the above will most likely be your line of management.

Hi,

I am 26 year old software engineer. I am also a patient sufferred by low back pain. My MRI scan report says that i have problem in L3/L4, L4/L5 and L5/S1. Actual problem is disc degeneration and disc prolapse with compression of bilateral roots and dural tube. This is what report says. L4/L5 and L5/S1 is severly damaged. L3/L4 part has less damage.

My consultant suggesting that i can go surgery, basicaly he is neuro specialist. But when i have consulted othopaedic specialists no one suggesting surgery as it could not be get cured compeletly. But neuro specialist also telling that after fifteen years i could get the same problem again. But i am not in emergency period where i need to go for immediate surgery . Because i dont have any numbness or pain in my leg portion. All that i am getting is pain on low back area. Mainly on left side of my low back(hip). The pain also coming when i am doing some specific works, Like walking continuously for 4 kilometres, Traveling long distance, lifting some weights or while running fast. But all these pain go away if i take some good rest like four or five days. If some body could give me some suggestion on this problem it will be great helpful to me.

Thank you very much.

--Senthil

If actual problem is disc degenration then you must follow your neuro surgeons advice. Right now you do not have much problems but things can be compounded due to faulty biomechanics of spine as well as due to stress over allready weekned structures. You didnt give full history of the disease. Plz tell me the cronicity of the problem as well as about how the things started ? What is your proffession? What are the aggravating and relieving Factors?

If there is no neurological deficit and too much formen compression or spinal stenosis, you may post pone the surgery and many continue with a programme of physiotherapy for your spinal stenosis due to the disc degeration and proloapse. You may get benefit from Physiotherapy.

==> Plz tell me the cronicity of the problem as well as about how the things
started ?
Actualy i have got the problem for the past ten years. It has started when i got hit by coconut at my low back. But time passed by it got worsed as i did not go for any further treatement. Last time i got the pain just one and half years back. Main thing doctors saying is my back is to weak.

==> What is your proffession?

I am working as a software Engineer. For the past 2 and a half years i am working.

==> What are the aggravating and relieving Factors?

Aggrevating factors are
1) Walking for long distance around 4-7 Kilometers per day.
2) Traveling in bike around 100 Kms or by bus around more than 500 Kms.
3) When i run fast for 500 meters.
4) Lifting around 20 Kg or more than that.

==> Releiving factos are

1) Take complete rest for 3-4 days
2) Dont lift any weights

The lumbar spine is made up of five vertebral bodies in the lower back. Nerves coming off the spinal cord travel though the spinal canal and exit the canal through small openings on the sides of the vertebral called foramen. Lumbar stenosis (spinal stenosis) is a condition whereby either the spinal canal (central stenosis) or vertebral foramen (foraminal stenosis) becomes narrowed. If the narrowing is substantial, it causes compression of the nerves, which causes the painful symptoms of lumbar spinal stenosis.

spinal stenosis