Not all pain in legs is due to knee arthritis – Think spine!

30 Apr Not all pain in legs is due to knee arthritis – Think spine!


In elderly people, pain in the legs restricting their walking ability is a common complaint. Most of times it is attributed to “ageing pain” due to arthritis of knee by family doctors and patients. Knee arthritis causing leg pain is fairly common at this age, but so are pinched nerves in the lower back (which carries sensations to legs) and sometimes even blocked vessels (the plumbing system of our body) in legs. These things cause similar kind of complaints from the patients – “I cannot walk more than 5 to 10 minutes, I feel like standing or sitting for some time after which I can walk again short distance only” they say.

This is an X-ray image of both knee joints taken while investigating a patient for leg pain. eventually it turned out that the spine needed more attention currently than the knee.

Red herring?

It is important to differentiate these, especially if knee joint replacement surgery is planned. Most joint replacement surgeons will ask for a spine specialist consultation to adequately evaluate the person.
If you have these complaints it is important to see a spine specialist. They ‘hear’ your complaints and try to rule out spine as the pain generator by examining and further evaluating with some imaging studies.

This approach prevents a bad surgical result of knee replacement surgery and further suffering by the patient.

A similar case in point.

Image of the lumbar spine MRI showing severely pinched nerve at one level with one vertebra slipped over another.

 Choked nerves!


Mrs P was having difficulty in walking and had decided to undergo knee replacement surgery (see earlier X-rays) by various doctors. The family had decided for the surgery when they were referred to us for a spine opinion by a colleague. She had the following images of her spine MRI showing compressed spinal nerves and X-rays of the knee showing badly worn out knee joints.


This image is a lateral view of a minimally invasive TLIF done with pedicle screws and rods with inter body fusion cage and bone graft. All through 3 tiny cuts in the lower back.

Restored BACK.



The spine was operated with a minimally invasive solution in the form of MIS – TLIF(spine surgery) at one level. She started walking the next day and was discharged out of the hospital on the 3rd day after surgery. The pulling sensation in the legs improved significantly.

Faced with both spine and knee problem of equal magnitude, the general rule is to treat the spine problem first and address the knee issue later.


In both legs pain restricting walking – Think Spine, think Knees and think vessels as culprits, in that order.


  • Aditya mishra
    Posted at 07:37h, 30 April Reply


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