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Lower Lumbar issues w/MRI report


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Old 09-09-2016, 01:36 PM   #1
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Lower Lumbar issues w/MRI report

Hi,

Found this board and hope to learn more surrounding my condition.

Ongoing lower back (lumbar issues). Specifically chronic pain in the central lower back and on each side of the spine, with sudden out of nowhere acute debilitating back spasms centered in same location. And worsening pain in both feet and ongoing tingling and numbness in toes. This summer I've experienced intense cramping in both legs at night (but I attributed that to dehydration but could be mistaken)

I've been in Physical Therapy over past two years which seemed to have helped at first (developing core and muscles around lower back and stomach). Unable to do squats as I used to.

This past spring the lower back pain and spasms have become worse, and PT no longer helping.

Have had several MRI's. One in 2014 and one last week (Sep 2016). The latest MRI report just came back and I visited my PCP yesterday.

Both the 2014 and the 2016 MRI's showed various degrees of stenosis and disk degeneration at all lumbars. The more significant issues are at L1-S1 and L4-5

Spinal stenosis L1-S1, most severe at L4-5.

Comparing MRI reports the latest MRI report shows for L1-S1:

Large paracentral right disc protrusion at the lateral recess and complete obliteration of the right neural foramen (increased in severity since previous exam).

I'm trying to obtain a consult appt with the only local Neurosurgery specialty practice. Just had the MRI reports/images and referral request submitted to them.

I would like to hear any advice/recommends on best way to proceed forward. Thank you.

Sky

Last edited by Skywatch; 09-09-2016 at 02:13 PM. Reason: Added add'l info

 
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Old 09-09-2016, 06:27 PM   #2
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Re: Lower Lumbar issues w/ MRI report

Welcome to the board. You didn't really include enough of the MRI report to be useful. What you provided just says what you already stated....central canal stenosis from L1 to S1, being most severe at L4-5....

Were there any comments about each individual level? Being "most severe" at L4-5 doesn't indicate how much stenosis there is at other levels, or just how severe it is at L4-5.

There is a large disc herniation but you don't indicate at what level..wherever it is, the disc material is coming out of the disc and is blocking the foraminal opening ( left side? Right side?) completely. If the foramina is truly completely "obliterated," that should mean that the nerve is being badly compressed. That would account for the numbness in the foot or feet, depending on whether both foramen are blocked, or due to the stenosis in the central canal if it is severe enough.

If the foramina is that badly blocked, you need to see a spine surgeon as soon as you can or you may end up with permanent nerve damage. If you develop sudden bladder or bowel issues like incontinence or sudden muscle weakness like foot drop you should seek medical attention immediately. This could be signs of cauda equina syndrome...and you would need to get the nerve or nerves decompressed right away to avoid permanent nerve damage.

 
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Old 09-10-2016, 12:41 PM   #3
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Re: Lower Lumbar issues w/MRI report

Thank you for your reply.

I just reported (repeated the exact wording) what the most recent MRI report stated regarding the issue at L5-S1. No other Lumbar levels had that severe degree of issue. However the recent MRI report only refers to changes from the 2014 MRI report, which I'll dig up and post soon.

Yesterday my PCP and imaging dept pushed the MRI report and images to a local neurosurgery specialist. The CSR for the specialist said they would review my case to decide if to accept me for a new patient consult. Which is strange because I am a returning patient from 2014 when they provided the orders to have my previous Lumbar MRI done (and did a Lumbar X-Ray as well), and then referred me to Physical Therapy. The doctor who I saw previously at the practice has since moved out of town to another practice, so I assume they are considering me as a new patient again?

I do note that my ability to hold my urine or bowels have significantly decreased this summer. I don't have much time to get to the restroom before urinating/defecating my pants (don't intend to be gross but that has happened several times on the last two months).

And now even when sitting, it feels like my circulation to my feet and lower legs is getting cut off. I assumed it was particular to specific chairs with ridge on the outside edge without enough padding. But now it seems that any chair I sit in I have same issue.

