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Ligamentum Flavum buckling

Resolved Question:

Name: RITA PALIT(Female) Age : 51yrs
Address : Rangapara, Assam

My present condition:
1. I find difficulty to stand from sitting position, I need support to stand either from someone or by holding furniture, wall etc.

2. I can’t bend forward and if I try to do it I feel pain over all around the lower portions of my back.

3. If I walk by taking support I feel weight on my waist and I also feel pain.

4. If I push myself to walk then my both legs shake very much and I feel it’s going to be senseless, then I need to stop walking and take rest and sometimes I feel very much pain and then I sit down.

5. I can’t climb upstairs and also face problem while going downstairs.

6. If I press over my thigh region of both legs I feel pain

7. I use to feel senselessness and no strength on my two sides of my waist.

8. I can’t stand by taking support for a long, I feel something is pulling me down

9. If I sleep in a straight position I use to feel burning sensation over the thigh region of my both legs

10. On Doctor’s advised I had gone through the physiotherapy treatment for almost 1 month but did not get any relief.

11. I had a surgery on November 2012 but did not get any relief. The reports of which uploaded.

12. I regularly take Amlodac (5mg) and Thyronorm (now 100 mcg). I never have the problem relating to sugar but I did a sugar test recently which has shown the normal result. I also did a thyroid test, a copy of which enclosed.

13. I have uploaded my so far treatment reports step by step as A, B, C, D and E

Category: Neurosurgeon

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Category: Spine Surgeon
Dr. Goutham Cugati is online now

Expert:  Dr. Goutham Cugati replied 4 Days.

Dear Mrs Rita,

Thank you for your consult at DoctorSpring.com. I am really impressed by the way you have preserved your treatment details.

I feel that the first surgery may not be a perfect one. I say that because a part of the problem mentioned in your initial MRI is still present in the recent MRI as well (Ligamentum flavum buckling).

The problems in your lower spine have no doubt increased as per your recent MRI report. I think you may require another surgery. Probably a fusion surgery where the bones/joints in your back needs to be fused. Your problems will certainly reduce, but it will be difficult to quantify as to what extent you will be better.

The other option will be to get facet joint injections and physiotherapy. But this is just a palliative treatment.

There may be other factors which may be affecting as well like-
1. In the second MRI there is atrophy of the spinal muscles in the mid back(Is there a add on muscular problem also?)
2. there is left pars interarticular fracture at L3-4 level (was there a fall?)
3. Are you an obese person?

However the optimum/ideal opinion can only be given after seeing and examining you and seeing the MRI films in detail.

I feel it is better to consult another neurosurgeon in a nearby metro city.
Hope this helps, please feel free to discuss further.

with regards,
Dr Goutham Cugati
Consultant Neurosurgeon
Narayana Hrudayalaya Multispeciality Hospital

Patient replied :

Thank you very much sir for the reply and your kind concern. While last time I visited GNRC, Doctor had given failed back syndrome and advised to fix plate to strengthen the muscles of the thigh. Your query in question 1 and 2 I have found little difficult to understand because of medical terms, but as per my understanding I my replying for query in 1, Yes I use to feel pain in the mid back, and for the query in 2 I think it needs to go through the plate of MRI, so if I able to concern physically with any neurosurgeon with MRI plate I will definitely communicate you. I am not an extremely fatty person. My present weight is 68kg in normal dress on 08-01-2014 after lunch.and my height is 153cm.
I have recently checked my thyroid, the report of which I have already uploaded in my previous query in uploaded file E. The report has shown that thyroid is little more than the prescribed limit. So if I need to go for another surgery or fusion surgery then what should I take to keep my thyroid in normal? Presently I am taking Thyronorm (now 100 mcg) for the last 1year. Before that I was taking Thyronorm (50 mcg) for 1 year. I have been also taking Amlodac (5mg) for the last 4 years.
Actually I am planning to go to south for my further treatment. So if I go to Narayana Hrudayalaya Multispeciality Hospital, Bangalore and if I need to go for another surgery or fusion surgery then would you please tell me the estimate cost for my treatment inclusively medicine and hospitalization charges and how much time probably it will take for my treatment or surgery? It will be a great help for me to go there by financially prepared.
Thank you.
Rita Palit

Expert:  Dr. Goutham Cugati replied 3 Days.

Dear Mrs Rita,

Regarding your thyroid level I feel that you can reduce T.Thyronorm for 75mcg 1-0-0.
Before coming to a conclusion for surgery it would be mandatory to examine you first. So you can schedule a visit to Narayana Hospitals. If you are a candidate for surgery the approximate cost would be around 2.5 lakh rupees. As I am placed in Mysore, I suggest you to meet my colleague Dr Komal Prasad at Bangalore Narayana Hrudyalaya by fixing up an appointment at the helpline no. 080 71222222. Please take all your investigation reports and scans.


Dr. Goutham Cugati
Category: Spine Surgeon
Residency: Neurosurgery, the Post-Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neuro surgical Center, VHS Hospital, Chennai, 2011

Postgraduate in Neurosugery: DNB, National Board of Examinations,
Part 1 - 2008, Part 2 -  2010

Medical School: Bachelor of Medicine, Bachelor of Surgery, JSS Medical College, 2004
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