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Old 09-24-2012, 11:13 AM   #1
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Help...

I have had back pain for the last few years getting worse in the last year. I have pain in my lower back that shoots down both sides of my backside in to both legs, groin and feet. I went to see and ortho. Dr. and was to told I needed and MRI. My Inc. would not approve the MRI till I did 4 weeks of P.T.. After the P.T. that only made it worse I got my MRI. I went to my Dr. only to be told that he can not help me and that I need to see a spine Dr. and he will not give me any pain meds. I have a copy of the report but have no idea what its talking about. Somehow I got the feeling nor did he.

Findings:
There is no evidence of acute fracture or dislocation. No focal marrow signal abnormalities are identified. Mild disk desiccation is present L4-L5. Visualized portions of the spinal core are normal in signal and morphology with conus terminating at T12-L1. No parasplinal masses are identified.

Lumbar disk Levels:
L1-L2: No significant disc/facet abnormality, spinal stenosis, or foraminal stenosis.
L2-L3: Moderate to severe central canal narrowing with effacement of the CSF from the cauda equina due to congenital narrowing of the spinal canal combined with prominent epidural fat.
L3-L4: Mild left neural foranimal narrowing and moderate to severe central canal narrowing secondary to congenital narrowing of the spinal canal combined with prominent epidural fat. Mild ligamentum flavum hypertrophy is present. There is effacement of the CSF from the cauda equina.
L4-L5: Mild right and moderate to severe left neural foraminal narrowing secondary to ligamentum flavum hypertrophy, prominent epidural fat, and broad-based disc bulging. There is a superimposed left lateral disc protusion which enters the neural foramen and probably contacts the exiting left L4 nerve root.
L5-S1: Mild right neural foraminal narrowing secondary to broad-based disc bulging, right greater than left.

Conclusion:
1. Moderate to severe central canal narrowing at L2-L3 and L3-L4 secondary to congenital narrowing of the spinal canal superimposed with prominent epidural fat. There is effacement of the CSF from the cauda equina at these levels.
2. Moderate to severe left neural foraminal narrowing at the L4-L5 secondary to a lateral dis protrusion with contacts the exiting left L4 nerve root.
3. Additional Mild-to-moderate degenerative changes as detailed above..



English please?

Thank,
Frank

 
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Old 09-24-2012, 11:21 AM   #2
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Re: Help..

I suggest another opinion,this time by a neurosurgeon who specialises in spine stuff. At least that is what I did. My pain was similar to yours but my MRI showed different than yours. Good luck and be your own advocate. Call your ins and start calling Dr's to get seen asap as you should not have to suffer in pain. Good luck.
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Old 09-24-2012, 11:40 AM   #3
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Re: Help..

First of all who should you treat with?

You have an option of treating with an Orthopedic Surgeon or a Neurosurgeon. But one thing that you should make sure of is this, they should be trained in treating spines and is that their speciality in their practice now?
The reason I say either Ortho or Neuro is this. I have had spine issues for 24 years. And it has become a complex problem over the years. I have been treated by both Ortho and by a Neurso surgeon and was satisfied with both.
But what is important to me at least in selecting a doctor is the following:
1. Where did they receive their degree from;
2. Are they specialists in spine related issues;
3. For me also being affiliated with a major teaching hospital is a plus, but that is just my opinion;
4. and what is extremely important in any doctor is how well do they communicate with YOU the PATIENT?

As to your spine issues:
1. the majority of people over 18 will find that they have some spine related issues. Doing an MRI on someone you will probably find some degenerative changes. So that in of itself is not unusual. But if it produces symptoms then you need to address the problem.
2. It appears that a majority of your issues are with "stenosis." Stenosis basically means that there is a narrowing. The narrowing can usually occur in 1 of 2 ares. The central canal. Think of your spine and down the center of the spine is an opening. Thru this opening runs the nerves. Some of the nerves will go to help with your arms; hands and others go further down to other parts of the body such as the legs and the feet. So that is the central canal. But also from each of the levels in the spine there are exits from the spine. For example nerves that exit one area in the neck affect the nerves in your amrs; hands fingers etc. In the lumbar area the nerves that exit your spine deal with the nerves in your leg.
You appear to have issues with both the central canal and also where the nerves exit from the spine which is called the "foramen."
So with this narrowing there is a pressure that is placed on the nerves thus pain etc.

