L4 compression #

Severe back ache radiating towards both leg Surgery or medications ( steroid injections ) which is the best plan for a 60 year old lady patient.

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L2 to L5S1 pedicle screw fixation with laminectomy of L4
Surgery and nothing else is curative and should not be offered to patients as lollypops to avoid surgery ..This non operative non curative options ha ve become a big racket and business which actually harms the patient by allowing nerve damage to continue which is irreversible
There is a compression fracture of L4 alongwith disc protrusion..if patients wants conservative then best with be kyphoplasty with bone cement injection and bilateral nerve root block..patient will be pain free
Confirm history of trauma Lumbosacral corset If injury is recent,bedrest for one month from injury Analgesics Muscle relaxants Calcium vitD Gabapentin will help Reassess after one month
Try SNAGS if the pain worsens on movement and eases at rest in particular position/posture. NSAID may be used along with electrotherapy if needed along with SNAGS.@
Vetebroplasty will give good pain relief. R/o metastatic or infective pathology.
Collapse? Traumatic ?? Metastasis