I have had lower back pain for many years. I have had been treated by the VA (Vet with disabled rating). In late October 2011 I had progressive symptoms -- pain down backside to right leg to foot, buttocks, to foot and weakness, contacted VA Doc and they ordered MRI, with the great speed if the VA system had MRI in early Feb but no appointment.
On Feb 28th symptoms increased and went to local ER. In the past I have been there a few times and they would always say no back emergency give me meds and send me on. This time they were able to get my MRI right away electronically.
The ER came in and said you have a major problem and kept me in ER until Neurosurgery came and talked to me and problems are from MRI and the Neurorsurgeon -- L2-3 and L3-4 severe canal stenosis with narrowing to 4mm and L3-4 has severe forminal stenosis, L4-5 has moderate to severe canal stenosis and forminal stenosis. L1-4 there is broad based bulging and L2-3 has right paracentral superimposed disk protrusion, Aslo advanced DDD and Disk Desiccation. The neurosurgeon stated at this time conservative treatment is not indicated and surgery should be done soon.
I was unsure of this because no conservative treatment offered, though PT in past and I am not a candidate for ESI and then I said lets see what happens and then got a some other opinions from both neurosurgeons and primary care, concurred with above.
I tried putting off but my symptoms have increased to where my right foot is numb quite a bit, increased pain in back and symptoms now increasing in the left leg. Yesterday I made the choice to have surgery due to PC saying my symptoms and weakness have increased in just the last few weeks. So I have scheduled another consult with original neurosurgeon I spoke to. Surgery will be MISS at at 3 levels for Central and Forminal Stenosis (Microdiskectomy).
Mind you I am fearful of surgery (greatly) mostly due to anesthesia due to high blood pressure (controlled) and I have been a smoker over 30 years, so any if you have any information, support, and information to offer would be appreciated. I will see the neurosurgeon on April 24th again to re-evaluate and reschedule surgery (I chickened out the first time) unless the surgery is earlier, my PC said my symptoms are increasing fairly quickly.
Thanks a lot for any help I have been lurking here for a few weeks and saw lots of good stuff and I done a lot of internet research.
Jerry
Last edited by martian5; 04-14-2012 at 07:41 AM.
The following user gives a hug of support to martian5: Serial (04-14-2012)
In the lumbar area, they are very few true emergencies -- you almost always have a chance to gather several opinions and reach a careful, considered decision. The spinal cord ends around the T12-L1 level...so any damage above this level can result in paralysis. Below this level, the nerves bundle together in what is called the "cauda equina". While lumbar problems can cause immense pain, there is not a medical emergency unless there is loss of bladder or bowel function, sudden muscle weakness such as drop foot, or, the most difficult one to define, horrendous pain.
Anyone with lumbar issues needs to be aware of the bladder and/or bowel symptoms as that is a sign of possible cauda equina syndrome, which requires immediate medical treatment. The timing of the treatment is important so the person doesn't suffer permanent, irreversible damage.
Luckily, you do not report any of those symptoms, so you have some time to consider your choice of a surgeon. It is always a good idea to get more than one opinion, and I always suggest seeing a neurosurgeon and an orthopedic spine surgeon because, even though the specialties have similar training, sometimes methods of treatment are somewhat different.
Usually when there is stenosis, a laminectomy is performed to create more room for the nerves. You mention have discectomy -- do you know if the surgeon is also planning laminectomies? Often if more than one level is necessary, a fusion becomes the surgery of choice due to the instability that is created when removing part of the lamina at more than one level. This will be something to look into when you meet with the neurosurgeon.
You can find information about these various procedures and can also read up on stenosis online. Just be sure you are reading information on a reliable source from a noted medical clinic, hospital, or the government's NIH. Then you will be familiar with the terminology so when you speak with the doctor, you will have some idea of what he is suggesting is wrong and what plan of treatment he has for you.
Thank you for your reply. At this time there is weakness mostly in the right leg and foot, there has been a history of right foot drop and exam shows significant weakness of the right foot and moderate weakness in the right leg. It has been noticed by the doctors that there has been some increase in these symptoms over the last 6 weeks. The first neurosurgeon states that not emergent at this time it should be taken care of quickly.
