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  • Lumbar Spinal Stenosis

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    Old 01-23-2019, 09:47 AM   #1
    Fred1111
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    Lumbar Spinal Stenosis

    Having always been an active, healthy senior (71), after retirement I experienced pain in my L outer calf, nearly 3 yrs ago. PCP ordered xray, result: severe spinal arthritis.

    Followed with 8 PT sessions, no change. Next an MRI. Then epidural steroid injection with posititive results for 6 weeks. 3 mo later another injection with no change. Next tried Gabapentin twice but the side effects (dizzy,sleepy,weak) were too much. Did not try Lyrica.

    The pain spread, with weakness, foot drag, lower back. Referred to spine surgeon. Cautioned against another injection, explained TLIF well to repair degenerative discs L4-L5, not urgent. I struggled on.

    8 visits with a chiropractor, after reviewing xrays/mri it was more for pain treatment than adjustment.

    18 months in, another MRI. Some worsening. The painful pinched nerve origin L lower back ... pain now in both legs, back of legs and lower back, hips and groin, down the front of my thighs and into my L foot. L foot pain bad 6 mo ago, 18 PT sessions helped.

    2+ yrs in I manage to walk 4x per week, 6000 steps ea. I live my life slowly, using ice or heat as needed. I seem to spend quite a bit of time sitting on a heating pad. Sitting anywhere makes both lets ache. Walking works, but I must take rests. I can't stand for too long. I am awakened by sciatica pain, and only take Ibupofren 800mg. To anyone looking I don't appear impaired, but I don't move with a purpose and activities are limited.

    How does one measure a "quality of life" decision here? Is getting along, getting by enough? Is it better to have the repair before I get older and other problems present? Is anesthesia safe as we age? Are pain meds the answer? It won't go away, but will it continue to worsen and how to calculate the risk before it does become severe.

     
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    Old 01-23-2019, 11:32 AM   #2
    MSNik
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    Re: Lumbar Spinal Stenosis

    Hi there. You asked some really good questions.

    "How does one measure a "quality of life" decision here? Is getting along, getting by enough? Is it better to have the repair before I get older and other problems present? Is anesthesia safe as we age? Are pain meds the answer? It won't go away, but will it continue to worsen and how to calculate the risk before it does become severe."

    First of all, 71 is not old anymore. Most people are living another 15-25 years past this- so how is your health other than this?
    Quality of life is a tough one. I live with MS- so I know that I have great days and horrible days. Sometimes I feel like my quality of life is bad...but other times when I think about the good days, I know its actually quite good. Its fear and pain that cause me to look negatively at the big picture.

    You asked about anesthesia being safe as we age...generally, no; however, that being said, if you have no cardio issues and no pulmonary issues, it can be very safe. Heart and lung issues can rule out anesthesia in the elderly unless it is life or death, which this doesn't appear to be.

    Pain meds....the pros and the cons...do you care if you take a med which you may become dependent on? I can't due to the type of work I do, but at age 71, I wouldn't probably care if I needed to. Being in pain is the single worst thing that anyone can experience, especially chronic pain. Have you tried anything besides Neurontin? By the way, that drug does nothing for me either, and neither did Lyrica. There are other drugs which are not addictive and can help, you would need to discuss those with your doctor.

    What is the guarantee that the surgery will fix your problem? Spinal stenosis is normal as we age; however, if it is pushing on a nerve, this is where the pain is stemming from. If they can simply ablate the nerve- end of problem. Can it be that easy? Something else to talk to your doctor about. If you are talking major spinal surgery, I would say- be very careful. I have never known anyone to have major spinal surgery who didn't need repeat surgeries down the road....an ablation however, is simply, outpatient, and can kill the pain as quickly as they block the nerve. A pain specialist can do this sort of surgery- possibly an orthopedic doctor as well.

    I would talk to your doctor and also get a second opinion from another doctor and weight your options. This may not be as major as you think...the stenosis cannot be reversed, but the opening can be widened- thats major...maybe blocking the nerve pain is possible and allot less invasive.

