[Alkymst]

I'm new to this particular forum but not NeuroTalk - have been on the Peripheral Neuropathy forum for some years now.

I have been dealing with lumbar pain for 15+ years, some of which is probably due to my lifelong struggles with my weight. In 2004/2005 two MRI's confirmed that I had a grade I anterolisthesis at L5-S1 with moderate right neural foraminal narrowing. Several subsequent courses of PT together with hot, moist heat and cold compresses helped me deal with the lumbar pain and occasional sciatica that I was experiencing and I have been relatively comfortable for the last 8 - 9 years. I have occasional bouts of lumbar pain or fleeting sciatica but nothing that has required meds.

About 4-5 weeks ago I noticed a fleeting "twinge" in my right buttock which usually indicated that sciatica would follow soon thereafter. This time however, the pain was much more intense, a burning sensation in my upper right thigh together with a cramp or vise-like sensation down my right calf and across my right foot. The pain was worst when I first got up in the AM or during the night, particularly as soon as I sat up on the side of the bed or sat down in the bathroom. It took several hours before I could move around with any degree of comfort.

Sitting was not comfortable unless I sat “ramrod straight”, but walking wasn’t really a problem with no noticeable discomfort going up or down stairs. Bending forward relieved the lumbar pain and reduced the sciatica. Arching my back didn’t seem to affect either pain. The pain was more tolerable when I was lying down and I could sleep for a few hours by keeping my right leg as straight as possible.

After several days I saw my PCP who ordered an MRI and gave me a prescription for vicodin (5 – 500), 1 every 4-6hrs as needed to help with the pain. The vicodin does not seem to be of much help nor is tramadol. I have peripheral neuropathy from Type II diabetes so it can be difficult to distinguish the nerve related pain.

A summary of the MRI results from 4/29/13 follows.
• The lumbar vertebral bodies maintain normal height, there are no acute fractures.
• Multilevel DDD throughout the lumbar spine.
• For T10-T11, T11-T12, T12-L1, L1-L2, L2-L3, L3-L4 there are either no or small disc protrusions, no central canal stenosis or neural foraminal narrowing.
• Interval increase in Grade II anterolisthesis of L5-S1 2nd ary to severe facet joint arthrosis.
• Interval increase in severe right neural foraminal narrowing of L5-S1 with mass effect on the exiting right L5 nerve root.
• Interval progression of mild central canal stenosis at L4-L5 and L5-S1.
• Interval progression in mild to moderate right neural foraminal narrowing at L4-5.

I have an appointment with an orthopod spine surgeon tomorrow (Friday) AM to review my symptoms and MRI and to recommend a course of treatment. I confess that I’m really apprehensive about this since my symptoms seems to have deteriorated markedly since my last MRI but I’m not ready to commit to a spine fusion yet. Does anyone on the forum have experience with more conservative treatment measures being beneficial in a situation like mine?
Thank you for your advice and help – it is appreciated

Alkymst

[Leesa]

Hi ~ Well, since you are diabetic, I would THINK that any type of surgery would best be avoided!! Spinal surgery should be avoided for ANYONE, but particularly for you!

You have degenerative disc disease throughout the spine, but we ALL have that. It's just a part of aging, unfortunately. It's drying out of the discs, which makes them flatten and when they flatten they tend to bulge & sometimes herniate.

Then you have foraminal narrowiing -- the foramen are the holes that the nerves pass thru to get to the spinal cord, and yours are getting narrow.

Then there's mild spinal canal stenosis - narrowing of the spinal canal -- thank goodness it's mild.

But then you have SEVERE facet joint arthrosis -- which just means a degenerative disease of a joint. Doesn't tell you much, does it.

I would certainly want to take as CONSERVATIVE a route as I possibly could and try ALL conservative methods until they were exhausted. I would not jump into surgery until I had tried everything. Surgery will NOT relieve your pain. Surgery is only for mechanical problems, and not for pain. Usually, after surgery, you're left with the same pain or worse.

Then you have to worry about the "Domino Effect" which most doctors don't tell their patients about. It's when the levels above/below the surgery site fail, because they've had to take on more of the load. I had both my surgeries before the internet, so I couldn't research properly -- and lo and behold, both levels above the surgery sites failed, meaning more surgery. Then after THAT surgery, the level above THAT one failed, meaning more surgery. And on and on......... That's where I stopped. I'm now disabled.

So try to stay conservative. I know you're suffering. If you haven't already, try a pain management doctor too. I wish you the very best. Please let us know how you come out, will you? We'd really like to know. God bless and please take care. Hugs, Lee

[Alkymst]

Leesa,
Many thanks for your insightful comments. Believe me I am not pushing for surgery, rather looking for any possible means to manage this for the future. I have a pretty high pain tolerance so I'm not ready to irrevocably cross the surgery bridge, and as you pointed out being diabetic only complicates things more.
I am so sorry for your situation and can't really offer much other than to say your kind thoughts and comments helped me.
Best regards,
Alkymst

Originally Posted by Leesa

Hi ~ Well, since you are diabetic, I would THINK that any type of surgery would best be avoided!! Spinal surgery should be avoided for ANYONE, but particularly for you!