And even after short time walking on hard surfaces (grocery store) and doing laundry, my feet ache. And the balls of my big toes and heels get sore (under the callous build up). Also walking in my bare feet in the house and standing in the shower has become very painful over the last year. Especially on my heels and big toe (having flat feet doesn't help). I have to wear shoes even when walking from the bedroom to the bathroom. My PCP referred me to a podiatrist, who left msg late yesterday to get on their schedule.

Anyway don't wish to be a complainer. My quality of life has significantly decreased this year and more so this past summer and I need to prepare myself for what may lie ahead. But have hope I get back to doing things I love outdoors.

Last edited by Skywatch; 09-10-2016 at 01:33 PM. Reason: Added info

 
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Old 09-10-2016, 01:10 PM   #4
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Re: Lower Lumbar issues w/MRI report

I have had three lumbar MRI's:
1. 12/2010
2. 05/2014
3. 08/2016

Results for 05/2014:

05/2014 Diagnostic report
MR LUMBAR SPINE WO CONTRAST (MR-35)

IMPRESSION:
1. Right parasagittal and foraminal disc protrusion noted at L5-S1 level. This abuts the exiting right S1 nerve root and effaces the lateral recess.
2. Multilevel disc spondylosis identified with moderate canal narrowing at L1-2 and L2-3 levels.
3. Multilevel neural foraminal narrowing as detailed in the body of the report secondary to multilevel
disc spondylosis and facet hypertrophic changes.

FINDINGS: The lumbar vertebral bodies demonstrate normal height and alignment. No anterolisthesis or retrolisthesis is seen. Minimal endplate irregularity is seen involving the superior endplate of L2 level. There is loss of disc height and hydration at all levels of the lumbar spine. Posterior disc bulges noted at L1-2 and L2-3 levels. The conus terminates normally. No paraspinal soft tissue abnormality is identified.

The following significant findings are identified on the axial images:

T12-L1: No posterior disc protrusion, central canal stenosis or neural foraminal narrowing is seen. Facet hypertrophic changes are noted.
L1-2: Diffuse annular disc bulge is noted with right foraminal component. There is moderate canal narrowing measuring 9 mm. There is moderate left neural foraminal narrowing.
L2-3: Moderate canal narrowing is identified secondary to diffuse annular disc bulge with a right parasagittal, foraminal and far lateral component. The AP diameter of the canal measures 6.8 mm. There is partial effacement of the CSF collar. Mild to moderate right neural foraminal narrowing is seen. Facet hypertrophic changes are noted.
L3-4: Diffuse annular disc bulge is identified. Mild canal narrowing is seen. Minimal thickening of the ligamentum flavum is identified. Facet hypertrophic changes are noted. No significant neural foraminal narrowing is identified.
L4-5: Diffuse annular disc bulge is seen with mild canal narrowing. There is moderate bilateral neural foraminal narrowing. Facet hypertrophic changes are noted.
L5-S1: There is a right parasagittal and foraminal disc protrusion superimposed on diffuse annular disc bulge causing effacement of the right lateral recess. There is moderate right neural foraminal narrowing. Facet hypertrophic changes are noted.

--

 
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Old 09-10-2016, 01:23 PM   #5
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Re: Lower Lumbar issues w/MRI report

Below is report from Lumbar MRI two weeks ago.

MR Lumbar Spine wo Contrast 08/2016

(Followup to CT kub in April 2016 (which showed) Multi level disc bulges throughout the lumbar spine and probable moderate spinal canal stenosis.)

IMPRESSION:
1. Spinal stenosis L1-S1 most severe at L4-5 but unchanged from prior exam.
2. Paracentral right disc protrusion increased in size from prior exam with obliteration of the lateral recess and right neural foramen.

COMPARISON: 05/2014

FINDINGS: The posterior vertebral alignment is normal. Multilevel discogenic degenerative changes are seen from L1 through S1. There is increased disc protrusion at L5-S1 compared to prior exam. Sagittal imaging shows mild-to-moderate foraminal narrowing on the left at all lumbar levels. The right neuroforamen are narrowed from L3 through S1 with severe narrowing at L4-5 and L5-S1. There is no acute bone marrow abnormality present the conus is at T12 and is of normal size and signal.

