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MRI - lumbar surgery suggested; how long can I wait?


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Old 06-14-2017, 04:40 PM   #1
jlj66
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MRI - lumbar surgery suggested; how long can I wait?

I am having lower back pain that is worse when I walk. The pain goes down my buttocks into my thighs and I feel like my hamstrings are really tight. My right foot will also occasionally go numb. The pain is relieved while sitting or laying down.

Below is my MRI results and I was told that I need surgery. I was referred to an orthopedic surgeon in my area that I have heard only bad things about him; my appointment with him is in 2 weeks. I live where my options are scant but there are several possible good options 85 miles from where I live and are covered by my insurance. I have scheduled an appointment with an orthopedic surgeon that I have read very good things about him but that appointment is 2 months from now. I am also going to try and schedule an appointment with a neurosurgeon that I have heard really good things about him and was given a phone number that should get me scheduled to see him faster than usual.

After looking at my MRI results, should I be concerned about waiting several months?

1. Multilevel degenerative disc disease and facet arthropathy as
detailed above most prominent at L3-4 and L4-5 with severe
spinal canal stenosis and redundancy of the cauda equina nerve
roots. Moderate to severe bilateral neuroforaminal narrowing at
L2-3 through L4-5.
2. STIR signal hyperintense signal involving the bilateral
pedicles at L4 and L5 indicating stress response.
3. Fluid within the bilateral L4-5 facet joints with grade 1
anterolisthesis of L4 on 5 which is more pronounced on the
previous radiographs but suggestive of abnormal motion at this
level.
4. Small synovial cyst projecting posteriorly from the facet on
the left at L4-5.

 
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Old 06-14-2017, 07:05 PM   #2
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Re: MRI - lumbar surgery suggested; how long can I wait?

Welcome to the board. You can afford to wait. You want to take time choosing your surgeon as it is the most important decision you will make except for the decision to have surgery in the first place.

I had similar issues and waited almost three years before deciding to proceed.

I would encourage you to keep the appointment with the first surgeon. It is helpful to get several opinions as you usually end up learning something at each consultation. Also, what you have heard may be incorrect, or you may hit it off with him. It is good to see both a neurosurgeon and an orthopedic spine surgeon. Just be sure the practice is limited to cases of the neck and back.

 
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Old 06-15-2017, 10:32 AM   #3
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Re: MRI - lumbar surgery suggested; how long can I wait?

Thank you so much for your reply. I am glad to know that I have time to do some investigation and get several opinions. The Physiatrist that I met with scared me a bit and suggested I get surgery as quickly as possible. I want to feel comfortable and confidant with the surgeon I choose to operate on me.

 
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Old 06-15-2017, 08:21 PM   #4
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Re: MRI - lumbar surgery suggested; how long can I wait?

Sometimes that is true with the cervical spine. If there is something badly indenting the spinal cord, there is potential risk that if it got worse, the person could end up paralyzed.

This almost never happens with the lumbar spine as the spinal cord terminates around the L1-2 level. Beyond this, nerves bundle together to form the cauda equina. By waiting a long time, you could end up with some nerve damage, but not paralysis. Since you have severe stenosis at several levels, I would encourage you to get in promptly...I wouldn't postpone it for a year or something, but waiting several months to find the best surgeon available to you is most likely worth it.

Unlike having an appendix out where you don't expect to have a long-term relationship with the surgeon, with your issues, you should find someone you trust and like as you may be seeing him/her on a somewhat regular basis. I've known my spine surgeon for about twenty years, even though he first operated on me eight years ago!

 
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Old 06-23-2017, 03:15 PM   #5
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Re: MRI - lumbar surgery suggested; how long can I wait?

Thank you again for responding to my post.

Did your pain start out annoying and then gradually increase to the pain you were describing in another post about not being able to walk to your mailbox?

Some days I hardly notice any pain and then others it is more noticeable but it seems like surgery is really drastic. On the other hand, after reading about severe stenosis with redundancy of cauda equina nerves and spondylolisthesis, it seems like it might be necessary.

The Physiatrist really didn't explain anything to me about the seriousness but just told me that surgery was necessary. He agreed to cortisone shots but told me he didn't think they would work for long because of the movement in my back. I had the shots on May 30th and the buttock and leg pain completely disappeared for 2 weeks but has come back but it doesn't seem as intense and my foot doesn't seem to go numb as quickly when I am walking.

teteri66 - You had mentioned in another post on the board that you know someone who rushed into surgery and now has nerve damage that was not there before the surgery.

It seems that it is all a bit of a guessing game. I don't want to end up with bowel or bladder issues and I don't want permanent nerve damage in my legs but I also don't want more pain or damage after surgery than I have now.

