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Degenerative Disc Disease.

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I have severe disc degeneration at L5/S1, also degeneration at other discs. I have very sudden sharp severe pain on occasions. Most of the time there is pain, discomfort & leg weakness.
I have difficulty walking up stairs & also after a few hours of work start to trip.
If i sit for more than an hour i have a lot of pain & discomfort.
What can I do??

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,

Thank you for choosing DoctorSpring.

L5 - S1 disc disease are becoming increasingly common. Since you have degenerative disc disc diseases in other levels , age related changes could be the cause. The approach to your symptoms - mainly pain is algorithmic.

There are three options here - Medications, Physical Therapy and Exercise, Surgery.

90% cases can be well managed with medications and Physical therapy. I would like to know some additional details so that I can give specific recommendations.


1. Are you taking any pain medications / NSAIDs ?
2. Can you please explain the weakness ? Where exactly do you feel weak ? Have you Doctor examined your leg for weakness ? ( I understand you are having trouble in climbing stairs)
3. Is there any numbness or loss of sensation anywhere in the back or legs?
4. Any trouble in urination
5. Are you doing any exercises as of now ?
6. Was a Surgery considered ?

You can reply as a followup.
Thank you


Patient replied :

1. I don't take any pain medication or NSAIDs.
2. I feel weakness in the legs, the longer I'm walking around the more the weakness especially after 4 or 5 hours on my feet at work. As for climbing stairs most times i find my self climbing at a slow pace using my hands & arms to pull myself along. Dr's previously examined leg weakness but nothing found.
3. No loss of sensation or numbness in my back or legs that is noticable though the feeling is that my legs are like jelly after 4 to 5 hours on my feet.
4. Sometimes when urinating there is leakage when finished.
5. I do basic recommended physio exercises, also weights that don't cause any stress or aggravate the lower back. Also try to do lots of walking.
6. Surgery not considered by Dr's


Thank you for the reply.

I think your treatment approach needs to be modified. Although I have not physically examined you and not seen your MRI, I am pretty sure the approach needs modification.

You will need to take NSAID pain medications. These are not just for the pains, but these potent anti inflammatory medications. You can take an OTC pain med like Ibuprofen 400 mg twice a day for 1 week with food. It is better taken in consult with your Doctor.

You have obvious neurological defect. The treatment of choice is Surgery in such cases. (Discectomy or Laminectomy). The urinary complaint does not appear to be significant, but could be due to the disc pinching of your lower nerves. A long standing disc compression can cause permanent nerve damage and weakness. You need to get a Spine Surgeons opinon on this for sure - on whether you need surgery on not.

Walking in not generally recommended at this stage. What you should do is back strengthening (extension exercises) under the guidance of a Physical Therapy. You SHOULD NOT do weight training under any circumstances now. Even if it does not impact the back. Make sure you are not arching and bending your back. DO NOT carry weights.

Again you need treatment modification, Surgery Opinion and Physical therapy. You stand a risk of nerve damgae if this is not addressed early.

Hope this helps
Feel free to ask followups
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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