45 female..known case of Dm..and hypothyroidism on rx.....weight 65 kg...back pain since 4 month..slightly day by day increases..tingling and numbness at lower limb....MRI done....neurosurgeon given medicine..but not rilife..tab flexon mr..tab neurobion forte ..tab shelcal 500 given...but not rilife......pls sugest medical managment or reqwired surgery. and outcome of surgery...pls suggest.

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Pt is diabetic Age 45 and wt is 65kg suggest she has higher bme and obese and overweight Suffering from PVID Thecal sac is indented and compressing both nerve roots with facitis She will need surgical intervention So far outcome is concerned depends on surgeon and pt herself Rx tab gabapentin 300mg+nortryptiline 10mg 1od at bedtime Tab vitneurin czs 1od NSAIDs like tab eterocoxib or celecoxib Cap indomethacin Physiotherapy

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I am interested in HBA1C level. Unless diabetic neuropathy is not controlled many problem would persist. So far Gabapentin is concerned its at present in contraversory..Replace with other SGLT2 as par present Glycemic index. So far spinal detotiatied pathology is concerned i think Complete Lumbo- Saccal region is concerned ,is worst compromised with progressive degeneration and herniation of disc causing reduction in inter vertrebal space ...leading to nerv end opening. Spinal surgeons are best and authorized medical person to text/advise in this reference. But i requesr that spinal surgery/ surgeries must be performed in metro city by most expirienced surgeion/ with Neuro sugeion/ Orthopedic...and off cource an experienced Endocrinologist. I wish your pt healthy recovery.

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Hypothyroidism DM Pain relief will to some extent depend how well DM and hypothyroidism are controlled . Rest, physiotherapy, pelvic traction, NSAIDS, Gabapentine, Neurotropic vitamins needed for conservative management If response is poor, consider endoscopic discectomy . Since other pathologies like liamentum flavum hypertrophy and facet joint arthropathy ,are also there complete cure can not be assured with microscopic discectomy

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75 mg gabapentin can be given At night And pain killer to it You can continue other drugs Once the pain reduces start physiotherapy In that Shock therapy might help in spasm of muscles and other exercises Start physiotherapy only after reduction in pain With gabapentin you can give after 20 days This drug sis taken at night Pt might feel head discomfort ask her not to stop suddenly can take half for a week and then stop

MRI images needed to opine regarding surgery As per report,trial of conservative treatment for few weeks Analgesics Muscle relaxants Gabapentin will help Calcium vitD supplements Lumbosacral corset Intermittent or continuous pelvic traction can be tried and continued for three weeks if beneficial

DM with Hypothyroidism Multiple levels PIVD with maximum in L4L4, L5S1 with nerve root compression Lumber spondyelosis HBA1c, Vit D3, Calcium level, FSH, TSH level Strict control of DM, better to start with Insulin Tab Gabantin NT(400/10) hs Tab Cyclobenzaprin 15mg hs Lactulose sos Tab Felcita OD daily LS belt Rest If no response within 3 months, better to plan for surgical Deco m decompression operation

It will be better with mri films... Any how none of these drugs having good effect on neuropathic pain.. Preferably Gabapantin or pregabaline will started with low dose Gradually up titrated as per response till maximum dose or tolerable dose..!! Other various group of drugs available for same..!!! LS belt should be give After 3-6 months with conservative management if response not good pt can be taken up for surgical decompression..!?

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Multiple discs prolapse Lig flavum hypertrophicus causing pressure on spinal cord Lumber lordosis lost curvature Ad laminactomy lumber spine to release pressure from spinal cord & nerve roots

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lordosis yu can do kati basti with lakshadi thail+maharajprasarnithail basti with panchtiktaghrit shir bastior maharajprasarni thail oral cap maharajprasarni thail,kanchnar guggulu,kaishor guggul,tryodhashang guggul,punarnava mandur

SUGGESTIVE OF DM HYPOTHYROIDISM DEGENERATIVE. DISC. DISEASE ADVISABLE... NSAIDS PHYSIOTHERAPY GABAPENTIN NEUROTROPIC. VITAMINS CALCIUM. +. D 3

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