Pain really getting me down, any suggestions.

I have suffered with back problems for the past 20years which over the last 7/8 years have gradually got worse.

It started of with pain in my lower back which was helped by regular trips to a Chiropractor.

This allowed me to continue walking with my local walking group.

But slowly over the past 7 years the pain has gradually worse with pain in my lower back, down my right leg plus both feet are numb.

I had an MRI scan November 2015 which showed problems at L5/S1 which causes moderate stenosis compressing the L5 nerve root.

Feb/2016 had a nerve block injection, this had no effect.

Pain management tried Pregabalin and Gabapentin, both did not help.

Pain was so bad now that I could only walk comfortably for 10mins, therefore walking group came to a stop.

Had a private consultation with a spinal consultant who made his own diagnosis of the MRI scan, which was that degenerative scoliosis was producing narrowing @ L4/5 and L5/S1 plus grade 1 spondylolisthesis @ L4/5 level. He suggested a lateral recess decompression surgery which I had December 2017 see his report below.

Result being that the surgery made no difference and the specialist said that I would have to learn to live with it!

Have tried living with it but GP sent me for a further MRI scan June 2019, followed by another nerve block injection, which also has had no effect.

GP now also says that I will have to live with it.

The pain is slowly getting worse sometimes stops me sleeping.

Also My main concern at the moment is that the numbness in my right foot is getting worse and is now making driving difficult in that It is hard to feel my foot on the accelerator pedal.

Any thought or suggestions would be welcome?

*Specialists report:

The underlying reason for the leg pain is likely to be related to spinal stenosis but I have explained to him that the long standing low back pain is likely to be related to the aging changes of the joints in his lumbar spine and that realistically there would be no good surgical solution to get rid of the lumbar back pain.

*His lumbar MRI scan shows scattered aging changes throughout his lumbar spine. He does have evidence of a degenerative scoliosis with the apex in the mid lumbar area convex to the right and there is a fractional curve below with the concavity facing the right side. The degree of scoliosis is not marked but is sufficient to produce foraminal-narrowing at both the L4/5 and LS/SI levels on the right side. However the foraminal narrowing at L4/5 produces L4 roòt‘ entrapment and he does not seem to have any relevant L4 symptoms. He also has a Grade 1 degenerative spondylolisthesis at the L4/5 level and not surprisingly there recess Stenosis which clearly would produce the L5 nerve root symptom. At the LS/S1 level he also appears to have a small disc protrusion which encroaches to the traversing S1 nerve root and he has a mild degree of lateral recess stenosis at L5/S1 as well so that it would be difficult to tell whether the current leg pain is also contributed to from the LS/Sl level.

Assuming that his lower extremity symptom is primarily related to the lateral recess stenosis at the L4/5 and LS/SI level, the main surgical option would be to decompress the lateral recess and being an anteroposterior decompression it would be relatively straight forward However, doing so would not be able to address the foraminal narrowing and there is a possibility that he can develop subsequent L4 root symptom and if that becomes a problem surgical treatment would be rather more difficult as it would involve at least a total facetectomy and in situ fusion be best addressed by an interbody fusion, which clearly is an even bigger undertaking.

I have explained the pathological anatomy at some length and the nature of surgery that may be involved at some length. I have encouraged him to persevere with conservative care but he can let me know otherwise if he wants to proceed and consider a surgical solution with a lateral recess decompression and I will put him on my waiting list on receiving his transfer form.

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