    Good luck!
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    Old 01-25-2019, 10:56 AM   #3
    teteri66
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    Re: Lumbar Spinal Stenosis

    Welcome to the board. You have been given some good suggestions, and I agree that you ask some thoughtful questions. Unfortunately without a Crystal ball, they are questions without answers!

    What are your current symptoms? Do you have foot drop? Numbness, tingling? Is the pain constant or is it mostly when standing/walking and relieved by lying down?

    Depending on what specifically are the issues, a procedure to decompress the nerve can be very effective. And sometimes people do get lucky and one procedure takes care of the issue. However, it is a fact that as we humans age, the spine degenerates. In some people this natural process doesn’t cause too many problems, but in others, it sets off a cascading series of events...degeneration continues, discs continue to flatten, more spinal nerves become compressed, etc.

    Spinal arthritis causes pain, contributes to “pinched nerves,” and can create a variety of new issues.

    Unfortunately there really aren’t any medications that help much if you have sciatic pain. Gabapentin/lyrical have some effect on nerve pain...but are not without side effects...which, in reality, is true for any medication. Opioids do nothing for nerve pain. They just make the person care a little less. Nerve ablation/rhizotomy can be a temporary solution, but if a spinal nerve is compressed, the nerve will eventually become damaged. Depending on which nerve or nerves are involved, this can lead to loss of movement in the legs/feet. Sometimes surgery becomes necessary to free up the nerve, whether we want it or not! And, generally speaking, the longer the nerve is left in a compressed state, the greater the chances for permanent damage.

     
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    Old 01-25-2019, 09:41 PM   #4
    rosebud55
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    Re: Lumbar Spinal Stenosis

    [QUOTE=teteri66;5491811]Welcome to the board. You have been given some good suggestions, and I agree that you ask some thoughtful questions. Unfortunately without a Crystal ball, they are questions without answers!

    What are your current symptoms? Do you have foot drop? Numbness, tingling? Is the pain constant or is it mostly when standing/walking and relieved by lying down?

    Depending on what specifically are the issues, a procedure to decompress the nerve can be very effective. And sometimes people do get lucky and one procedure takes care of the issue. However, it is a fact that as we humans age, the spine degenerates. In some people this natural process doesn’t cause too many problems, but in others, it sets off a cascading series of events...degeneration continues, discs continue to flatten, more spinal nerves become compressed, etc.

    Spinal arthritis causes pain, contributes to “pinched nerves,” and can create a variety of new issues.

    Unfortunately there really aren’t any medications that help much if you have sciatic pain. Gabapentin/lyrical have some effect on nerve pain...but are not without side effects...which, in reality, is true for any medication. Opioids do nothing for nerve pain. They just make the person care a little less. Nerve ablation/rhizotomy can be a temporary solution, but if a spinal nerve is compressed, the nerve will eventually become damaged. Depending on which nerve or nerves are involved, this can lead to loss of movement in the legs/feet. Sometimes surgery becomes necessary to free up the nerve, whether we want it or not! And, generally speaking, the longer the nerve is left in a compressed state, the greater the chances for permanent damage.[/QUOTE]

     
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    Old 01-25-2019, 09:45 PM   #5
    rosebud55
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    Re: Lumbar Spinal Stenosis

    Hi, I had surgery for spinal stenosis almost six years ago. I waited to have surgery because I was scared mostly. I just want to say, it's amazing how I feel now. I can stand straight instead of looking for a cart whenever I went to a store and I can sleep without pain. I do not take any type of pain medication now.
    I do have weakness in my left leg from waiting so long for surgery. Please get a second opinion and do research on the subject. I personally am very happy with the results of surgery.

     
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    Old 01-29-2019, 04:31 PM   #6
    teteri66
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    Re: Lumbar Spinal Stenosis

    Always great to hear of a positive outcome!

    Barring something a bit unusual happening during surgery, I think “most” people end up better than they were prior to the surgery. Sometimes one ends up trading one set of “symptoms” for another. All one can do is find the best spine surgeon that is available to you, do tons of research and then try to find peace in reaching a decision. Usually easier said than done!

     
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