Diagnosis
Status post-lumbar discectomy (December 2009) at the L4–L5 level. Persistent and progressively worsening lower back pain. Symptoms include sharp, cutting leg pain, pulling pain in the buttocks, subscapular pain, and numbness in the fingertips. Conservative management, including medical therapy and physical rehabilitation, yielded no clinical improvement.
Patient:
Male, 44 years old, Kazakhstan
Physician:
Dr. med. Andrey Bitter, Head of Spine Surgery Department, Neuwerk Clinic
Expert Opinion by Spine Specialist Dr. Andrey Bitter:
In my assessment, an active inflammatory or infectious process is unlikely, as the laboratory results remain within reference ranges: white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are all normal.
The provided MRI scans demonstrate a chronic Schmorl’s node at the L4–L5 level, which represents the primary structural concern. Additionally, there are localized regions of segmental instability accompanied by bone marrow edema (Modic changes). These changes are likely driving the axial back pain radiating into the lower extremities. Spinal canal stenosis appears minimal.
Following an in-person physical examination, functional dynamic X-rays of the lumbar spine, contrast-enhanced MRI, and possibly a lumbar myelogram, we will formulate an optimal treatment strategy. This will either involve targeted conservative management—such as a series of image-guided therapeutic nerve blocks—or a surgical stabilization via dorsal lumbar interbody fusion (dorsal spondylodesis) at L4–L5.
We can conduct all preliminary diagnostic evaluations on an outpatient basis at our clinic and proceed with surgical intervention if indicated.
Do not delay your treatment! Book an online consultation today: +49 170 62 47 020