[jenng]

for surgury???

I am so confused! My EMG/NCS states sensorimotor axonal damage. My lumbar MRI shows sponylosis/spondylithesis with pars defect, conjoined nerve root at L5-S1 with probable compression on left side (where I have symptoms at left foot & leg.)

I have seen one neurologist who poo-pooed the MRI, barely looked at it really. My husband asked me to have a neurosurgeon look at it. He thinks I should consider a PLIF (fusion at L5-S1) He thinks things look pretty messed up down there, and the left sided nature of things suggests some mechanical problems.. My regular neuro said, "of course, a surgeon would want to cut." This guy, though, is the best in the area, doesn't need to drum up business in any way. I actually went to the appt thinking he would say there was nothing surgical to be done.

I am getting an opinion of another neurologist in August. If I did the surgery it would be in Sept. I really really need some input!

Thanks!

[ginnie]

You are doing the best thing you can do, getting that second opinion. Sometimes a third is called for too. Don't consent to surgery unless all other measures have been tried OK? Not necessarily steriods, but PT, etc. I am not all that fond of cortisone injections. Never did a thing for me and just made the pain worse. I am fused C3-7/ Can help decifer MRI if you need to. I have some experience and am good at research. I sure hope it all goes well for you. I want you also to know surgery can work. My second fusion was successful. There are also some questions you need to ask the surgeon if you go that route. First being the condition of the onces above the trouble spot, and below the surgical site. There is something called the domino effect, were the verterbre fail in time, leading to more surgery. They need to be strong to support the hardware. Let me know if you have any quesitons. I will help you all I can. There is where I came a few years ago seeking help too. Take care of yourself. ginnie

[Dr. Smith]

Originally Posted by jenng

I have seen one neurologist who poo-pooed the MRI, barely looked at it really. My husband asked me to have a neurosurgeon look at it. He thinks I should consider a PLIF (fusion at L5-S1) He thinks things look pretty messed up down there, and the left sided nature of things suggests some mechanical problems.. My regular neuro said, "of course, a surgeon would want to cut." This guy, though, is the best in the area, doesn't need to drum up business in any way. I actually went to the appt thinking he would say there was nothing surgical to be done.

I am getting an opinion of another neurologist in August. If I did the surgery it would be in Sept. I really really need some input!

Hi Jenn,

Yes, surgery for PN could be appropriate in certain cases (like nerve compression that threatens further damage). Just keep in mind that surgery may (and probably will) not repair damage that's already been done, and research for yourself any proposed procedures and related risks. Some doctors have been remiss in adequately informing patients in these areas.

Doctors discounting MRIs (in favor of other evidence) does not surprise me. Two patients with virtually identical MRIs can present vastly different symptoms -- one may function perfectly normally, while the other is in abject pain 24/7, requiring intervention/treatment. I've heard this scenario many times from different neuros & orthos.

The different neuro opinions & comments don't surprise me either -- that's why they're called opinions. _ When they're in agreement is usually when the course of action is clear. What your experiences tell me are, 1.) surgery should only be considered as a last resort after all other treatment options have been tried first (it cannot be undone), and 2.) more opinions (plural!) and information are needed in order for you to make an intelligent informed decision.

If you haven't yet, you might post something about this in the Spinal Disorders & Back Pain forum.

Doc

[jenng]

Ginnie, do you mean the actual picture? I will have to learn to do that!

The written report does show that I have degenerative changes from L3 to S1. L3 and L4 have tiny annular tears with disc bulge.

It is at L5-S1 where I have bilateral pars defects with grade 1 anterolisthesis. (found out grade 1 is the least.) I have an annular tear here too, along with a conjoined left L5-S1 nerve root. Mild effacement of the thecal sac at the origins of the bilateral S1 nerve roots, left greater than right. Mild bilateral Neural foraminal stenosis.

I have had lumbar back pain/spasms on and off since age 21. Honestly, the pain hasn't been an issue. I have pretty high pain tolerance and have never taken anything for it other than muscle relaxants and motrin when it flares. It is the neurological symptoms that seem to really throw me for a loop--numbness, burning, pins and needles, now weakness. I can't move my last 2 toes on my left foot. I have muscle wasting in that foot on the outside as well. Very tight hamstrings both sides, but left greater than right.

