From the Guidelines
You should see a neurosurgeon or orthopedic spine specialist for evaluation and treatment of lumbar spinal stenosis with spondylolisthesis. Your symptoms of leg numbness, balance issues, foot pain, and tingling up to the knees are consistent with nerve compression from the moderate spinal canal stenosis at L3-L4 and L4-L5 levels, along with the Grade 2 anterolisthesis (forward slippage) of L4 on L5. Initial treatment options typically include conservative measures such as:
- Physical therapy focusing on core strengthening and lumbar stabilization exercises
- Anti-inflammatory medications (like ibuprofen 400-800mg three times daily with food)
- Possibly gabapentin (starting at 300mg at bedtime and gradually increasing) for neuropathic pain Epidural steroid injections may provide temporary relief and can be discussed with a pain management specialist 1. If conservative treatments fail to provide adequate relief after 6-12 weeks, surgical intervention may be necessary. Surgical options include:
- Decompressive laminectomy to relieve nerve pressure
- Possibly spinal fusion to stabilize the spondylolisthesis The blisters between your toes should also be evaluated separately, as they may indicate a dermatological issue or diabetes that could contribute to your neuropathy symptoms. It is essential to follow the treatment guidelines recommended by the American College of Physicians and the American Pain Society, which suggest that clinicians should provide patients with evidence-based information on low back pain, advise patients to remain active, and provide information about effective self-care options 1.
From the Research
Symptoms and Diagnosis
- The user is experiencing numbness in the legs, loss of balance, blisters between the toes, neuropathy in the feet, pain in the feet at night, and tingling in the feet up to the knees.
- The diagnosis includes disc space narrowing, attenuated disc hydration signal, diffuse disc bulge, and spinal canal stenosis at various levels of the lumbar spine (L1-L2, L2-L3, L3-L4, L4-L5).
- The impression is evidence of multilevel chronic degenerative spondylosis with stable Grade 2 anterolisthesis of L4 on L5 and moderate spinal canal stenosis.
Treatment Options
- According to 2, conservative therapy is appropriate for many patients with lumbar spinal stenosis, and a course of physical therapy should be started promptly.
- 3 emphasizes the importance of using appropriate conservative care in the management of low back pain.
- 4 suggests that conservative care is poorly defined in randomized trials, leading to ambiguity in research procedures and unclear guidelines for clinicians.
- 5 found that physical therapy services and exercise therapy utilization occurred infrequently in the year before elective lumbar spine surgery, while opioid prescriptions were common.
Specialist Referral
- Based on 2, the user may benefit from consulting a physiatrist, neurologist, or orthopedic surgeon for additional help with treatment.
- A primary care physician can provide strong guidance and help determine the best course of treatment, as suggested by 2.
- 6 highlights the importance of carefully tailoring treatment decisions to the individual patient, considering the potential risks and benefits of surgical and conservative management.