Q: I am 68 years and have pain from waist to the leg with maximum pain in the ankle & feet {right leg}. X-ray shows that I have degenerative changes in the lumbar spine but the spaces are normal. There is no abnormal para vertebral soft tissue shadow or calcification. The sacro iliac joints are normal. The right knee X-ray shows a well defined cystic lesion in the medial femoral compartment ?osteo chondritis dissecans. The joint space is diminished on either side with prescence of secondary osteophytes and tibial spiking. The MRI report of the LS spine shows: 1) diffuse annular bulge of the L5-S1 intervetebral disc abutting the thecal sac; 2) ligamentum flavum hypertrophy and bilateral facetal arthropathy at L4-L5 & L5-S1 levels. Please advice me.

A:The present pain is due to the slipped disc at L5-S1 pressing against the nerve exiting between L5-S1. As the pain has been there for only 25 days it would be worthwhile to pursue a longer period of conservative treatment i.e. pain killers, rest, precautions, graded exercises. There are several factors which reduce the chance of improvement by such a line of therapy and they include: 1. Past episode(s) of similar pain. 2. Degenerative changes such as ligamentum flavum hypertrophy and facet joint arthropathy, both of which you have. 3. A very large slipped disc 4. A lifestyle which prevents adequate conservative treatment 5. Significant neurological deficits 6 Instability of the spine. Failure of conservative treatment may imply a surgical procedure.