Hi All.
My name is Melody and I usually post on the peripheral neuropathy message boards. My husband found out that his neuropathy is directly related to his back. He had an MRI last year and here are the results.

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TECHNIQUE: Neurtal/Sitting: Sagittal T1 Sagittal T2, Axial T1

Interpretation: Desiccation of all the lumbar intervertebral discs is present. Minimal narrowing of the L1/2 disc is present. Ventral marginal osteophytes and diffuse disc bulging are noted at the L1/2 and L2/3 levels. Both bulging discs impinge upon the thecal sac. Moderate narrowing of the L3/4 and L4/5 discs is present. Ventral and dorsal marginal osteophytes and diffuse disc bulging are noted at the L3/4 and L4/5 levels. Both bulging discs cause small ventral impressions upon the thecal sac and extend into the inferior aspects of the adjacent neural foramina bilaterally. Minimal narrowing of the L5/S1 is present. A diffuse disc bulge is noted at the L5/S1 which impinges upon the thecal sac and extendes into the inferior aspects of the L5/S1 neural foramina.

A moderate fat island hemangioma is noted within the L4 vertebral body. Minimal bilateral facet hypertrophy is identified at the L4/5 and L5/S1 levels.

The lumbar lordotic curve is well maintained. There is no evidence of loss of height involving the lumbar vertebral bodies. The bone marrow demonstrates normal signal intensity.

The paravertebral soft tissues demonstrate normal signal characteristics and morphologi appearance.

There is no evidence of spinal stenosis. The cous medullaris and cauda equine demonstrate normal signal intensity. The conus is within normal limits in size. There is no evidence of an intra-dural lesion.

IMPRESSION: L1/2 DISC BULGE, WHICH IMPINGES UPON THE THECAL SAC.
L2/3 DISC BULGE WHICH IMPINGES UPON THE THECAL SAC.
L3/4 AND L4/5 DISC BULGES CAUSING SMALL VENTRAL IMPRESSIONS
UPON THE THECAL SAC AND PARTIALLY COMPROMISING THE ADJACENT NEURAL FORMAINA BILATERALLY.
L5/S1 DISC BULGE WHICH IMPINGES UPON THE THECAL SAC AND PARTIALLY COMPROMISES THE L5/S1 NEURAL FORAMINA BILATERALLY.
DEGENERATIVE DISEASE.
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My husband goes to a chiropractic/neurologist who does his adjustments and got him off the fentanyl pain patch. That, so far is absolutely amazing. but he still has the neuropathy when he lies down at night. And if I don't massage him, well, he doesn't sleep. We recently went online and found that there is a procedure called non-invasive discectomy.

I called the phone number from the SpineOnline website and the person on the other end, told me the following:

"Melody, from what you just read to me, Alan's problem is quite fixable, since we go through the Foramina".

The man also said that they don't take any medicare HMO's and that the surgery costs $25,000 so that let's us out of the ball park.

BUT!!!! the guy gave me a lot of information and this is what he said:


" Melody, when you speak to any surgeon make sure you ask them the following: "Does the operation involve taking any of the bone, or Lamina? There should be no lamina to be removed!!! The surgeon should not say to you "oh, perhaps we might take a little of the bone". Then he said "Melody, we don't touch the bone. Not even a little bit. Make sure you get that absolutely straight if you talk to any surgeon"

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So my question to any of you knowledgeable people is the following:

From what I have posted about his mri results, do you think he might be a candidate for this procedure, and have any of you had this procedure??

My husband has been told he is not a candidate for surgery, both by his primary care phsysican and his chiropractic/neurologist.

And a few days ago, we went for a free consultation to a nearby doctor who does the DRX 9000 decompression machine. That would cost $5000 and they don't take insurance either.

So my husband (he had the misfortune of taking a fall today and is resting comfortably), will eventually go back to the gym and keep up his exercises but the neuropathy drives him crazy. He would just like to know if there is hope out there!!!

any comments would be most welcome.