And, to top it off, now I don't know if my back is causing this, or some idiopathic PN.

Thanks for your help, I need all I can get.

I will post this on the spine forum as well.

[ginnie]

I will also be in the spine forum. My impression is that you have multipal issues going on. I am curious as to how old your MRI is?. The neruo symptoms do have me concerned as well, because you have nerve impingement. Those pins and needles, etc, do happen with PN:, but because of what your symptoms are, I would venture that it is due to your back. It would serve you well, if you could find another couple of doctors to talk to you about this. Loss of strength is showing there is a problem. Do you have a neurologist surgeon? Not all of them want to do surgery. They will be able to tell you if it is the nerves that is causing the PN like symptoms. Either way, doesn't feel very good. You don't want your spine to deteriorate, so evaluations really are the way to go. The more information you get from the doctors, the better off you will be when making a decision on what to do about it. It is your choice, so don't be talked into anything you don't want. Look up all tests that your doctor may want to do other than the MRI. Some of them just confirm that you have an issue, and just cause pain. I declined some of those painful tests. You did give enough information without the actual pictures. When nerves are compressed, this does indeed cause the symptoms you are feeling. Before consenting to my last fusion, I had multipal opinions that said it was absolutely necessary, All doctors gave same impression. I do wish you all the best. Get the help you need to get better. ginnie

[ginnie]

L5 S1 is the conjoined nerve roots I was concerned about ginnie

[jenng]

I am thinking I have multiple things going on as well. My sensory neuropathy is equal on both sides, sural nerves on the EMG. It has worsened slightly in the 4 years between my EMG's. It is idiopathic, although I did find out late last year that my B12 was in the 200's. (700's now.)

My gut feeling is I have super-imposed symptoms on the left leg, which is causing the more electrical-type pain down my anterior calf and all through my foot. Reading about dermatomes and myotomes it follows a predictable pattern as L5-S1. The EMG showed partial denervation of the muscles in my left foot--read an article how this can happen with nerve root compression. Even muscle atrophy can be caused by this!

Ginnie, my MRI was from March 2013. My lower back is not that of a normal 44 year old woman. I have both parents to "blame" for crappy genetics. The 2 neurologists I have seen don't do surgury, just diagnostics. Neither one even looked at my MRI films, just read the written report. The neurosurgeon I saw Monday, he specializes in brain and spine surgury. He did the opposite--just glanced at the written report, but studied my films (and pointed lots of bad stuff out to me.)

Doc, I totally get that I need to be very cautious with my decision. Surgury is the final frontier, so to speak. No matter how much I want to jump on that train and be "fixed," I know there is no such thing as far as our neurological systems go. I wish this decision was easier.

Jen

[Dr. Smith]

Originally Posted by jenng

The 2 neurologists I have seen don't do surgury, just diagnostics. Neither one even looked at my MRI films, just read the written report. The neurosurgeon I saw Monday, he specializes in brain and spine surgury. He did the opposite--just glanced at the written report, but studied my films (and pointed lots of bad stuff out to me.)

Also sounds typical (to put your mind at ease). Diagnosticians don't always know what they're looking at (imaging); they leave the interpretations up to experts who look at those things full-time, and apply the interpretations to their assessments/DX. Surgeons, OTOH, want to see what they may actually be dealing with before opening a patient up.

Doc

[glenntaj]

--from being 'co-morbid'; that is having problems with the spine causing nerve compression that may be superimposed on other more peripheral pathologic processes going on.

There is even a category name for this--'double-crush hypothesis'--in which a nerve already compromised by some difficulty, such as glucose dysregulation, is then compressed somewhere along its pathway by mechanical forces and the symptoms thus produced are 'greater than the sum of the parts". This is often reported by diabetics who may have spinal problems, but it is likely present in those who have other causes of peripheral neuropathy (autoimmune, toxic) more often than it is generally looked for, especially when they may also have spinal issues.