I have consulted with 2 internal medicine doctors and 2 neurosurgeons and they all concur, I was trying to find someone to kind of say no maybe conservative but they feel conservative measures only have at most 10-20% chance iof helping.
Initially the MISS is to be at 3 levels though the laminectomy has not been ruled out. Full decision will be made on the 24th of April. Oh and the pain, let me say it is there, has been for some time, but has greatly increased over the last 4 months. Thanks for the input.
Last edited by martian5; 04-14-2012 at 10:26 AM.
Reason: correct info
There are many "more expert" board members that can weigh in on a situation like this, and I'm sure that they will.
I'm having multi(3)-level lumbar fusion surgery in a few weeks and I've found this board to be an invaluable resource.
The best advice that I've gleaned from this message board community (teteri66 and others) is to solicit the opinion of a "fellowship trained spine specialist" whose practice revolves around this type of spine surgery. The credentials of the spine doc are very important. Hopefully the VA will make this type of professional available.
Trust me; I'm going into my 2nd surgery with a decompressive lumbar laminectomy being my first surgery 4 years ago. Am I apprehensive and maybe a little scared? Absolutely.
But get expert second and third opinions, and give yourself all you can to make an informed decision. For me, it comes down to being able to live any semblance of a normal life.
Also, I know it’s easier said than done, but quit smoking as soon as possible. My surgeon tested me for nicotine in my pre-op physical. Nicotine inhibits fusion of the spine levels and overall healing. My surgeon will cancel the surgery if I test positive.
Again thanks for all the replies. I will clarify a bit more. The VA was dragging it's feet so when things started going bad at the beginning of March I went to the local civilian ER, and that is where the neurosurgeon saw me from a very well known regional orthopedic and neurosurgery group. They are well qualified and he is board certified. I got my 2nd opinion at the Northwest's most highly regarded university hospital and their spine center. At this point I will not be using the VA system for this (luckily I still work and have decent insurance and will be covered on this).
My problem is I have a great fear of surgery, not actual procedures, but the anesthesia. Had a bad experience many years ago but was due to the nerve block and had a bad reaction from that. So I am working that out, I cancelled the surgery once, but I realize this may need to be done so seeing the neurosurgeon again to reschedule and go over my fears.
Sounds like you've done a lot of good research. In my run-up to surgery I was asked as to any adverse reactions to anesthesia. I'll bet they can get it worked out.
If things are getting worse I would think it's wise to consider surgery. I have a severely herniated disk but luckily I feel better every day. I can put weight on my left leg now and I can walk most of the time without a cane (unless I've been sitting, or standing or walking for a while) I shuffle like an old man, and I'm only in my 40s so I hope things get better on their own. If not I will consider surgery.
I don't fear anesthesia, I was put out for a colonoscopy once, but that wasn't deep anesthesia. I fear that the surgery could make me worse, or give me constant pain, what I have right now is just some discomfort and I can live with that for now.
If you are getting worse you should do the surgery, things are not going to magically get better on their own, good luck.
Be sure to explain your prior experience with the anesthesia to the surgeon. There are many options available, so they can work around any problems. If other specialists are needed in the operating room, they will take care of that.
My grandmother (RIP) had to have a heart surgeon in the operating room for any other surgeries she had, and they had to make adjustments for her heart condition (2 prior bypass surgeries). They can make adjustments for other conditions and issues as well.
I would definatly talk to doc about your anxiety regarding surgery to help ease your concerns. Wit severe stenosis you really have to weigh your options. I know surgery is scary but so is ending up with perm nerve damage, I am not a doctor and can not offer any medical advice, but I do know the longer you put it off and the more nerve damage that occurs the more healing time it is going to take. your nerves are going to have to adjust and your body will go through stages of healing, something I would definatly bring up with doc pre-surgery so you are educated on what to expect.