Thanks much.
Melody

If it were me, with thecal sac compression at those levels, I would be seeking the opinion of an experienced orthopedic surgeon, as well as another neurosurgeon. Naturopathy and chiropractics have their place in medicine and I do believe they can be beneficial. But with an MRI like that, I would definitely be looking to get the pressure off the cord and the neural foramina and get rid of the lower limb issues. Be on the look-out for symptoms of Cauda-Equina Syndrome (CES), which include loss of bowel and bladder control.

If you haven't already, check out http://www.chirogeek.com and read up. Dr. Doug Gillard is a chiropractor who is also a lumbar spinal sufferer and has taken the time to make a "soup to nuts" tutorial of all things lumbar spinal in a plain language format.

Theresa

Hi. A few years ago, my husband went to one of the top orthopedic surgeons in NYC. He ordered the MRI of the back. When Alan went back to him, he shook his head and said Alan can't have surgery, that they would discuss pain management and some kind of implant thing (like Jerry Lewis had done) so the pain could be managed. He even prescibed some kind of epidural shot in Alan's back to relieve the pain. These are the impressions that the doctor who gave him the shot, said:

"There was a mild degenerative scoliosis of the lumbosacral spine. S1 was transitional. There were degenerative changes, including disc space narrowing most prominent at the L4-5 level, marginal osteophytes and facet arthropathy. A good epidurgram was present with excellent disperasl after the medication was injected. The patient tolerated the procedure well. He was kept in the office for one hour after the procedure for observation and monitoring. he was discharged in stable condition, with post injection instructions."

Maybe it helped with the pain for about a week. After that, no help at all.

Only much later, (After Alan went to a pain management doctor who prescribed the fentanyl patch), and I went on the Peripheral Neuropathy boards, and I found out there was a special kind of chiropractor who specialized in neurology also, and we went to him, did any help come for my husband.

When Alan first walked into that office, he weighted over 260 lbs, was stiff as a board and could not bend anywhere. He never exercised a day in his life and was in agony.

The chiropractic/neurologist (A Dr. Theirl in NYC) did all kind of tests, and besides reading his MRI results, also had some of his own results. This is what his chiropractic/neurologist said in his findings:

"alan has been diagnosed in my office with the following:
Lumbar Sprain/Strain, Parasthesia, Cervical Sprain/Strain, Thoracic Lesion.

The doctor also had many neurological impressions. (Too much to type here).
But I will mention the Orthopedic Impression:

"Severely hypertonic and tender to palpitation/stretching bilateral lower extremity musculature as well as gluteal and spinal musculature. , Lumbar spine active range of motion limited to: 45degree flexion, 10 degree extension, 10 degree lateral flexion bilaterially, 10degree rotation bilaterally: all with mild dull pain reported in bilateral lumber spine. Minor's Sign was present. SLR positive bilaterally at 60degrees. Ely's positive left for femoral flexion contracture.

TREATMENT: Manual manipulation using gentle flexion/distraction of the lumbar spine. Post Isometric Relaxation (PIR) stretching of hamstrings, quads. Trigger point muscle therapy of gluteal origins and lumbar spine erector spinae. Exercise, home stretches and diet recommenations.


Now this was written in 2003.
To date, my husand went off the patch (detoxing in a hospital and later at home). He also never went to the bathroom on the patch.

Since going to his chiropractic/neurologist, (at first 3 times a week initially, to about once a month to two months at present), my husband is a new man.

He lost 73 lbs. he goes to the gym three times a week. he was able to get a part time job as a security guard (he still can't drive because he doesn't think he will feel the pedals and that's why he gave up driving in the first place).

But his flexibility is amazing. He looks better, feels better (he had a stent put in in January, and is on meds, and a low salt diet) so he dropped all excessive weight and went from a 50 waist to a 38 waist.

His neuropathy improved so much he doesn't even take a pain pill anymore.

And he goes to the bathroom two times a day because he eats fruits and vegetables.

But the only time the PN annoys him is when the weather changes or when he lies down on his back. Then he takes a small amount of xanax and I give him a massage on his calves and lower back. By the way, even though the PN was attributed to his back condition, my husband never had a back problem. never was crippled by back pain. Nothing like that. We never knew about the back until they took an MRI of his back to see maybe that could be the reason he had neuropathy. He is not diabetic.

