SGBP Final 4

4. Difficulty in moving the ankle upward or downward or raising the
   great toe


5. Gait disturbance – difficulty in walking


6. Changes in reflexes in the legs (this can be detected by the physician).

If you have one or more of the above symptoms you definitely have a pathological cause
that may need surgery. The timing of surgery will depend on how severe the symptoms
are.

Conditions that can cause severe nerve compression and damage producing one or more
of the above symptoms are:

1. Spinal stenosis caused by severe osteoarthritis, osteoporosis, spondylolisthesis,
   inflammation, or a herniated disc which decreases available space for the spinal
   cord, thus pinching and irritating nerves from the spinal cord


2. Cauda Equina syndrome


3. Spondylolisthesis caused by stress fracture of vertebrae


4. Vertebral compression fracture due to osteoporosis


5. Severe sciatica caused by:

a. Prolapsed lumbar intervertebral disc

b. Osteoarthritis of the spine

c. Spondylolisthesis – lumbar or isthmic spondylolisthesis

d. Tuberculosis of the spine

e. Piriformis syndrome

f. Tumors of the spinal column – including secondary malignant deposits

g. Tumors of the spinal cord or cauda equina

h. Tumors of the sacrum or ilium

i. Pelvic tumors

The opposite is also true. IF THERE ARE NO RED FLAGS, SURGERY IS NOT
REQUIRED.