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Old 10-19-2012, 12:52 AM   #1
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diffuse disk bulge, moderate to severe spinal canal stenosis

About a year ago I hurt myself lifting some very heavy furniture. My Dr. seems to believe my symptoms were waiting and ready to bloom and the strain pushed them over the edge. Since the injury , I feel extreme pain in my lower back, radiating down into my left buttock and down my left leg into the outer thigh. I believe when i use the word pain members here know it's not being used lightly.Jolts of shooting pain lasting 10-15 seconds at a time, as if i'm being electrocuted, is the best way to describe the shooting stabbing, burning pain ! ! My MRI's describe :L3-L4: Diffuse disc bulge with superimposed central disc
protrusion along with facet joint hypertrophy and ligamentum
flavum hypertrophy determining moderate to severe spinal canal
stenosis and mild foraminal stenosis bilaterally.L4-L5: Diffuse disc bulge along with facet joint hypertrophy and
ligamentum flavum hypertrophy determining mild spinal canal
stenosis and mild foraminal stenosis bilaterally. Degenerative disease of the lumbar spine as described above,
more prominent at the level of L3-L4 where moderate to severe
spinal canal stenosis. I've had 6 epidural steroid inj.'s with minimal results, forget therapy it just aggravated it worse. I can barely walk up stairs or carry any weight at all. An EMG backed up the results as well of the MRI.. Here's the problem, my neurosurgeon seems to think the damage is not severe enough to attempt surgery. The radiologist who performed my last epidural reviewed my MRI with me in detail on screen and believes the surgeons hesitation is due to the difficulty reaching the area where the damage is most prevalent. He showed me the facet joint in L3-L4 where the nerve is trapped and there's bad build up of arthritis trapping the nerve badly. When i reviewed the MRI with my neurologist he seemed less concerned with the radiologists opinion and more towards the encroaching disk at L3-L4 showing the protrusion and where the spinal canal should've been straight and white on the MRI it was severely bent and totally black proving there was limited space due to the protrusion and stenosis at L3-L4.I've developed a bad limp now because the pain in my leg as i step triggers the nerve pain to the point where i have to bend over to alleviate the shooting pain!! I can't live like this, the pain is really bad, I'm a regular at the pain clinic which I'll eventually become more tolerant with the narcotics prescribed. My questions are, Why is the surgeon hesitant to operate on the facet area? Is it true what the radiologist said about the surgeon difficulty getting to the damaged area around the facet joint? Hard to get to? I've seen two specialists already, both see the damage but both seem uneasy with proceeding , why?? Are there any more tests I can push for aside from the MRI's ? They haven't used any contrasts in either MRI, would it help them define the damaged areas better? I'm getting desperate, as we know the pain can become soo overwhelming that it leaves us feeling alone and helpless......My previous health problems include a degenerating RT shoulder rotor cuff - repaired 7 times awaiting total replacement prior to this recent injury. I'm 51 years old and have bad arthritis , becoming worse in my hands and shoulders.

Last edited by finaritwo1; 10-19-2012 at 01:14 AM. Reason: additional info

 
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Old 10-19-2012, 06:31 AM   #2
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

Welcome to the board. Sorry for the reason you found your way here. I had similar issues, so can totally relate to the pain of stenosis. I was reluctant to have my first spine surgery, and as a result, probably waiting too long. I will probably always have numb feet as a result. In hindsite, I wished I had made a decision sooner.

What I did learn during that time was how even the best surgeons do not always agree how to proceed to resolve the issues. Before that surgery, I got evaluations from 8 different spine surgeons, and had opinions that varied from the necessity to fuse one level up to four levels....

The problem with severe stenosis is that no amount of PT or injections is going to make more room for those nerves that are being compressed.

Obviously I am not a doctor nor do I have any formal medical training, so I can't say what it is about your situation that makes your surgeon reluctant to operate. I imagine your facet is enlarged -- arthritic changes usually result in the ligaments thickening up and the formation of bone spurs. These problems can be dealt with surgically. Actually if you were being fused, the facet can be almost entirely removed.