Axial imaging:

T12-L1: Normal.
L1-2: Moderate stable concentric spinal stenosis.
L2-3: There is a discogenic J protrusion paracentral and right foraminal in location with mild spinal stenosis unchanged from prior exam
L3-4: Mild symmetric spinal stenosis no focal herniation. No change from prior exam.
L4-5: Mild to moderate spinal stenosis with bilateral facet hypertrophic changes and small central disc protrusion not significantly changed from prior exam.
L5-S1: Large paracentral right disc protrusion at the lateral recess and foraminal level increased in severity over prior exam complete obliteration of the right foramen.

--

Last edited by Skywatch; 09-10-2016 at 01:25 PM.

 
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Old 09-11-2016, 10:23 AM   #6
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Re: Lower Lumbar issues w/MRI report

I find the wording of the latest MRI interesting in that the stenosis in the upper lumbar spine is barely mentioned. I would think it significant that a couple years ago it was 6.8mm at the L2-3 level. Keep in mind that "average" diameter is anywhere from 15 to 27mm, depending on the bone structure of the individual. Anything below 12mm is considered stenotic...and 6.8mm is practically half that dimension...so it is no wonder you have pain and symptoms.

I find it odd as well that they consider you a new patient. If for some reason they don't accept you, I would call them and ask about it. Usually when a doctor leaves a clinic, they make an attempt to transfer the case to a different doctor within the same clinic.

Do you live where you have access to other spine specialists? If so, you might want to look for a fellowship-trained orthopedic spine surgeon as well.

I also suggest you see a spine surgeon before you get too hooked up with a podiatrist. I would be surprised if your feet issues are not directly a result of your stenosis in the lower lumbar central canal. My original spine issue was severe stenosis at L4-5. The first symptoms I had, years before any other symptoms, were weird cramps in the middle toes of my right foot. Then, gradually some slight numbness began. It was another four years before I began developing some sciatic pain, and pain when standing and walking.

Obviously, I can't speak to every podiatrist...but I had some invasive procedures suggested by three different podiatrists that I chose to ignore. When I later went to a foot and ankle orthopedic doctor, he basically told me thank goodness I hadn't followed through with the surgeries they had recommended.

It is important to recognize that the feet are the foundation of the building blocks which form our posture and structural alignment. When there are foot issues which you no doubt have being flat-footed, it affects the joints stacked above, like the ankle, knee, hip, etc. People with back issues often have problems with structural alignment, and foot issues.

Why did you have the first MRI in 2010?

Last edited by teteri66; 09-11-2016 at 10:29 AM.

 
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Old 09-20-2016, 09:53 PM   #7
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Re: Lower Lumbar issues w/MRI report

The doctor at the neuro/spine specialist practice who I previously saw has moved to another practice in another city, so the practice is considering me a new patient. Since I had a referral with chart notes and images submitted to them a couple weeks ago, but as of yesterday they had not yet even attempted to review my case. They now say they are short staffed. But I've has previous issues gaining followup contact with this practice so I'm done with them.

Thus I called both my PCP and my PT for other recommends. And both offered up some of the same specialists. So yesterday requested my PCP fax my chart notes, etc, and the imaging provider to push my MRI images to another specialist who I confirmed accepts my insurance. And the specialists office called and left a message stating they have received everything they need and by the end of this week should have a decision to accept me, at least for a consult.

So I guess that is progress ;-)

 
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Old 09-20-2016, 09:57 PM   #8
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Re: Lower Lumbar issues w/MRI report

Again thank you for the advice!

I do have an appt with podiatrist early next month. I do feel my foot problems (numbness in toes and pain in big toe and heel, on both feet, are directly related to my back). But I also know that my the various shoe inserts I have been using the last two years are no longer cutting it. With my flat feet and pronation issues its time I step into custom orthotics (forgive the pun), no matter the deal with my back. But I'm not looking for any kind of foot surgery.

Last edited by Skywatch; 09-20-2016 at 10:02 PM.

 
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Old 10-20-2016, 02:36 AM   #9
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Re: Lower Lumbar issues w/MRI report

Finally some news to report.

Neurosurgeon recommended laminectomy & discectomy on both L1-2 and L2-3. And right hemi-laminectomy and discectomy on L5-S1. Surgery in hospital (2-day stay) scheduled for early December pending insurance authorization.

