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Old 11-27-2011, 01:22 PM   #1
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L4/L5 Spine problems

hi guys, sorry if I lack some info will provide what i know,

a family member of mine who is around 50~ has been reciving some pain lately around the outside of the thigh area. When for MRI scan and was told that the L4/L5 is quite narrow and that they have the following options:

Either a injection (from what little i know i presume its a epidural?) is this safe?

then if that does not work Surgery.


Does anybody have any more info about this that I can read up on, is there anything one can do to ease the pain? I have been told acupuncture works for some people? they have only got the letter yesterday from he hospital stating about the L4/L5 being out of place. My knowledge on this subject is very limited,seeing what I can find out on the internet and wondered across this site.

thanks

Last edited by harvie111; 11-27-2011 at 01:24 PM.

 
Old 11-30-2011, 12:44 PM   #2
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Re: L4/L5 Spine problems

Surgery should always be the LAST option.

Depending on what is wrong, they can do epidural nerve blocks to find the exact problem and then do steroid injections in the same area to relive the pain and slow the degeneration of the area. If the facet joints are involved(on the back of the vertebrae) they can go in and burn off the nerve endings with radio frequency waves giving 6-12 months of pain relief. Physiotherapy and pain meds can help as well.

Unfortunately, there is not much else and usually once you start surgery, it becomes a never ending cycle of surgeries with absolutely no guarantee of any kind of pain relief. I'm waiting on a full lumbar fusion myself. Already fused from C3 to T1 in my neck(6 vertebrae fusion).

Unlike knees and other joints that can be replaced, you can't replace a spine.

Jenny

 
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Old 02-21-2012, 11:24 AM   #3
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Re: L4/L5 Spine problems

Hello, I also have been recently diagnosed with stenosis, or narrowing of L4/L5 and my left hip area aches. I got my first epidural last week, they give a total of three, one month apart and the goal, according to the doctor, is 50% pain relief in 6 months time.
I also started physical therapy and I'm going to try everything possible before I have surgery, just want it as the very last resort only. My left hip feels weak as well and therefore I use a cane or hang on to the shopping cart, being slightly bent forward helps.
I am also told this is a very common problem for people with arthritis.
My advise is to try everything first, however, if the pain or quality of life becomes unbearable, they have surgery and many people do say they have had good results.

 
Old 02-21-2012, 05:15 PM   #4
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Re: L4/L5 Spine problems

You can find tons of info over on the Back Pain board.

I've had both the Epidural Steroid Injections (ESI) and also a RFA (Radio frequency ablation). The ESI was for neck and back issues, the RFA for my SI joint (sacroiliac). The RFA did a great job of relieving my pain in that area. It comes back sometimes but not often enough to need to do RFA again.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 02-29-2012, 09:38 AM   #5
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Re: L4/L5 Spine problems

Quote:
Originally Posted by harvie111 View Post
hi guys, sorry if I lack some info will provide what i know,

a family member of mine who is around 50~ has been reciving some pain lately around the outside of the thigh area. When for MRI scan and was told that the L4/L5 is quite narrow and that they have the following options:

Either a injection (from what little i know i presume its a epidural?) is this safe?

then if that does not work Surgery.


Does anybody have any more info about this that I can read up on, is there anything one can do to ease the pain? I have been told acupuncture works for some people? they have only got the letter yesterday from he hospital stating about the L4/L5 being out of place. My knowledge on this subject is very limited,seeing what I can find out on the internet and wondered across this site.

thanks
Pain on the outer thigh alone is 99 times out of a 100 is meralgia paresthetica
which is pressure on the lateral cutaneous nerve of the thigh. It is caused by having a big belly, ie pregnancy or just being fat, tight corsetts, very tight jeans, sitting over a desk for extended periods and sometimes it comes on for no apparent reason. It is easy to test for, get a pin or needle and stroke across the pain full area and mostly but not always you will find a somewhat lessening of sensation at the middle of the pain area as compared to a non painfull area of thigh.
If it is not MP then have an xray or whatever but not before a good examination and possibly saving you from great expence and worst of all surgical intervention.
James

 
Old 02-29-2012, 10:20 AM   #6
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Re: L4/L5 Spine problems

I have had thigh pain associated with my lumbar stenosis and compressed nerves. Primarily on the back and side of the thigh. Everyone is wired differently, so look for a dermatologist chart picture which will show you where L4/5 nerve compression can be felt by the person with pain. The charts will show you that L4/L5 can indeed be felt in the front of the thigh.

If the ESI works then he/she will know for sure that the pain is related to problems in the spine. ESI are common, easily tolerated, can be done under light sedation if someone can drive the parent home, and are used for diagnostic and treatment purposes.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

Last edited by SpineAZ; 02-29-2012 at 10:24 AM.