I went thru surgery years ago on my neck because I had stenosis of the foramen, the exits from the spine and was causing pain etc. Thus they had to take the pressure off of the affected area before damage was done to the nerves. I also have stenosis in the lumbar area and now stenosis in the neck again but this time it is of the "central canal.:

Medication can relieve the problems for you, plus therapy can help too. Before any surgery is considered I would suggest "conservative treatment: which means medication & therapy.

Only when all else fails would I recoment surgery. I have been thru 7 spine related surgeries of both the cervical (neck) and lumbar (low back). Due to the severity of my issues I have Harrington rods in 1/2 of my spine.

I wish you the best. If you have any questions please feel free to ask. There are a lot of people here with a lot of experience as "patients" and can tell you what they have been thru "good" and "bad"
Please keep us posted. Good luck

 
Old 09-24-2012, 01:33 PM   #4
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Re: Help..

The problem that you have is a bit more serious than normal central canal stenosis. The cauda equina is the bundle of nerves that serve the area of your body from your hips down to your toes. Are you having any issues with either emptying your bladder or bowels completely? Difficulty completing bodily functions? Experiencing more numbness and difficulty standing or walking? More pain and or numbness in the areas of your body where they would come into contact if you were on a saddle to ride a horse?
Your MRI says that you have congenital narrowing in the L2-L4 areas. Congential means that you have had it since birth. The problem that I see mentioned is the congenital narrowing accompanied by the excess epidural fat is compressing the nerves in the spinal canal which is most likely what is causing the majority of your symptoms. The usual remedy for that is to relieve the excessive pressure on the spinal nerves since ongoing pressure to them can cause more problems down the road. Mild means that treatments are usually conservative, injections, physical therapy, TENS, etc...when you move into moderate and more importantly severe cases of stenosis, injections are not likely to work, physical therapy can help strengthen your core muscles but will not relieve the compression of the nerves in the canals.
A second and even a third opinion with a board certified spine ortho and neurosurgeon is always a good idea before going down the surgical road but keep an eye out for those symptoms that I mentioned in the first part of my post. If those occur, you need to contact your surgeon immediately as those are considered to be a surgical emergency. Cauda Equina Syndrome can become permanent if you wait too long to relieve the pressure on the canal nerves.
I don't want to scare you, but do want you to be aware that if you are experiencing or start to experience those symptoms you do want to let your doctor know right away.
Good luck
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Old 09-24-2012, 04:08 PM   #5
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Re: Help...

Thank you all for the info. I have a few more questions now that I have seen the replies. I'm a 38yo male, I have been in the same trade most of my life. I'm an industrial electrician. Lot's of walking, climbing, bending, keeling, and lifting. Over the last year this has be very hard for me to do. Thank God I work with such a great bunch of guys and gals that they have looked out for me most of the time, but I can only ask them to do that for so long. So here goes, Is this ever going to get better? Am I ever going to feel like I did when I was 30? If not I guess I need to start looking at other ways to make a living. As far as my pain, It seems to get worse at night. I have nights where I cant sleep due to the dull deep pain on the outside of my hips. I have weakness in my left leg. I have fell a few times getting dressed. The pain kinda comes and goes as far as hurting very bad, but Its always there dull ake. Back, hips, down the back side of my butt, groin, back side of my upper legs, both knees and feet. I feel like I have to go to the bathroom alot more now than I used to, most of the time with very little coming out and it getting on the front of my paints when I "think" I'm done. I have told all this to the Dr. I was seeing without him saying much. To tell you the truth I'm scared. I have always been a go getter. This has just slowed me down so much without much help when I was made "wife" to go see a Dr.
Thanks,
Frank

 
Old 09-24-2012, 05:03 PM   #6
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Re: Help...

