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Serious Condition or Hang Nail?

My hubby, (56 y/o road construction worker for 35 yrs), has had lower back pain 5-6 years accompanied the last 6-8 months by numbness and weakness in legs and stumbling-tripping. Conservative treatment by family MD for over 2 years. May 8th MRI findings: Diminished hydration signal of disc material at all levels indicates disc desiccation and degeneration. T12-L1: Broad based posterior protrusion of disc material centrally; L1-L2 and L5-S1: Posterior bulging annulus fibrosis; L2-L3: Disc degenerative change; L3-L4 and L4-L5: Same as T12-L1 only mild plus L4-L5: Moderate facet arthritis and thickening of ligamentum flavum and narrowing mild narrowing of lateral recess bilaterally and neural foramen on right side related to posterior lateral protrusion of disc material; L5-S1: Posterior bulging annulus fibrosis. Neurosurgeon's interpretation: Mild to moderate spinal stenosis, discs probably not cause of neuropathy. June 24th Peri-vascular study normal. July 26th Nerve conduction study findings: (as explained by neurologist) Probes indicate overall mild to moderate neuropathy, suspected cause diabetes. Needle probes indicate significant spine generated neuropathy (left leg minimal reaction to either probes with increased voltage). Referred back to neurosurgeon with L5-S1 surgery recommended. QUESTIONS: 1. Why the lack of urgency - appts/studies a month apart plus have called surgeon twice only to be told he will review nerve study report and call us to schedule consultation, (we hand-delivered report to his office the day of study a week ago). Are we too impatient? 2. Are there other causes for neuropathy? Neurologist says no, but hubby's diabetes diagnosis within 1 yr and his 3/6 month average tests on high end of normal range. He has been told by family Dr. that the back pain could result in false readings for his daily results. 3. What about the other bulging discs? 4. What kind of surgery will likely be recommended? 5. What is prognosis? 6. Recovery? 7. I'm fairly confident he also suffers from undiagnosed sleep apnea as he is a heavy snorer and stops breathing for 30-45 seconds (if not more) numerous times every night. How will this effect his recovery/surgery? 8. What about the spinal stenosis? Footnote: Family history-Mother diabetes and neuropathy resulting in foot amputation. Father incapacitated by degenerative arthritis resulting in nursing home care at age 50. Any insight you can share would be greatly appreciated! Both hubby and I feel that his physicians' casual attitude seems to indicate his condition is not that big of a deal, but I'm WORRIED SICK!

Welcome
hope you don't mind, I added some spacing to make for easier reading, my eyes kept jumping to other lines.

After you talk more with the dr or surgeon about these results, I'd get another independent opinion, just to be sure suggestions match up. Also seek out the best surgeon that you can if he goes through with the surgery.

Quote:

Originally Posted by Tillie (Post 681073)

My hubby, (56 y/o road construction worker for 35 yrs), has had lower back pain 5-6 years accompanied the last 6-8 months by numbness and weakness in legs and stumbling-tripping.

Conservative treatment by family MD for over 2 years.
May 8th MRI findings: Diminished hydration signal of disc material at all levels indicates disc desiccation and degeneration.
T12-L1: Broad based posterior protrusion of disc material centrally;
L1-L2 and L5-S1: Posterior bulging annulus fibrosis;
L2-L3: Disc degenerative change;
L3-L4 and L4-L5: Same as T12-L1 only mild plus L4-L5: Moderate facet arthritis and thickening of ligamentum flavum and narrowing mild narrowing of lateral recess bilaterally and neural foramen on right side related to posterior lateral protrusion of disc material;
L5-S1: Posterior bulging annulus fibrosis.

Neurosurgeon's interpretation: Mild to moderate spinal stenosis, discs probably not cause of neuropathy.
June 24th Peri-vascular study normal.
July 26th Nerve conduction study findings: (as explained by neurologist) Probes indicate overall mild to moderate neuropathy, suspected cause diabetes.
Needle probes indicate significant spine generated neuropathy (left leg minimal reaction to either probes with increased voltage).

Referred back to neurosurgeon with L5-S1 surgery recommended.

QUESTIONS: 1. Why the lack of urgency - appts/studies a month apart plus have called surgeon twice only to be told he will review nerve study report and call us to schedule consultation, (we hand-delivered report to his office the day of study a week ago). Are we too impatient?
2. Are there other causes for neuropathy? Neurologist says no, but hubby's diabetes diagnosis within 1 yr and his 3/6 month average tests on high end of normal range. He has been told by family Dr. that the back pain could result in false readings for his daily results.
3. What about the other bulging discs?
4. What kind of surgery will likely be recommended?
5. What is prognosis?
6. Recovery?
7. I'm fairly confident he also suffers from undiagnosed sleep apnea as he is a heavy snorer and stops breathing for 30-45 seconds (if not more) numerous times every night. How will this effect his recovery/surgery?
8. What about the spinal stenosis?

Footnote: Family history-Mother diabetes and neuropathy resulting in foot amputation. Father incapacitated by degenerative arthritis resulting in nursing home care at age 50. Any insight you can share would be greatly appreciated! Both hubby and I feel that his physicians' casual attitude seems to indicate his condition is not that big of a deal, but I'm WORRIED SICK!

--is that he could be "co-morbid", that is, he has symptoms from more than one cause and they are exacerbating each other.

In neurology, there is something called the "double-crush hypothesis"--that is, soemthing external, such aas diabetes or autoimmunity, compromises herves enough to cause some degree of symptoms, but then another aspect, usually a mechanical compressive force--carpal tunnel, disc bulges presing on nerve roots (known as radiculopathy), or some such--affecting the same nerves results in symptoms that are more than the result of the component causes.

It certainly seems he has enough compromise in his spine to produce neuropathic symptoms alone. But they may be exacerbated by impaired glucose tolerance/diabetes, or some other cause that hasn't bee found yet. There are over two hundred KNOWN causes of neuropathy, and it seems his situation warrants a much more extensive work-up. I recommend the Liza Jane spreadsheets:

www.lizajane.org

These were put together by a bunch of us (and coordinated by Liza Jane) as the most comprehensive listing of potential tests for neural symptoms we could come up with--excellent for suggesting aveneues of testing to physicians and for tracking test results/patterns over time.

Hi ~ The surgeon is probably acting the way he is because this is NOT what you would call an "emergency case." Your husband's spinal cord is not being compromised (that would be an emergency). I'm wondering if they got the wrong disc identified for surgery, cause L4-5 is the one that has the herniation, not L5-S1. I would think they'd want to take care of the herniation before any bulge. I would call the Radiologist's office and see if there was an error in transcribing or an error on the Radiologists part. I might be all wet, but I'd at least check. This kind of bothers me, looking at this report.

Take care. hugs, Lee