Also the surgeon wants me to go in for a cervical MRI.

Last edited by Skywatch; 10-20-2016 at 02:50 AM.

 
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Old 10-20-2016, 07:22 AM   #10
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Re: Lower Lumbar issues w/MRI report

Have you seen this surgeon or was this recommended from looking at MRI, etc.?

 
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Old 10-20-2016, 04:07 PM   #11
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Re: Lower Lumbar issues w/MRI report

[QUOTE=teteri66;5436752]Have you seen this surgeon or was this recommended from looking at MRI, etc.?[/QUOTE]

Yes, saw a neurosurgeon and this is what he recommended after giving me an exam and reviewing my previous diagnostics and history.

Looking at the MRI images on DVD I can clearly see those points are where the herniated disk material is pushing into the spinal section much more than at the other vertebra (I have issues at all lumbar vertebra).

I'm a bit ****** that the spine surgeon who I saw in 2014, and who had me get a lumbar MRI, did not discuss ANY of those issues with me. Clearly those issues were evident on the 2014 MRI and I was observing and reporting similar issues (except a higher degree of pain now).

Wish I'd never gone to the previous practice (I won't name names here, but they are all marketing and no substance). My new neurosurgeon has a much better demeanor, able to explain things clearly, and is the head of a much more professional and successful practice. I was lucky to get him.

Sidenote: Kind of strange that following the day my new surgeon accepted me as a patient, I got calls from two other neurosurgery practices wanting to set me up with an appointment, including the previous practice I was a patient of but who was referring to me as a new patient (since their surgeon who I previously saw had moved on).

So I'm very happy now that I'm moving forward on this. I understand that surgery doesn't help everyone and/or to the degree that they hoped...but at least there is hope for the return of some of my previous quality of life.

Last edited by Skywatch; 10-20-2016 at 04:12 PM.

 
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Old 10-20-2016, 04:42 PM   #12
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Re: Lower Lumbar issues w/MRI report

This is why I always recommend getting several opinions. I am happy you like the new surgeon and I hope you get your insurance approval soon so you can move forward.

 
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Old 12-22-2016, 01:33 AM   #13
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Re: Lower Lumbar issues w/MRI report

Had surgery last week and was in hospital for 3 nights.

* Spinal stenosis, lumbar region, without neurogenic claudication.
* Bulging (herniated?) disks.

I don't yet have copies of any notes but the vertebra involved were L1-L2, L2-L3, and L5-S1
Surgery was 3 laminectomies and diskectomies.

Follow-up appt with the Surgeons PA happened earlier today.

The morning of my last day in the hospital I began having issues with upper right leg, specifically the buttock, and right hip. When putting weight on right foot, and attempting to stand up, I experienced sharp pain in right buttock upper leg, not allowing me to completely stand up. (like a hinge getting stuck in the middle)

The issue lessened as the day wore on. And when the surgeon visited to discharge me he did not show much concern, as if it was a common issue that would quickly go away on its own. However, when I awoke the next morning ro use the bathroom, the issue had returned, but this time with a significantly higher degree of pain. And its been the same since for the last five days. I have been unable to stand completely erect, and unable to walk normally. When standing I must scrunch over, keeping most my weight on left leg. However while doing this (compensating) I am observing pain in left knee and right shin.

In pre-surgery consultations, and printed documents provided to me, it was said that PT was suppose to occur before discharge. However I received no PT while in the hospital or after discharge.

On my followup appt today the PA did not show much concern with the pain issue, and recommended I get signed up to my own physical therapist, and provided me a prescription for Oxycondone and Flexeril.

I'm feeling that both the surgeon and his PA did not want to be involved in discussing the issue of the new pain and what might be causing it.

The surgeon stated at the time of discharge, that on my followup, the PA would provide an aok to start driving or not. However the PA was unwilling to provide that today. Said it was up to me.

It seems that some of the original pain issues that led to me having the surgery have subsided, but it is difficult to know, in that I've not done any significant walking, reaching, flexing, bending or lifting, to test if my previous issues have improved. And I am presuming the new pain issue is masking any other issues that I may be experiencing.