All depends on what they can do for.you. I had a double fusion, I have metal in my back, did heavy lifting and that is how I injured my back but it turns out I already had DDD and arthritis. I was told by my neurosurgeon before surgery that with or without surgery I would never lift again. Or, if I attempt to post surgery I would be in worse shape. I'm bummed of course, but to not have the pain shooting down the legs, in the butt, etc. I am ok with that. I have no idea if my work will put me into a sit down job with no lifting or not, as I was on probation when I got hurt, so we are just making it up as We go along. Everyone is so different, but I personally can't see a Dr letting you return to that much bending, lifting, etc but then I am no Dr. Good luck. Maybe you could give the estimates, do.the paperwork?
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Old 09-25-2012, 09:27 AM   #7
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Re: Help...

Frank,
I have had Cauda Equina Syndrome twice. It is not a good thing, which is why I mentioned the symptoms to you when I read your post. If the surgeon that you saw did not take you telling him that you are not able to empty your bladder and or bowels completely, the feeling of having to "go" but not being able to tell when you are finished or the leaking, then you need to find another surgeon and fast. A lumbar fusion is not the end of the world, although the recovery takes up to a year. Once the vertebra fuse, then most likely, you can return to making a living.
The falling is also not a good thing and I am afraid that either your surgeon is not taking your symptoms seriously enough or could you be downplaying your bladder and bowels issues a bit? I know that I did, mostly because I was embarrassed that I was having "accidents". If you are minimizing things, don't...this is serious. The sooner the pressure is relieved on your spinal canal, the better chance you have of recovering well....
Please call your surgeon and have a serious talk with him....and if he doesn't listen, find a new surgeon....today.
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Old 09-25-2012, 04:26 PM   #8
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Re: Help...

I tried to call the Orth. office with no call back. I just got off the phone with the ER and tried to tell them what was going on. Is it just me or do health care people just don't care anymore? I was told that if I have a Dr. taking care of me I need to see him. I was told by the ER to keep calling his office back till I get someone to talk to me. I have had it. My stomach is so upset all the time due to the one Med. that the Dr. did give me. (Mobic). I'm in pain today. I'm so sick of being treated like this is all in my mind, anyway it looks like its going to be a long night.

 
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Old 09-25-2012, 04:37 PM   #9
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Re: Help...

Unfortunately I am not happy with the status of health care. Yes there are doctors offices that will call back in emergency situations. But I find getting return calls a problem. I have complained about doctors offices especially if they are affiliated with a hospital directly to the CEO if I get the run around long enough.

If you feel it is an emergency then you should consider going to the ER. But that is your judgement as to what is best. I know if I call a doctors office and get the usual voice mail it says if this is an emergency go to the ER. Otherwise you go thru the usual prompts to leave a message on right voice mail.

I would call again and see if you get an answering service a live person to ge the message that you need to speak to the doctor immediately.

Good luck

 
Old 09-25-2012, 04:54 PM   #10
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Re: Help...

[QUOTE=FrankL;5061895]I tried to call the Orth. office with no call back. I just got off the phone with the ER and tried to tell them what was going on. Is it just me or do health care people just don't care anymore? I was told that if I have a Dr. taking care of me I need to see him. I was told by the ER to keep calling his office back till I get someone to talk to me. I have had it. My stomach is so upset all the time due to the one Med. that the Dr. did give me. (Mobic). I'm in pain today. I'm so sick of being treated like this is all in my mind, anyway it looks like its going to be a long night.[/QUOTE]

Frank,
I'm sorry. I would call them first thing in the morning and tell them that you either need to speak to the surgeon, or you need an urgent appointment if you are experiencing the symptoms that I mentioned. As far as the ER, many doctors are unaware of the symptoms of Cauda Equina Syndrome and many more are unversed in it's urgency. I don't think it's that they don't care, it's that they don't know what it is, what it can do.....are you taking the Mobic with something to eat? If not, you should try to eat something either before taking it, or right after. That may help with the stomach upset.
I'm sorry that you are hurting.
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Old 09-26-2012, 05:58 AM   #11
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Unhappy Re: Help...

