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Posted By : Alex31 - 6/6/2017 8:41 AM
I am a 73 yr old man with lumbar spinal stenosis and herniated/bulging discs with moderate chronic pain. Have tried PT, chiropractic, and meds; getting acupuncture now. Since my pain is not unbearable but manageable, I have avoided epidurals, and I have opted to postpone a laminectomy. My main problem is poor balance and unsteadiness on my feet when standing or walking. Will a laminectomy help to correct that problem or only reduce pain?

Posted By : (Seashell) - 6/6/2017 9:26 AM
Poor balance and unsteadiness on the feet is generally multifactorial in its origin. In someone in their early 70's, a few possible causes of balance issues would be:
1. Any history of diabetes or neuropathy of the lower legs and feet?
2. Any history of moderate alcohol consumption on frequent basis over the years
3. General deconditioning and loss of strength, loss of flexiibility. A large number of people, as they age, become weak due to sedentary tendencies. Critical in effective balance is good range of motion and flexivility in the ankles and feet. A good portion of balance recovery comes from postural sway that originates with the feet and ankles.
4. Age related vestibular changes.
5. Early onset of any number of possible neurological conditions (Parkinson's, as one example).

You mention that you have physical therapy for your lumbar stenosis. Did they also address your balance and ambulation concerns that you mention here?

By itself, a laminectomy will not "fix" balance recovery strategies or steadiness in ambulatory. A laminectomy will relieve pressure on specific lumbar nerve roots. If these nerves were compressed causing a loss of motor/muscle strength and sensation, then you can expect improvement in these particular functions.

Balance recovery reactions are highly correographed and automatic in recruitment at both the level of the spinal cord and brain. The corrective response is elicited in microseconds. All without our conscious awareness. A laminectomy alone cannot correct for balance recovery and steadiness in the feet - but it can help if the balance problems are owing to sensory or muscle loss of the associated nerve roots.

A visit to a functional medicine physician might be helpful as well as additional consultation with a physical therapist to specifically address your balance concerns.

Fear of falling is a large problem as people age and falls a major contributor to a more constrained quality of life. Like other aspects of our bodies, people need to "work" on honing balance skills and core strength and flexibility - from top to bottom. You are wise to begin to look for support and answers to better your balance and steadiness in your feet.
- k -

Posted By : straydog - 6/6/2017 9:34 AM
Hello Alex31 & welcome back to Healing Well its been awhile. My first question is do you have nerve involvement, such as a pinched or compressed nerve? How many levels has the surgeon proposed doing surgery on? Did you obtain an independent second opinion? If not, I suggest getting one with a board certified neurosurgeon. Speaking of surgeons, is your dr an orthopedic or neurosurgeon? Many of us prefer a neurosurgeon as they have far more expertise dealing with nerve issues involving spine surgery.

Just my opinion, since you say your pain is manageable, I would not consider surgery until the pain is no longer manageable. If the pain were out of control & affected my daily living activities then yes, I would look at other options. Going into surgery for pain control such as what you are now describing I personally would not do because the surgery may not relieve the pain & there is a potential of it becoming worse. Surgery is a big step & given your age the recovery will be not be as easy as it would be for a much younger person. I am almost 64 & I know how hard it is to recover from things now.

The unsteadiness you speak of, what does the dr say about this & the cause? Is this directly related to your back problems or do you have underlying issues going on? What about the physical therapist, I would have thought this would have been something he/she would have worked on.

I am sorry for so many questions, just trying to get a bigger picture of your situation. Look forward to hearing back from you. Take care.
Moderator in Chronic Pain & Psoriasis Forums

Posted By : Alcie - 6/6/2017 3:31 PM
You've "avoided epidurals," but one of the types of spinal injections (there are several) might serve as a test - reduce swelling temporarily with steroid - to see if surgery might help. I would ask an anesthesiologist pain doctor, not a surgeon or other type of doctor. An anesthesiologist who practices pain medicine knows the nerves and what the injections do.

I'm in your age range and suddenly acquired moderate balance problems after a bad fall, landing on my head and breaking my neck. I have had lumbar problems for years, but that never bothered my balance. I have also had some temporary balance issues with sinus problems, but clearing the sinuses (mostly with sinus washes for a day or two) has cleared that problem every time it has occurred.

My head or neck (can't tell which) injury-caused balance issue has a different feel from sinus infection-caused loss of balance. I have no dizziness with the head/neck, but I do with sinus. My sinus dizziness can go to vertigo/whirling.

Bottom line is surgery is a big jump from treatments you've been doing.

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