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Old 01-12-2013, 12:43 AM   #1
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L5-S1 Nerve root denervation & what to ask neurosurgeon

Hello! I posted in October regarding my husband. I posted the mri report then but since I'm not sure how to link it here, here is a partial summary. The mri showed bulges from l2-l4, and herniation at l4-l5 and a large herniation of 9x14 mm at l5-s1 with ap stenosis at 6mm. After being hurt in August at work this has been a very slow process and hopefully he will finally be seen by a neurosurgeon in February. He had his second esi last week and thankfully had decent pain relief from the first and so far the second, and had an emg/nerve conduction test this week which found the denervation. This explains why his pain has been reduced but the tingling and numbness has never completely gone away. The orthopedic treating him has agreed that he needs to be seen by a neurosurgeon, which I knew thanks to many here....but being a wc case this has been nothing but slow treatment between unqualified doctors. We were alarmed to find out that the original treating doc who has to do all doctor referrals and who sets work restrictions has had my husband working at almost maximum capacity these last 5 months. My husband has been working 12 hrs a day and lifting 20 to 40 pounds all this time. Never did the orthopedic or the pain mgmt. doctor ask about my husbands work restrictions until this week, though they knew he was supposed to be light duty. This week they both said he should have never been lifting more than 10 pounds and preferably even less. We stupidly assumed all docs involved shared their notes and the treatment plan. Sorry for venting, I think I am sharing so hopefully anyone in a similar situation will ask more questions. I wasn't able to attend every doctor's appointment and my husband has the belief that the doctors are always right...well, not anymore! So finally to get to the point, does anyone have any suggestions or questions we should ask the neurosurgeon?

 
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Old 01-12-2013, 10:27 AM   #2
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Hi its meG, Oh my goodness thats a huge herniation! Im so sorry that you all had such a misunderstanding & hope it didnt worsen your husbands condition.I assume you are seeing the neurosurgeon about possible surgery to relieve the nerve compression, yes?

 
Old 01-13-2013, 10:23 PM   #3
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Hey there! Yes, I believe so.

 
Old 01-14-2013, 10:15 AM   #4
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

[B]The findings section states: There is a large broad based disc herniation at L5-S1 flattening the thecal sac. Lateralizing disc bulges are seen from L2 to L5. The verterbral body height and disc spaces are maintained. There are mild endplate degenerative changes at L5-S1. There is no acute vertebral body compression injury. The distal cord and conus are normal, and the sagittal images of T11 through L-1 are normal, as well as retroperitoneal structures.

I am including the impression for for L3-4 as well. It states there is a 2.5mm lateralizing disc buldge, most accentuated into the neural foramina, and there is minimal neural foramina narrowing, left greater than right, when combined with facet hypertrophy and no central spinal canal stenosis.

L4-5, there are posterolateral osteophytes and a 2.5 to 3mm lateralizing disc protrusion complex extending into the neural foramina with mild to moderate neural foramina narrowing when combined with facet hypertrophy. The AP spinal canal measures just at 10mm.

At L5-S1, there is a large broad based disc herniation measuring at least 9 x 14mm in AP and transverse dimension, containing a very large annular tear. There is flattening and concavity upon the anterior thecal sac, and the AP spinal canal diameter is narrowed at 6mm. Lateralization of the disc into the neural foramina results in mild to moderate neural foraminal narrowing bilaterally, probably slightly greater on the right, when combined with facet hypertrophy.[/B]

I'm sorry your husband has been working all this time. Be sure to tell that to the neurosurgeon. I would think he would want a new MRI -- usually six months is about as "old" as they feel are still relevant, and given the amount of stress that has been put on your husband's spine since then, I would think they'd want to know if there is further damage before proceeding with a "diagnosis" and plan of treatment.

Second, even though the problems at L5-S1 appear to be worse than the problems at L4-L5, I think there is a very good chance that this segment may be causing just as much pain. In any case, if surgery is being discussed, you would want to find out if this level needs to be addressed too.

What are your husband's symptoms? You mentioned he still has numbness and tingling. Where is this located?

 
Old 01-14-2013, 05:16 PM   #5
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

He is having a mild lower back pain, he says its about a 3 on his pain scale but he's happy to not be the 7+ it was before starting meds and the injections. The pain shoots up to a 6-7 if he walks/sits too long or has to squat down. The numbness/tingling runs down his left leg from thigh to the outside bottom of his left foot. The right leg and foot occasionally has numbness/tingling as well. Before the injections he had major pains on the bottom of both feet, now he feels the back pain more...not sure if that is a good or bad sign.

 
Old 01-14-2013, 08:37 PM   #6
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Hi, so sorry you all are going thru this. One thing I would like to share and I know being a wc case it may be difficult but just today I was talking with my pain mgt dr and he said no matter which surgery be it shoulder, back, ankle whatever always get a second opinion. Now since this is a wc case I would call and find out if you can and I if one person tells me no I'd go ahead and call someone else, just try your best to get it. So important. I'm sure you've read it on here.