I wish you the best of luck and I'm sorry you are going through all this pain and anxiety. Please keep us posted after your doctor visit with any recommendations and/or concerns. And of course the decision to have or not to have the surgery. Good luck.
Sorry I have not updated lately. The last 3 weeks have been hectic. I wanted to thank all for your advice and I did follow many of your suggestions. I have gotten another opinion as well as seen my PCP. All have agreed that surgery would be the best bet. Weakness has progressed in the right leg as well as pain an no reflex in right ankle. Also symptoms increased on left side, oh and the pain.
Anyway surgery is now scheduled for June 15th (soonest available for time frame needed for actual surgery and gives me time for paperwork and set my financial concerns) and will be a 3 level microdiskectomy . I have discussed my anxiety and concern and they have been addressed by my neurosurgeon and he will help best as can.
If anyone would like I would appreciate any information on what I might expect and some of what I might prepare for. I will be researching some of the previous posts to gather information. I know mine will be minimal compared to what many of you have gone through and you all have my due respect. Any help or information would be appreciated.
Did everyone you spoke to recommend that particular surgery? Discectomy is usually not done for stenosis...so I'm wondering if he is also planning on doing a laminectomy.
Good point. From what I was able to discuss the PCP agreed and the 2nd NS also stated would be proper. I think this is the reason I was asking a couple of weeks ago if any of you had seen a 3 level micro-d.
My understanding the NS will place the tubes at 3 different points and at each point remove a small piece of the lamina then go in and clean out microscopically. From what I understand a endoscopic laminectomey. Supposed to make recovery much quicker on a 1 level basis. I have researched his background and he specializes in this type of surgery and is highly regarded in the northwest for this type of surgery. Another interesting fact is that he got his PHD in neurobiology before going on to med school.
Again you bring up the reasons I was asking for information about preparing and what to expect in recovery (and beyond). The NS states it will be about 6-8 weeks before going back to work (I have a desk job, data research analyst).
I would also talk to them about scar tissue, in my personal experience the scar tissue after a discetomy is what has caused me so much pain. Any recommendations on prevention on this by your docs? Especially a three level leaves more room for fibro build up. I wish you luck and hope you have a quick, semi-painless recovery. Keep us posted
One thing you want to look at when looking at "success" rates, particularly regarding endoscopic disc surgery, is how long do they last? When this endoscopic procedure is done correctly, the surgeon should be able to preserve the posterior spinal structures, which will minimize postoperative weakening or instability of the spine. Multiple level surgery can be performed without increasing the risk of creating instability.
Am I correct that the surgeon will be performing laminectomies rather than discectomies?
Thanks for the information and questions you have raised. I have contacted the neurosurgeons office with some of the things you bring up.
The full actual surgery will be a discectomey and 3 levels with bilateral decompression using microscopic techniques. The NS states there should be a 90% chance of success with a 75% success at 7-8 years. He did go over that there may be no improvement and most of his concern is with permanent damage at the L2-3 level (this is where the disk protrusion is largest and the stenosis is greatest with less than 4mm of space left and nerve impingement). There could be scarring but with this technique and if I follow through with my after care (walking, PT which will begin at 6 weeks post-op) we hope to keep this at a minimum. Again the aspect of 3 levels play into this. The NS has done 3 levels before and feels that this will work for me. He is not one to jump into surgery, I checked this out with others but especially with my PC and the ER doctor who initially saw me in the ER a couple of months ago, this was a concern with me and I checked on this.
Since I value your advice, you have given me great question to ask and research, I will give you the NS name: Dr. Wael Musleh. By the third time I spoke with him I felt comfortable with him and he was very helpful, listened to and answered all of my concerns and questions.
Sounds like you have done your homework...and that's what I want potential surgical candidates to do before signing on the line!
No one can predict who will end up with nerve damage, whose nerves will regenerate and recover and how long it will take, if it does happen.
I was told by several doctors after my first fusion that chances were excellent that I would have permanent damage. I had my second fusion several years later and the nerves were still compressed. I do have numbness in my toes and to some extent my feet that will probably remain, but all the nerve pain is gone and my feet have improved...so, you just never know.
