[61F] With degenerative disc disease and severe lower back pain

Patient Description

A 61-year-old female presents with degenerative disc disease, four herniated discs, and spinal narrowing. She has been experiencing constant soreness and severe pain in her lower back for about four months, rated as 8 out of 10 in severity. The pain is exacerbated by bending and is accompanied by extreme numbness in the lower buttocks and upper back of the thighs, leading to muscle weakness and difficulty walking. The numbness, which has been present for about three months, extends to her toes and makes her feet feel squishy or spongy when walking. Elevating her legs on pillows provides some relief. Recently, she has had trouble holding her urine, leading to accidents if she does not hurry to the bathroom, but there are no changes in urine color or consistency, and she does not have a fever. She also reports numbness in the 'saddle' area, including the back of her thighs and lower buttocks. Her medical history includes hypothyroidism managed with levothyroxine for over 25 years, a recent diagnosis of Type 2 diabetes with an A1C of 7.5, and fibromyalgia diagnosed about a year ago. She is currently taking Metformin, Farxiga, Levothyroxine, Tramadol, and Pregabalin (59mg, one capsule three times a day). She has no known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Degenerative Disc Disease: This condition involves the breakdown of the discs in your spine, which can lead to pain, numbness, and weakness. The discs lose their cushioning ability, which can cause pain and discomfort, especially when bending or lifting.

    • Treatment: Physical therapy, pain medications, anti-inflammatory drugs, and sometimes surgical interventions can be used to manage symptoms.
  • Herniated Discs: You mentioned having four herniated discs. This occurs when the soft inner gel of the disc pushes out through a tear in the outer layer, which can press on nearby nerves and cause pain, numbness, and weakness.

    • Treatment: Physical therapy, pain relief medications, and sometimes surgery to remove or repair the herniated portion of the disc.
  • Spinal Stenosis: This is the narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. This can lead to pain, numbness, and muscle weakness.

    • Treatment: Physical therapy, medications to relieve pain and inflammation, and sometimes surgery to create more space for the spinal cord and nerves.
  • Sciatica: The pain and numbness radiating down your legs could be due to sciatica, which is caused by irritation or compression of the sciatic nerve.

    • Treatment: Physical therapy, pain relief medications, and lifestyle changes to reduce pressure on the sciatic nerve.

What you can do

  1. Consult a Specialist: Given the complexity and severity of your symptoms, it is important to consult a spine specialist or neurologist for a comprehensive evaluation and personalized treatment plan.
  2. Physical Therapy: Engage in physical therapy exercises designed to strengthen the muscles supporting your spine and improve flexibility.
  3. Pain Management: Continue taking your prescribed medications, and discuss with your doctor if adjustments are needed. Over-the-counter pain relievers and anti-inflammatory drugs may also help.
  4. Lifestyle Modifications: Maintain a healthy weight, practice good posture, and avoid activities that exacerbate your pain. Gentle exercises like swimming or walking can help keep you active without putting too much strain on your back.
  5. Use Supportive Devices: Consider using supportive devices like lumbar cushions or braces to help alleviate pressure on your spine.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Loss of Bowel or Bladder Control: This could indicate a serious condition called cauda equina syndrome, which requires urgent medical intervention.
  • Severe or Worsening Pain: If your pain becomes unbearable or significantly worsens, it is important to seek medical help.
  • Fever or Signs of Infection: If you develop a fever or notice any signs of infection, contact your healthcare provider.
  • Progressive Weakness or Numbness: If you notice increasing weakness or numbness in your legs or other areas, seek medical attention promptly.

Remember, while this information can help guide you, it is essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment.

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6 mo ago


People Also Ask


What is degenerative disc disease and how is it treated?

Degenerative disc disease is a condition where the spinal discs lose their cushioning ability, leading to pain, numbness, and weakness. Treatment options include physical therapy, pain medications, anti-inflammatory drugs, and sometimes surgical interventions.


What are the symptoms and treatment options for herniated discs?

Herniated discs occur when the inner gel of a disc pushes out through a tear, pressing on nearby nerves and causing pain, numbness, and weakness. Treatment includes physical therapy, pain relief medications, and sometimes surgery to repair the herniated portion.


What is spinal stenosis and how can it affect the body?

Spinal stenosis is the narrowing of spaces within the spine, putting pressure on nerves and causing pain, numbness, and muscle weakness. Treatment involves physical therapy, pain and anti-inflammatory medications, and sometimes surgery to relieve pressure.


What should I do if I experience loss of bladder control or severe pain?

Loss of bladder control or severe pain could indicate a serious condition like cauda equina syndrome, requiring urgent medical attention. It's important to seek immediate medical help if these symptoms occur.


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