We also went to spinal decompression place but they want $5000 and we don't have that.

I don't know if he will go further and try to find a surgeon to get rid of the remaining neuropathy. All I can definitely tell you is this:

If my husband had never gone to see Dr. Theirl and had those adjustments (or whatever this guy does with a G5 machine), my husband would have either gone crazy from the pain or be dead now. He was up to 150 of the fentanyl patch and also vicodin for breakthrough pain.

Every single improvement he made has been attributed to Dr. Theirl and the stretching and exercises at the gym. He is now a new man, eats differently, looks different and can actually move much better. He was literally crippled before.

I know that chiropractic is not for everybody but in my husband's case, this man literally saved his life. I just wish we could get rid of the remaining neuropathy so he could drive again.

I know that his problem doesn't compare to most of the problems that people on these spinal boards have. My heart goes out to anybody with that kind of pain.

My husband told me he was contemplating suicide right before we found Dr. Theirl. I never knew this.

It's a damn shame.

I wish you well.


melody

Hey Melody,

I'm not saying chiropractic treatment doesn't have it's place...never in a million years. I've had treatment from a DO doing similar distraction techniques, and they've provided tremendous relief. But, my concern when you posted was the MRI images. Sometimes folks who post just don't realize how damaging chiropractics can be, if the patient has an MRI like your husband's and a chrio is doing Grade 5 manipulations (cracking with alot of torque).

I am glad to hear your husband's progress, and that the neuro/chiro has been able to improve his symptoms to the point that he doesn't really need pain medication on a regular basis. Unfortunately, once there's been nerve damage, even when you do take the pressure off with decompressive therapies, the nerve pain continues because of somatization.

I've been to HSS's orthopedic surgeons myself for evaluation and like your hubby, I'm not a surgical candidate. Good luck in the search for more information and treatment. Don't give up hope that the neuropathy will ease over time. Take care.

Theresa

Hi, I was just comparing his mri reports.

The one from May14, 2003.

The patient's symptomatology is consistent with neuropathy. He does not appear to have symptom's of neurogenic claudication. However he does have significant spinal stenosis.. blah, blah, Surgical decompression for neuropathy would not reliably afford the patient relief of his lower extremity pain. However, if there is radicular component secondary to stenosis, thi smay afford him some pain relief.

Please tell me what radicular component secondary to stenosis means???


Now heres the kicker.

The other mri report (a standup MRI) was done in 2005.

Here's what it says on that one: "There is no evidence of spinal stenosis. The conus medullaris and cauda equina demonstrate normal signal intensity. The conus is within normal limits in size. There is no evidence of an intra-dural lesion.


So here's my dilemma. The first report says "significant spinal stenosis".
the second report says "There is no evidence of spinal stenosis.

How is this possible?

Melody

Radicular in this case is referring to radiating pain down his legs. When there is exiting spinal nerve root compression (or stenosis), then you can have pain that extends to whereever that nerve root supplies. If you take a look at a dermatome map, then you can see whether the corresponding nerve root is a possible causative for extremity pain.

One thing to note is that each radiologist reads an MRI and reports, often using similar langage for the same things...and other times, they miss things completely, and sometimes the body changes enough, that what was seen at one point is no longer as markedly present in the future. Another difference could be between the position of the MRIs...one was standing and the older was a supine MRI (laying down)? His stenosis could be related to load bearing.

Just based on what you've written, my best guess that the L4-L5 nerve roots are the cuplrit for his neuropathy, barring any other causes. Of course, I'm not a doc, so I could be full of hooey.

Best of luck to you.

Theresa

You are very knowledgable, so I think I'll pick your brain.

Have you ever heard of the procedure "endoscopic dischectomy"?????

I mean, compared to the other kinds of surgery, this one is a walk in the park, an expensive walk in the park but a walk in the park.

On the website http://www.spineonline.com/

they explain all about it and my husband and I saw a video of the actual operation. It's amazing.