In my case, it took three surgeries to "get it right." All along, everyone felt my problem was at L5-S1 after I was fused at L4-L5. But in the end, when the surgeon got in there, he discovered that my L3 facet was basically worn away to a tiny little numb. This had not shown up on any MRI or other imaging I'd had done. It was a surprise but the surgeon was able to deal with it. Turned out that level had been the biggest pain generator all along. By day 4 post surgery, my sciatic pain was completely gone for the first time in about eight years! What joy!

I would suggest you do some research, find the best orthopedic spine surgeon that is available to you, and make an appointment. Sometimes they have a slightly different way of approaching things than the neurosurgeons.

You need to be careful letting the PM doc continue to inject you, especially when it has little effect. Some doctors limit their patients to three ESIs within a six month period to avoid the adverse effects of the steroids.

For pain, you might try a far infrared heating pad.

 
Old 10-19-2012, 07:51 AM   #3
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

Thank you for your response. I know what you mean, the bottom of my right foot is completely numb.. The neurologist explained it as waiting too long from the nerve damage.. Just walking causes extreme pain in my left buttock.. Who knew!!

 
Old 10-19-2012, 09:05 AM   #4
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

Wow...I can only imagine that level of pain on a constant daily basis. Ive had it only a few times when I tried to jump out of bed to fast and hit the floor, unable to stand up...having to claw my way downstairs, to call for an ambulance...but I refuse to have surgery. Refuse too. Why??? Because its a guessing game at its best. You can sit there and look at MRIs, XRays, CT's right along with the Dr, but how do you know that this guy has any idea what really needs to be done?? Just ready some of the post on here...how many of them, probably more than 80% required repeated surgeries after cutting you open, and seeing that OOPS, Dr. didnt see how BAD it really is, or OOPS, you really were not as bad as he thought, and surgery was unnecessary. I cannot tell you not to...just remember this...if your body works in manner x, and becomes broken, looks how much it hurts...now, as your body tries to fix itself, by compensating, you learn to limp, not do as much physical work, etc...and sometimes that does more than any medicine can...so not only do you have a weakened structual body with the injuries, imagine cutting that open, and destroying the muscles and tendons or severing those, that had been toned to help you even if it hurt...you basically end up with such a compromised skeletal structure that your body has to put all that stress on healthy joints, limbs, vertebrae, etc....say hello to another and another surgery as they try and out run the damage being done....so if you do this, you might as well have the whole plan done and that way you limit and stop the damange from spreading.

Just a final thought...have you ever tried spinal decompression??

 
Old 10-19-2012, 06:43 PM   #5
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

Exactly why I've been hesitant towards any surgery. When I completely tore my rotor cuff tendon, the ortho said not to worry, we only have to do it with a scope. Well 5 days later I was still in the hospital with a 6 inch incision across my shoulder. It ended up being MUCH worse than expected ,spurs, a fracture, degeneration,etc.... This is with, in my opinion, a shoulder with an MRI that was suppose to be in and out in the same day..Now as you explained , imagine searching for that needle/nerve in a hay stack somewhere ,L3-L4, L4-L5, ruptured,bulging,encroaching,and what ever happened to L5-L6?? it never showed up in the MRI results.. I know that the pain has become life altering and almost disabling, but how many surgeries will it take? The big question from the beginning was why is my nuero soo scared to go in and remove the burs from the facets? I spoke to the radiologist this morning. He educated me on a piece of new equipment that hasn't been approved by most major HMO's. It's been in use for alittle over a year he said. Interestingly enough he said if i was on welfare or Mass health the hospital would approve the use of the procedure with it. My HMO will not due to the experimental phase. The radiologist explained how this tool enabled the surgeon to enter the minimal incision and angle it towards the injured facets ,able to remove burs,grind and free up the space. I'm sorry I didn't write down the name of it but it was only a number, like "L909". He said it didn't even have a name yet. If someone in the Boston area that's been operated on in Brigham & Womans Hospital or The Baptist Hospital might know what I'm talking about..Let us know!!