To be clear, the NEW pain issue in my upper right leg/buttock significantly outweigh all the other previous pain issues I was reporting.

Today after visiting the PA, I had to schedule my own PT. And I learned the earliest I can get in is 01/12/17. If I had known the neurosurgery provider was not going to provide/schedule me for PT, I would have scheduled my own PT appts way in advance to ensure I received proper PT at the earliest time possible post-surgery.

So unless the new pain automagically disappear it appears I will have to endure the status quo for three and a half weeks, without any exercises, and just relying on prescriptions, and hoping that I will eventually be able to completely stand up and walk without extreme pain.

Needless to say, at this point I am wishing I did not have the surgery. And I have lost all confidence on this provider. I have a follow-up appt with the surgeon (not the PA) scheduled in one and a half months. I'm going to write a detailed letter on how I feel I've been disrespected throughout the whole process (including changing the date/time of surgery five times over two weeks before surgery).

Hopefully all this makes sense as I am a bit ditzy from the prescriptions. Thanks for listening. Time for bed.

Last edited by Skywatch; 12-23-2016 at 04:58 AM.

 
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Old 12-22-2016, 08:04 AM   #14
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Re: Lower Lumbar issues w/MRI report

Not that it makes any difference to you, but many spine surgeons do not send patients to PT after the type of surgery you had, feeling it isn't necessary or that it creates more issues than it resolves. My surgeon does not have a PA as he sees all his patients himself, but he has his own PT that he has been working with for years...most of his time in practice. It is terrific in that the PT always knew exactly what my surgeon wanted done or, in my case, not done.

A few years ago my elderly aunt had a stroke and I went to live with her and help her for about nine months. I went with her to physical therapy and had a chance to observe a number of different therapists working with spine patients. It was very interesting and very revealing. So much of physical therapy directed toward people with back pain is so generalized as to be really ineffective.

Oops, I am off on a tangent. What I really wanted to ask you is to clarify where your new pain is. Do you have pain on the front side of your thigh or is it mostly in the buttocks running over toward the hip?

 
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Old 12-23-2016, 04:54 AM   #15
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Re: Lower Lumbar issues w/MRI report

This new severe pain starts in the center of the right buttock and runs down the back of the thigh. Sometimes it radiates toward the outside of the right butt/hip, and other times radiates toward the inside of the right leg. As of this evening the pain extends down to the middle of the right ham, and it is getting worse. From looking at anatomy drawings, I am guessing possible nerve compression or entrapment in the area underneath the gleutus maximus near the piriformis.

Again, I did not have this pain issue before going into surgery. It is new the night before discharged out of the hospital.

In order to move the short distance from one end of the house to the other, I have to lean on the wall or some other object for support me while I shuffle walk (half step at a time). The specific pain occurs when putting weight on the right leg, when attempting to stand up and/or attempting to walk. Only marginal pain when sitting down. When I clamp down on the butt muscle with my hand, it helps to reduce the pain.

The pain I was having pre-surgery was bearable at least, when not lifting or bending. However this new post-surgery pain, which is far more severe and in a new body region, is unbearable. And of course I am avoiding any lifting, bending or twisting.

The oxycodone and flexiril is not helping with this new pain, but is helping minimize pain which I had pre-surgery, along with the pain from the incision sites.

And the flexiril/oxycodone is causing blurry vision and producing hot flashes.

The pre-surgery documents I received from the surgeon lists specific exercises I was suppose to receive instruction on from the surgeons PT.

I'm unable to get in to see my previous PT (who I trust and has helped me in the past) until early Feb.

The message I left with my surgeons office this morning was not returned.

Tomorrow I will call my primary provider's office to see what they can recommend as I feel my surgeon is done with me. (one more follow up appt with the surgeon in early Feb). I'm beyond frustrated with the lack of communication and lack of follow through from his practice.

At this point the results of the surgery have put me in bad place physically and mentally. The light at the end of the tunnel is beginning to dim. I'm beginning to think I'll be crippled for life and that is scaring the hell out of me. Never been in this dark place before.

Possible "Failed Back Syndrome" aka "post-laminectomy syndrome"?

Last edited by Skywatch; 12-23-2016 at 05:00 AM.

 
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