Especially with back surgeries. I don't know if you've heard of failed back surgery syndrome. Check into that. Don't let them send him back to work too early either make sure he gets his pt.

He should get a back brace as well. Once he's pretty much healed I'd use that brace when working around the house and stuff to protect it too.

There was a thread on here dedicated to tips for after back surgery. From getting something to raise the toilet seat, to getting a grabber tool. There are many of them. Shower chair too. Maybe search for it under the back problems thread. It's real helpful.

Things to ask the dr would be the approach he plans on using, ask about the brace, pt, pain meds, hospital stay, any in home care, type of clothing he should wear, shoes, when he can drive, kind of stitches/staples, does your hubby have problems with anesthesia? Does he need anti nausea meds before surgery? Is he on NSAIDs where he would have to come off like 10 days before surgery. If he smokes he needs to stop so he will fuse. How long will he be out of work? I think there's a limit to sitting 15 min every couple hrs or something too. Is your master on 2nd floor? If so ask about steps. He probably will be given a walker at the hospital. One trick I learned is to put a plastic bag on his car seat so it's easier to get in and out.

That's all I got now, too much lol!

Please keep us posted, Cathy

 
Old 01-14-2013, 10:41 PM   #7
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Thanks, Cathy. That was a lot of great info and no it wasn't too much!

 
Old 01-15-2013, 02:00 AM   #8
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Hi Meg. Sorry to hear about all the trouble you and your husband has been having.

It always bothers me when I hear about the lack of communication that goes on between doctor & doctor about a patient or the communication that is lacking between doctor and patient.

It is extremely important that everyone communicate EFFECTIVELY & OPENLY with everyone. This is to assure that everyone is on the same page and has the same information.

NEVER EVER assume that the doctors are always right. You as the patient has to be proactive in your own behalf. Since most of have multiple doctors we have to make sure that we communicate our histories with all doctors, make sure that they know all our medications that we are taking etc.

Doctors are so busy that sometimes they also have to be reminded of what is going on And unfortunately I've seen to many problems with the "office staff" in not properly relaying information.

It was like I just went for a Intrathecal Pain Pump for pain control. Since I have kidney issues when I left the doctor to checkout I left my kidney doctors information so that the 2 doctors caught up and talked before the surgery. So I gave the name & number to the person that does the checkout. Yes she wrote it down on the chart, BUT that was as far as it went. Some time after that I had called the office on several matters and checked to see if the 2 doctors spoke. There was nothing in the notes that they talked at all & was extremely important in my case that they did.

So while we may have to repeat a lot of information when we go from doctors office to doctors office it is best to have the bases covered and know that things have been communicated and that things get done.

While there are a lot of good doctors as to be efficient in getting things done. I've seen to many POORLY run offices where no one knows what the other person is doing.

Hope things progress smoothly for your husband. If things were communicated better then your husband wouldnt have been lifting more then he should have.

Good luck keep us posted.

 
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Old 01-15-2013, 07:44 AM   #9
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

[B] Before the injections he had major pains on the bottom of both feet, now he feels the back pain more...not sure if that is a good or bad sign.[/B] I think this may be both a good and a bad thing! It is good to get the pain to move out of the legs and into the back as that usually means the nerve compression is easing...and would indicate the injections are having a positive effect.

However, when it comes to surgery, decompression surgery tends to be more successful when it is relieving leg pain than when the patient just has pain in the back. That seems to be more difficult to alleviate through surgery.

 
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Old 01-15-2013, 07:53 AM   #10
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Hi me again, does he take any nerve pain medication such as neurontin, lyrica, topomax? The first two can add weight quickly but topomax actually has a side affect of weight loss. In all cases you must start at a very low dose and work up slowly to help avoid side affects, if/when he develops side affects he can go back down a bit or try another med. I take topomax 100 mg and just at night to avoid the sleepiness side effect.

These will help with leg pain cathy

 
Old 01-15-2013, 03:39 PM   #11
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Thanks for your input, pebble. I hope your mix up didn't cause you any extra harm. After realizing the lack in communication between doctors I have bought a sectioned spiral notebook and each doctor has a section where I am writing all questions and a short report from each visit...which now I wish I had been doing all along. I am learning to be more vocal with the office staff too, weeks ago the docs office was to fax some prescriptions to the pharmacy well 3 days later the scripts never arrived after a call to the pharmacy we realized the office staff just put the scripts in my husbands file and forgot about them. Now if we can just make the doctors spend more than 5 minutes with us at appointments...wishful thinking I know!

 
Old 01-15-2013, 03:52 PM   #12
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Re: L5-S1 Nerve root denervation & what to ask neurosurgeon

Yes, he has been on 1200 mg of neurontin a day since the end of November and had a 10 pound gain the first month. The doc felt it was mostly water since he had swelling in his legs and feet so he put him on a diuretic and it helped him lose most of it. But as time goes on I think its increased his appetite. Thanks again!

 
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