 
Old 10-19-2012, 10:02 PM   #6
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

You can try waiting until the technology is approved...but by then you will probably have additional issues that will need attention.

I believe the spine is somewhat unique among various body parts. It is so complex and the parts are all interconnected...what happens to one part has an effect on other parts...so there is seldom a situation where one procedure resolves all issues, now and into the future.

Also, the spine continues to degenerate as we age...so it is an uphill battle to try to stay even.

With lumbar issues, since there isn't the cord compression issue to worry about, people can take their time in reaching a decision about surgery. Unless there is bowel or bladder involvement, or a sudden muscle weakness, most lumbar issues are not considered a medical emergency. Most lumbar surgeries are considered "elective."

It is always best to avoid surgery if you can...but when nerves are being compressed, it is a gamble as one never knows at what point nerve damage will become permanent and irreversible. People told me "You will know when it is time to have surgery." Turns out they were right. But that point is different for every person.

 
Old 10-20-2012, 07:38 PM   #7
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

I've heard that before, " when it's time you'll know it ", honestly it's about time. One big mistake I've made is googling disk operations, stenosis, fusions, etc. Oh my God, the layman's understanding of the recklessness, burring, chiseling,literally snipping out pieces of bone is amazing. I expected it to look more precise. In one particular video of Laminectomy Bilateral Decompression where the back of the spine is completely removed and it allows the decompression of the nerves,supposedly to move freely afterwards, is daunting. All of that to discover the area in particular that my nerve may be trapped and to eventually free them/it. WOW... My big question here is after two regular MRI's without contrast is there another type of imaging that can give the surgeon a more detailed look or a better understanding of where the entrapment is? Today , for example was very intense, pain ,constant, with breakthroughs every half hour or so. So intense that i saw little white stars... Looking at me from the back the pain initiates on the base of L3-L4 facet area on the left side shooting/exploding into my left buttock and down my left thigh ending up in the shin bone as though someone is scrapping it down with a razor! The Dr. can't see this or it's origination? Thoughts!?!

Last edited by Administrator; 10-20-2012 at 09:26 PM.

 
Old 10-20-2012, 10:51 PM   #8
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

I have never watched any of those videos. I had to have a temporal artery biopsy and I made the mistake of watching that procedure and it made the experience that much worse.

In my experience, it is not always possible to tell definitively where the pain is coming from. After my first lumbar fusion, the surgery was "successful" but my sciatic pain was the very same as before surgery. My MRIs that were taken post surgery indicated that there was no nerve compression so my doctors were baffled. According to the location of my pain, my pain should have been coming from the L4-L5 and L5-S1 segments.

But ultimately when my surgeon opened me up once again, surprise, surprise!
My facets at L3 were worn away to tiny little nubs, allowing incredible instability. He was very surprised as this had not been evident on any of my testing....and, after he worked his magic, four days later my sciatic pain was gone for the first time in about seven years.

 
Old 10-21-2012, 04:31 AM   #9
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

God bless! Just hearing someone tell their story and end it with " I'm pain free or the pain bis nowhere near what it was.." , puts a smile on my face . I'd still like to hear about different testing that are available to the dr.'s. imaging that can diagnose the difference between facet and disk issues..?

 
Old 10-21-2012, 05:11 AM   #10
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Re: diffuse disk bulge,moderate to severe spinal canal stenosis

On a side note, and most important reason of all , I'm a 51,year old new dad with my first child , a boy, who is 2 1/2 years old , and a second on the way ! Started out late in life , but I need my health to keep up with my little guy .. I never imagined being a dad , but now everything's changed. I have to get up everyday and no matter how much pain I'm in , I must provide..

Last edited by finaritwo1; 10-21-2012 at 05:14 AM.

 
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