Well got to go see the company Dr. today. He would not let me go back to work even on light duty. After reading the results of my MRI and the symptoms I am having there is no way he can let me back on an industrial site. He did tell me that I did not have Cauda Equina Syndrome, but to be on the look out if some of the things I had going on got worse. Now its a waiting game to see what the Dr. has to say next Wed. Till then it's ice packs, heating pads and OTC pain meds.

 
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Old 09-27-2012, 07:19 PM   #12
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Re: Help...

Frank,
I'm glad that it is not CES yet....but it does sound like the doctor is concerned enough to take you off work which tells me that he believes that it could become that urgent. Many doctors believe that CES ( cauda equina syndrome) must have a completel lack of control over bladder and bowels and nowhere does any of the literature say that....it says a change in your ability to move or empty your bladder or bowels or an inability to start or stop the flow/bowel movement...
Again, be very, very careful about sudden movements, especially bending, lifting or twisting...and see your surgeon and discuss the symptoms you are having, and see what he says....until then, do as the company doctor told you....take it easy, rest and take your meds.
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Old 10-04-2012, 08:56 AM   #13
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Re: Help...

****** off is an understatement right now. I went to this so called Orth spine Dr. today. Walked in to the room, never told me his name. Sat down and ask me what's been going on. I told him all about the pain and having trouble taking a pee and how when I have to go I HAVE to go. He took one look at my MRI (only one now) shot. Never looked at the report and looked me in the eye and said I really don't see anything wrong here maybe you should go see a urologist!!!! Then say that I could come back and see the Dr. that does the back shots if I like. Well I hate to say it fooks but at this time the Redneck took over in me. I fired him, his staff and told them if they wanted the Co-pay to go to hell. Got copy's of my med. records and headed to a Nero Dr. Showed the nice lady at the check in window it, who handed it off to the PA that was standing next to here and low and behold I have an apt at 1:30 that someone must drive me to! Not sure whats thats about but we shall see.
Frank

 
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Old 10-04-2012, 09:41 AM   #14
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Re: Help...

I've had horrible ortho like that too. Good for you! Let us know what happens later. Good luck, finally you may get taken seriously and get some relief!
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Old 10-04-2012, 09:48 AM   #15
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Thumbs up Re: Help...

I have had back problems that started in 1973 I will do my best to explain the Conclusion. The first is from your report. The second is in my words. I am not saying I am 100% right, only my opinion.


Conclusion:
1. Moderate to severe central canal narrowing at L2-L3 and L3-L4 secondary to congenital narrowing of the spinal canal superimposed with prominent epidural fat. There is effacement of the CSF from the cauda equina at these levels.
2. Moderate to severe left neural foraminal narrowing at the L4-L5 secondary to a lateral dis protrusion with contacts the exiting left L4 nerve root.
3. Additional Mild-to-moderate degenerative changes as detailed above..

Conclusion:
1. Moderate to severe spinal canal narrowing at L2-L3 and L4-L4 that is second to narrowing maybe from birth of the spinal canal. Extra fat is in the spinal canal, putting some pressure on the nerves in the lower back. There is the shortening, or thinning, of a tissue of the CSF(cerebrospinal fluid) from the cauda equina that is a bundle of nerves occupying the spinal column below the spinal cord in most vertebrates that consists of nerve roots and rootlets attached to the spinal cord. It serves the legs

2. Moderate to sever left neural foraminal (opening) has narrowing at the L4-L5 second to a lateral small contacts at the exiting left L4 nerve root. This will maybe make your left leg hurt the worst or week.


I hope this kinda helps you out. Find a Dr. that will explain the MRI findings and show you the images. Put your foot down and tell him/her it is your body and you need to know what this all is about.

The pee problem is a BIG problem, can you walk on your heels and just your toes? If not this is not good. Can you have a orgasm, if not this is a big problem. I have had the leg pain before, OMG if others only knew!

Remember, the Doctor works for you, YOU do not work for him!

Ask and Ask and Ask over and over until you understand this about your health. If you do not do it, who will!

Good Luck my friend. I see my back surgeon today at 4:30pm EST and again talk about surgery. I have not had any as to date on my back.

You can do it! Hell I know it is very hard on you, family and friends too. I do not even want to talk about how hard at work! WOW

MAN Hugs to ya Brother!
Dave

 
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