You have degenerative disc disease throughout the spine, but we ALL have that. It's just a part of aging, unfortunately. It's drying out of the discs, which makes them flatten and when they flatten they tend to bulge & sometimes herniate.

Then you have foraminal narrowiing -- the foramen are the holes that the nerves pass thru to get to the spinal cord, and yours are getting narrow.

Then there's mild spinal canal stenosis - narrowing of the spinal canal -- thank goodness it's mild.

But then you have SEVERE facet joint arthrosis -- which just means a degenerative disease of a joint. Doesn't tell you much, does it.

I would certainly want to take as CONSERVATIVE a route as I possibly could and try ALL conservative methods until they were exhausted. I would not jump into surgery until I had tried everything. Surgery will NOT relieve your pain. Surgery is only for mechanical problems, and not for pain. Usually, after surgery, you're left with the same pain or worse.

Then you have to worry about the "Domino Effect" which most doctors don't tell their patients about. It's when the levels above/below the surgery site fail, because they've had to take on more of the load. I had both my surgeries before the internet, so I couldn't research properly -- and lo and behold, both levels above the surgery sites failed, meaning more surgery. Then after THAT surgery, the level above THAT one failed, meaning more surgery. And on and on......... That's where I stopped. I'm now disabled.

So try to stay conservative. I know you're suffering. If you haven't already, try a pain management doctor too. I wish you the very best. Please let us know how you come out, will you? We'd really like to know. God bless and please take care. Hugs, Lee

[Alkymst]

Leesa,
My thanks again for asking after me and how my visit went on Friday. I'm posting a somewhat lengthy reply which follows.

My appointment with the orthopedist Friday AM was much different from any of my previous appointments with orthopedists since this doctor specializes in spine surgery. First off, he was friendly and not condescending, and after he introduced himself to my wife and me he asked me to describe my situation. I gave him a detailed sheet that I had prepared which he read, asked me some further details and then told me that he did not believe that I had progressed to a Grade II anterolisthesis.

He said that he didn’t pay a lot of attention to others interpretation of MRI results via reports and that he preferred to view the films/CD and then draw his own conclusions. Based on the CD from my 4/29 MRI he interpreted my situation as Grade I. For comparison I had the films from my prior MRI’s 8 and 9 years earlier and he sat with us and showed us how he would interpret those results. He explained the sagittal and transverse views to us and then drew lightly on the film to show us the actual slippage at that time. He measured the slippage of L5 vertebrae on S1 it was < 25% at that time and the latest MRI was essentially the same in his opinion.

He explained the significance of the neural foramen and showed us on my old MRI film the difference between nerves exiting the left (relatively normal) vs. the right (moderate narrowing). He said that the latest MRI shows some additional narrowing on the right which certainly could give rise to my pain.

He ordered AP and lateral plain films which he had printed out and then brought them to us. He showed us that there was no significant movement in my L5/S1 joint between the 2 views which meant that my anterolisthesis was stable. Further, he outlined on the x-ray the antherolisthesis and again the slippage was <25%.

The plan then is for an extended course of PT with a woman who specializes in PT of the spine. I dealt with her 8-9 years ago and she helped me a great deal at that time. He wants her to focus too on my hamstrings which he described as tight as piano wire and which only aggravate my situation. Too, he said that some belly weight loss on my part could reduce the constant distortion on my spine but he acknowledged that this is always easier said than done even with this type of motivation. This won’t correct the damage done but could only improve my situation.

If I still need some relief in the future we will consider injections but neither he nor I are pushing for them. We left it that there was no need for a formal follow-up appointment unless I was not improving or there was a significant change for the worse in which case I should follow-up for an appointment. He allowed that there was no need to consider surgery at this time so it was never discussed at this visit. He also said that he would pursue a slow and very conservative treatment plan to postpone surgery permanently or for as long as absolutely possible.

All in all, this was better than I was expecting from all aspects. I’ll post back after I’ve had my PT evaluation and some time to apply the exercise program.

Dave

Originally Posted by Leesa

Hi ~ Well, since you are diabetic, I would THINK that any type of surgery would best be avoided!! Spinal surgery should be avoided for ANYONE, but particularly for you!

You have degenerative disc disease throughout the spine, but we ALL have that. It's just a part of aging, unfortunately. It's drying out of the discs, which makes them flatten and when they flatten they tend to bulge & sometimes herniate.

Then you have foraminal narrowiing -- the foramen are the holes that the nerves pass thru to get to the spinal cord, and yours are getting narrow.

Then there's mild spinal canal stenosis - narrowing of the spinal canal -- thank goodness it's mild.