I would appreciate your thoughts on such a procedure.

I think when my husband goes to his next primary care phyician's appointment, he's going to run this by him.

He really wants to get rid of the neuropathy pain once and for all.

melody

P.S. I asked Alan about pain radiating down his leg (I have sciatica, so I know about pain), and since my husband has never once complained about any pain radiating down his leg, when I asked him he just said "oh, I have pain in my lower back down the leg, once in a rare while, (I think it's kind of a dull ache for him), He never has gone around going "oh vey, my back my back", ever in his life.

I know sciatica, I've had two attacks, took an mri and have the L1, L2, L3, thing going on. I exercise every day but when it rains, forget about it because I suffer from degenerative joint disease. No walk in the park, believe me.

The big difference between a traditional discectomy and an endoscopic discectomy is that an endoscopic discectomy uses a much smaller incision and the use of scopes versus scalpel. They still have to access the disc, and remove the offending portion. The recovery is much easier because there's less collateral damage to the surrounding tissues.

As to the difference between "attacks" of sciatica and the pain from a compressed nerve root is that the attacks are transient in nature and are usually the "sharp, stabbing pain" that's associated with nerve pain. When you have a nerve root that is constantly under pressure, you're going to have a constant pain, often dull, but it can be described as a buzzing, or bugs crawling, or twitching.

I'm a thoracic spinal sufferer, so I can't speak from first hand experience about pain down my legs from compressed spinal nerves. But, I have a constant ache/pressure that wraps around my ribs and abdomen, with these occasional zaps when I change position. I can only imagine that it's similar with the L-spine and the legs.

I would definitely run it by the PCP the next time you're in. It can't hurt to ask, and find out if something like an endoscopic disectomy could relieve some of his symptoms. Some people respond well to medications like Neurotin or Topomax for neuropathy associated to spinal nerve root issues. I've been lucky to have the worst of my back problems alleviated with Botox injections (minimized the spasms), so it's possible that some type of injection to the spinal nerve roots might be appropriate for your husband.

If you haven't already, check out the web for SNRB (selective nerve root blocks) for more info on it.

Theresa

Thank you Theresa, I will check out the web for selective nerve root blocks.
They tried Neurontin on Alan two times, he became violently ill.

the only thing at the time that worked was the fentanyl patch.
But he no longer has the need to use it.

My confusion is: If the endoscopic discectomy is a much easier procedure and does the same thing then WHY DON'T ALL THE DOCTORS PERFORM THIS PROCEDURE???

This drives me crazy.

I faxed alan's mri reports to the Spinal place in Los Angeles (the place where they do the endo thing). The guy on the phone said "Oh, your husband's problem is easily fixable.

Yeah, that's great but who on earth has $20,000 to pay for this operation. And we don't think that his medicare HMO will cover it but we are looking into that. His insurance would cover an open spine procedure but not a minimally invasive one (now how stupid is this?).

I just don't get this.

melody

I honestly think alot of it has to do with the skill of the surgeon and their willingness to learn new techniques. It also has to do with money, since there's quite a bit of training involved with learning the new technique.

Its not easy to find a doc that is up on all the new stuff, but if you search around, you'd be suprised. I was frustrated with the local docs when I went to HSS, but before I did, I asked around the local NS and OSS groups for recommendations, and they were actually suprisingly willing to name names when I told them what I was looking for. Finding docs who do T-spine surgery is like looking for a needle in a hay-stack.

Another thing you might want to consider is to look into AlphaKlinik (sp?) in Munich, Germany. I know, long haul to go there, but they're so much farther ahead of the US in terms of spinal medicine it's not even comparable. The will review films and make recommendations, so you won't have to take a trip there if he's not really a candidate. A couple of members here have gone to Germany, for a similar amount that you were quoted for LA, and that included getting pre-op, the whole hospitalization, and rehab. Go check out http://globalpatientnetwork.com if you haven't already. Mark and other's have had wonderful successful experiences with going out of country to get the best care possible. A couple of folks too out loans, or maxed out CCards to do it, but are thoroughly pleased with their results.

Best of luck to you.

Theresa