Case ScenarioI, Mr.Somanath Kumar, 53 year old male, is suffering from low back pain and left leg pain for the last two years. Initially I was treated with traction, physiotherapy and medications (Brufen, Pregablin, Pantaprozole) for two months. Since the pain persisted, I underwent spine surgery (L4 laminectomy and discectomy) in my native place in June 2014. The pain improved considerably after surgery but in the last one year, I am having severe pain in the low back region and both the legs also, associated with numbness in the feet. I am not able to walk even up to 50metres. I underwent a recent MRI and I have attached the report herewith. The doctor, who operated on me, had advised spine surgery again. I am diabetic for the last 15 years on Insulin treatment. Apart from that, there are no other medical illnesses. I am currently severely disabled by the pain. I request you to kindly advise whether I need surgery treatment.Expert Opinion reportDear Mr.Somanath, we thank you for your query. We understand from your history that you underwent spine surgery for lumbar disc prolapse in 2014. Currently you state that your pain has recurred in both legs and associated with severe back pain. Apart from diabetes, you have been fit medically. Your MRI report dated August 2015 shows that there are post operative changes at L4-L5 level with Grade I degenerative spondylolisthesis and significant thecal sac and nerve root compression. The rest of the spine appears normal without significant neural compression.The surgery for disc prolapse has a 1-3% chance of recurrent disc prolapse which can happen any time after the primary surgery. Further in your case, there is also evidence of spinal instability in the form of degenerative spondylolisthesis. Spondylolisthesis can result in significant back pain and also aggravate compression of the nerve roots over and above the prolapsed disc. So, your current problems are related to spondylolisthesis and spinal nerve root compression, which may require surgical intervention. However, if you have not taken any medical management so far, we would advise you to start back strengthening exercises and appropriate medications from your primary surgeon for a period 6 weeks. In case, if you have already taken medical management and the pain still persists, surgery would be a better course. Surgery, if planned will be in the form of spinal fusion and decompression with titanium screws.Evaluation and decision making on spinal disorders requires critical assessment of the patient’s symptoms, detailed clinical examination and corroborative radiological tests like xray and MRI. The above opinion has been given based on the brief clinical history and a recent MRI report which you had sent to us. For a more clear assessment of your problems, we would advise you to have a personal clinical examination and assessment with our spine team, based on which we can give a final opinion. For further queries please feel free to contact us @[email protected].