 
Old 02-29-2012, 11:11 AM   #7
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Re: L4/L5 Spine problems

Quote:
Originally Posted by SpineAZ View Post
I have had thigh pain associated with my lumbar stenosis and compressed nerves. Primarily on the back and side of the thigh. Everyone is wired differently, so look for a dermatologist chart picture which will show you where L4/5 nerve compression can be felt by the person with pain. The charts will show you that L4/L5 can indeed be felt in the front of the thigh.

If the ESI works then he/she will know for sure that the pain is related to problems in the spine. ESI are common, easily tolerated, can be done under light sedation if someone can drive the parent home, and are used for diagnostic and treatment purposes.
You seem to be confusing a spinal nerve compression with a peripheral nerve compression. A spinal compression can indeed cause pain front back and side of the thigh but the author's friend had lateral thigh pain only therefore the exam should begin on this premise. Dermatomes do not corrolate with peripheral nerve distrobutions. Easy to treat a meralgia with instructions on the cause and perhaps an injection into the offending area.
James

 
Old 02-29-2012, 11:15 AM   #8
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Re: L4/L5 Spine problems

Try all the conservative and low end invasive (like injections) options available. What type of work do you do? Some people sail through laminectomies and are back at work at sedentary jobs in 4-6 weeks, others have a longer recovery and if you have a medium to heavy job it could be that you need 6-12 weeks off. If you are employed, find out if your employer offers Short Term Disability (STD). Often employers pay for the benefit and employees aren't aware they have it. You may also be eligible for FMLA for 12 weeks of unpaid leave OR concurrent with STD or extended sick leave if offered by your employer.

If you live in CA, NJ, NY, HI, PR or RI there is state short term disability available. No other states offer state short term disability.

If you are worried about asking your employer about STD and LTD (long term dis) do it with a different approach "after tax season we're meeting with a financial planner and he wants us to gather all the informatino on what our employers offer in the way of Life Insurance, Short Term Disability and Long Term Disability, Can I please get copies of those plans?". By adding Life in (which is good to know anyway) you are deflecting any hint that you may need time off. If you do have STD/LTD and get copies of the plans or Summary Plan Documents (SPD) I can answer any questions you may have (used to work in that field before becoming disabled myself). I'm pretty good at FMLA as well and can refer you to official DOL sites that discuss it in more length.

For my neck, ESI worked well for about 2 yr. I would do 3 ESI per cycle, one every 2 wk with 3 shots so 6 wk worth. I could do this twice a year (otherwise beyond that it's too much steroid use). I knew it was time for neck surgery when the pain wouldn't even get partial relief from the ESI and I started having steroid side effects (steroid hunger....where you can eat an entire pizza. Feel full. And 10 min later you are starving. The steroids temporarily shut down your "full" switch. If I had eaten more I'd get sick but the feeling was as if I was starving!

My back was a different story. I have spondylolisthesis where the vertebrae, not the discs, start moving forward or backward out of line. They have to be brought back into line and fused. Laminectomies are much easier than this and are a good conservative surgical approach. Some surgeons jump to fusion when only a laminectomy is needed. There are some good animations of laminectomy procedures (animation so not graphic, but there are some on YouTube of actual surgeries which are harder to watch if you are squeamish.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 02-29-2012, 11:26 AM   #9
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Re: L4/L5 Spine problems

James: If MRI correlates with symptoms, then it may indeed be a spinal nerve compression as described by his doctor. Given what the MRI shows the cause is most likley spinal and the best place to start in diagnostic ESI.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 02-29-2012, 01:13 PM   #10
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Re: L4/L5 Spine problems

Quote:
Originally Posted by SpineAZ View Post
James: If MRI correlates with symptoms, then it may indeed be a spinal nerve compression as described by his doctor. Given what the MRI shows the cause is most likley spinal and the best place to start in diagnostic ESI.
In a 50 year old the MRI will almost certainly correlate with the symptoms, no matter what the symptoms are. This is one of the reasons why Americans have four or five times the amount of spinal surgery than countries where much less relience is put on such scans. Also the reasons why the results from surgery are so poor. Pain in the outer thigh should be looked at clinically and treated in the most conservative way. If it is a peripheral nerve a hundred dollars instead of a $2000 MRI.
James

 
Old 02-29-2012, 01:23 PM   #11
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Re: L4/L5 Spine problems

Sorry, I respectfully disagree. As a veteran of many spine problems an early MRI can lead to appropriate treatment before permanent effects of nerve compression set in.
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Rt&Lt thumb arthroplasty 2012 ; RT TKR & Bilat CTS 2011
Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 02-29-2012, 03:19 PM   #12
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Re: L4/L5 Spine problems

Quote:
Originally Posted by SpineAZ View Post
Sorry, I respectfully disagree. As a veteran of many spine problems an early MRI can lead to appropriate treatment before permanent effects of nerve compression set in.
I think this shows that we are having the images make the decisions rather than the clinician. If your statement were true we could MRI everyone and operate on those whom the doc would consider at risk. I would be the first under this protocal if I developed pain looking at my xrays.
James

 
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