But then you have SEVERE facet joint arthrosis -- which just means a degenerative disease of a joint. Doesn't tell you much, does it.

I would certainly want to take as CONSERVATIVE a route as I possibly could and try ALL conservative methods until they were exhausted. I would not jump into surgery until I had tried everything. Surgery will NOT relieve your pain. Surgery is only for mechanical problems, and not for pain. Usually, after surgery, you're left with the same pain or worse.

Then you have to worry about the "Domino Effect" which most doctors don't tell their patients about. It's when the levels above/below the surgery site fail, because they've had to take on more of the load. I had both my surgeries before the internet, so I couldn't research properly -- and lo and behold, both levels above the surgery sites failed, meaning more surgery. Then after THAT surgery, the level above THAT one failed, meaning more surgery. And on and on......... That's where I stopped. I'm now disabled.

So try to stay conservative. I know you're suffering. If you haven't already, try a pain management doctor too. I wish you the very best. Please let us know how you come out, will you? We'd really like to know. God bless and please take care. Hugs, Lee

[fireman9915]

Alkymst, as leesa said deinitely try any and all conservative treatment, even if its med control with restricted activities etc...surgery definitelymneeds to be a very last resort for anyone, but especially you since u have ghe "wild" card thrown in there with diabetes which would make recovery 100x harder....definitely see what your dr. Says when you see him, maybe try PT again, an trying ice again 20 min on, 20 off, or as often as u can especially for the next several day...also after you see what the dr. Says maybe try some yoga, or get PT to teach you some gentle exercises to loosen the muscles up, an also some core exercises to strengthen your core. You may also look into a TENS unit it has worked miracles for me. An also possibly even accupuncture, kve been doing a lot of resear h on it an ive heard some wonderful things about it! Whatever you do do NOT go to a chiropractor it will only make your issuses worse! Ive had a lot of issues since I had surgery in december, granted I tried EVERY conservative treatment I knew, an I didnt have much chlice bc my nerve rootatL4-L5 was completly impinged! Try not to over think things and just take it a day at a time, since my injury I have definitely learned patience!!! Time is the only thing that will help you get answers and heal an it just gakes time!! I nope you get to feeling better soon....take care!

[Leesa]

Hey Alkymst ~ Thank you SO much for letting us know what the doc said! I really do appreciate it.

I'm so relieved that he didn't want to do any surgery! It seems that so many surgeons are "cut happy" and it's refreshing to know that there are actually honorable doctors out there who won't do it just for the sake of doing it! Know what I mean? And there ARE doctors who WILL perform surgery when it's really NOT needed -- when they SHOULD be referring their patients to physical therapy!

So I'm really relieved that you got a really GREAT doctor! I hope you refer him to others too, who may need him.

Yes, please keep us posted as to your progress. I know I'd love to know how you're getting along. Thanks again, and God bless! Hugs, Lee

[Alkymst]

Just a fast note to update my last post re: physical therapy. As I noted before I've gone back to the same physical therapist I saw some years back that specializes in and is certified for spine/back problems. Her initial evaluation was detailed and thorough after which she determined that my pain does NOT originate from the foraminal narrowing given that extension relieves it and flexion aggravates it. Thus far we've taken a very conservative approach using moist heat, some simple extension exercises that I do many times/day and some pretty firm back manipulations, not chiropractic.

All in all this seems to be helping since the sciatica pain has been reduced substantially although I have found that my inane and foolish attempts to do yard work, gardening, garage clean-ups and the like can and will bring on a bout very quickly so I'm by no means "cured" but certainly going in the right direction.

That said she just instituted hamstring stretches this week and found 1 - that my hamstrings are tight enough to endanger her with snapback and 2 - the order in which I do the exercises matters greatly, i.e. if the hamstring stretches are the last thing she does before I leave, driving home is more unpleasant than if she does them immediately after the moist heat. So I'm sure this PT plan/program will have its blind alleys and corners while we figure out what to do and when. I can say that my flexion has improved just in the 3 weeks that I've been doing PT both in terms of the amount of pain and how far I can bend even with the tight hamstrings.

That's it for now, I've got to interrupt the program for a necessary trip to see the wizard for thyroid surgery Monday AM. I'll post back once I've started up PT again.


Alkymst

[Leesa]

Good heavens, thyroid surgery? I must have missed that somewhere!

Thank you SO much for updating us Alkymst! We SO appreciate it! I've been wondering what was going on.

It sounds like your therapist has a good handle on what's going on, and your progress is excellent! I sure wish I had had someone like her when I first started with the sciatica business. Now it's just too darn late.

And I know what you mean about trying to do things like cleaning the garage, yard work -- I won't even TRY gardening. If I got DOWN there, I'd never get UP. lol

Do us a favor? Keep giving us updates, will you? We'd sure like to hear about your progress! Again, thanks and take care of yourself! ONWARD to healing! LOL God bless and take care. Hugs, Lee