Can you offer any advice? I know everyone is different but I would appreciate any insight you might be willing to offer.

 
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Old 06-25-2017, 03:29 PM   #6
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Re: MRI - lumbar surgery suggested; how long can I wait?

Yes I started out in the fall of 2004 with sciatic pain. It was probably about a year before I had a correct diagnosis and told the only resolution would come through surgery because I was unstable...but, it was up to me if and when I chose to have surgery.

I waited until Jan of 2008. By that point, I had done enough research through visiting a variety of spine surgeons that I was convinced there were no new options on the horizon. By then the pain was such that my activities were very limited, so I decided to have surgery.

A guessing game is one way to put it. I call it a crap shoot. You never know how things will turn out. Even surgeons get surprised on occasion.

 
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Old 09-05-2017, 03:38 PM   #7
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Re: MRI - lumbar surgery suggested; how long can I wait?

I have seen 3 different surgeons and I found one I really like. He started me on gabapentin at the beginning of August and I am going to physical therapy twice a week. I am seeing improvement with the numbness in my foot and it takes longer before the buttock and leg pain starts. I was able to walk for 3.5 miles with my dogs this weekend; stopping occasionally to bend over and do stretches to help relieve pain.

Teteri66 - thank you for your advice and helping me to realize I did not have to rush into surgery.

I am wondering a bit about physical therapy. It seems that I have learned all the exercises that they want me to do and I am able to do them at home. I don't understand the reason to go to physical therapy 2-3 times a week. It seems excessive and expensive even with insurance. However, at physical therapy they also use an ultrasound on my back and also electrical stimulation but I am not sure that part is really making a difference. As well, the physical therapist is more than willing to set up appointments for 2-3 times a week but even he seems a little bit surprised by this and doesn't really seem to know what else to do with me while I am there.
I see the surgeon again on October 24th.

Has anyone else had this type of experience?

 
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Old 09-05-2017, 08:43 PM   #8
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Re: MRI - lumbar surgery suggested; how long can I wait?

Do you have a surgery scheduled at this point? What is the doctor's reason for waiting?

I don't see the need for so many PT appointments per week, especially if you can do the exercises on your own. I think the e swim and ultrasound are more for your comfort than anything else. Would it make the surgeon unhappy if you went to fewer appointments?

 
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Old 09-06-2017, 02:37 PM   #9
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Re: MRI - lumbar surgery suggested; how long can I wait?

The surgeon told me that he thinks I am straddling the line between surgery and not needing surgery at this time but most likely at some point in the future I will need surgery. He put me on Gabapentin with physical therapy 2-3 times a week and then I go back on October 24th. The unfortunate thing is that he is 1 1/2 hours from my home but it is worth it for the peace of mind I had after talking to him. The physical therapy is being done in my hometown and they are supposed to be coordinating with the doctor; I received a call from the surgeon's office 2 weeks after I started therapy asking why I hadn't started. I talked to the physical therapist's office and asked that they contact the surgeon as soon as possible.

I have been thinking about calling the surgeon's office and tell them what I have said here and ask if it is truly necessary for me to attend that often, as I am doing the exercises at home.

 
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Old 09-06-2017, 04:39 PM   #10
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Re: MRI - lumbar surgery suggested; how long can I wait?

That sounds like a good plan. I have found it is a good idea to stay on the surgeon's good side while remaining under his care! Some are sticklers for following orders. Others are more flexible.

I just went back to reread your MRI report. How much pain are you in and how much does it disrupt your life?

Also, please go online and find several different websites that explain the symptoms of "cauda equina syndrome." When one has severe nerve compression in the lower lumbar area, it is smart to have heard about CES and to know the symptoms. Some doctors are not that familiar with it (maybe other than remembering they heard about it back in medical school...I have heard of people who have to fight to be taken seriously in an emergency room when presenting there with the symptoms....)

CES describes an extreme swelling and pressure of the lower lumbar spinal nerves. If it is not picked up quickly, it can cause problems like paralysis, impaired bladder, and/or bowel control, difficulty walking, and/or other neurological and physical problems.

Again, CES is RARE, but, if you should suddenly develop bowel or bladder issues or suddenly experience extreme muscle weakness such as foot drop, seek medical attention right away. Do not call for an appointment and wait two weeks to get in! If it should turn out to be CES, you need to be evaluated right away as the longer you wait, the greater is the chance for permanent nerve damage. Now, CES is rare! But it is worth mentioning just so you have heard of it...and would know to call a doctor or go to the ER quickly.

 
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