MRI Results and Major Issue in Lumbar Spine - What now?

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Birder Nancy
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Date Joined Mar 2015
Total Posts : 77
   Posted 5/30/2018 7:16 PM (GMT -6)   
T12 - L1: Unremarkable.
L1-2: Unremarkable.
L2-3: Broad-based disc protrusion. Moderate central stenosis. Mild bilateral foraminal stenosis.
L3-4: Broad-based disc protrusion. Hypertrophic changes of the facet joints. Moderate to severe central stenosis. Mild bilateral foraminal stenosis.
L4-5: Hypertrophic changes of the facet joints causing grade 1 anterolisthesis and severe central stenosis effacing CSF around the nerve roots. Moderate right foraminal stenosis. Mild to moderate left foraminal stenosis.
L5-S1: Mild disc bulge. Left paracentral disc protrusion which abuts and possibly impinges transiting left S1 nerve root. Moderate right foraminal stenosis. Mild to moderate left foraminal stenosis.

Is there a way to upload a photo here? The MRI image is sobering.

For the last 4 months I’ve had pain deep in my right buttock, and numbness in my right leg ankle and foot. Also in my left ankle and foot. Impaired walking and difficulty sleeping. Taking Gabapentin and had a steroid injection three days ago. First day the pain was much less but since then it has returned.

I was told this is normal and it tales several days or a week for the full effect of the injection to take hold.

I’ll write more in my next post. Thanks for any good words!

straydog
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Date Joined Feb 2003
Total Posts : 16796
   Posted 5/31/2018 6:54 AM (GMT -6)   
Nancy, you sure do have lots going on in the lumbar spine. Some areas more concerning than others. If you had an epidural, yes it can take close to two weeks become fully effective. I do hope it brings you some relief. When do you see your dr again? How long have you been on Gabapentin & what dosage?

Keep us posted.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Birder Nancy
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Date Joined Mar 2015
Total Posts : 77
   Posted 5/31/2018 10:36 AM (GMT -6)   
Susie, my next appt. with the Dr. Is in July though she told me I could contact her at anytime with questions of concerns. I’ve been on Gabapentin 3 weeks now and am up to 3 300mg pills per day.

I cannot seem to post the image of my MRI film. I tried both the image and url tags and no luck. Any suggestions? Thanks!

Alcie
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Date Joined Oct 2009
Total Posts : 5029
   Posted 5/31/2018 10:49 AM (GMT -6)   
Did you try before the url with no space between and also with no space after it?

(Seashell)
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Date Joined Dec 2012
Total Posts : 890
   Posted 5/31/2018 12:47 PM (GMT -6)   
Nancy:
A large number of disc bulges (even of moderate description) can successfully recede with patience and time (2-3 months). This may be one reason why your physician has scheduled your follow-up with a longer time frame.

The gelatineous make-up of discs allows for this passive receding. To optimize the possibility of the disc to recede back into proper position, avoid overt flexion and forward bending. I do not know if you can tolerate lying on your stomach with your cervical history, but lying prone on one’s stomach is an ideal position to facilitate the passive realignment of disc material. If you can not tolerate lying prone, you can also try standing, placing your hands over your low back/“kidney dimples,” and gently arch backward. Gently with a slow sustained stretch, as tolerated. If you feel an easing of your symptoms, this is informative.

McKenzie Extension is the named methodology. You can work with a physical therapist for a few sessions to see if this methodology would be helpful. You can also google “McKenzie Extension for lumbar spine posterior disc protrusions” to learn more about this helpful approach.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Birder Nancy
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Date Joined Mar 2015
Total Posts : 77
   Posted 5/31/2018 12:53 PM (GMT -6)   
/nancyjune.smugmug.com/Other/Misc-photos/i-qF8Z3d3/0/ca23c95f/M/IMG_1047-M.jpg

My MRI photo. Note the compression of the nerves between L4-5, and also the offset vertebrae. I believe the numbness in my legs and feet as well as the pain are due to this compression. The injection may at some point help the pain but I cannot see it helping with the numbness. Maybe the PT Karen mentioned will help. I have an appt. with a PT therapist on June 13th and I’ll see what she says about the McKenzie Extension.

Post Edited (Birder Nancy) : 5/31/2018 12:03:52 PM (GMT-6)


Chartreux
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   Posted 5/31/2018 12:58 PM (GMT -6)   
for the first 24 hours after injections your supposed to put ice packs on for 20 minute intervals and this will help. Yes it can take a week to get relief.
So very sorry you have a lot going on with your back.
Physical therapy ultrasound treatments might help, but you want to wait for a week as those injections do need some time to recover from...

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 5/31/2018 4:14 PM (GMT -6)   
Thank you, Chartreux. I think I’m on the right track so we’ll see.
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16796
   Posted 6/1/2018 7:36 AM (GMT -6)   
Nancy, L4-5 is probably the culprit for the leg issues. Yes, some bulges can go back in place if a person is lucky. You have a lot of things going on besides the bulges. I say take the conservative care approach to see if it brings any relief. The dr can also increase your Gabapentin to see if that helps with the legs. Do talk to the physical therapist about the McKenzie exercises.

Keep us posted.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 6/1/2018 10:27 AM (GMT -6)   
Thank you, Susie. The Dr. has increased the Gabapentin dosage from 300mg once a day to 300mg three times a day. This was done gradually over about 6 weeks. I’m looking forward to my PT on June 13th. Right now I’m up for anything that will help. I forgot to mention that I have had some pain relief from medical cannabis. As I’m diabetic I do have to be careful when taking edibles. So far it’s been ok. Thanks for all the good words and info!
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16796
   Posted 6/1/2018 10:57 AM (GMT -6)   
The severe stenosis is an issue. Lets hope the steroids will calm those nerves down & hopefully relieve some of the swelling. Being diabetic the steroids will most likely cause your sugar to fluctuate. Will be hoping you can get this under control with conservative measures.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 7/11/2018 1:07 PM (GMT -6)   
Latest update:

I've been to PT twice now and am going again this afternoon. Two different sets of exercises haven't really helped much, if at all. Pain and numbness in my right foot, leg, and now right hip has increased and is much worse at bedtime, making sleeping difficult as I can only get some measure of relief in one particular position.

I emailed my Phys Med Dr. and she sent a referral to neurogery at Kaiser Sunset (where I had my cervical laminectomy and fusion 3 years ago). She also fiiled out a form authoring a temporary handicap parking placard and I mailed that in a few days ago. I'm now waiting for a call from neurosurgery to schedule an appt. for a consult.

It looks like the handwriting is on the wall.

Coincidentally a friend had this exact L4-5 issue a couple of years ago and was very helpful in describing her experiences with symptoms, surgery, and recovery. She advised me not to wait too long because of the worsening symptoms and possible further compression/damage to the nerve root, and also my age - I'll be 73 next month. I certainly don't want to become even more disabled than I already am: not being able to walk very far, even with a cane, and not being able to drive more than a short distance because of a lessening ability to feel the gas and brake pedals due to increasing numbness after 15-20 minutes behind the wheel. UGH.
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 890
   Posted 7/11/2018 7:21 PM (GMT -6)   
Birder Nancy:
While it is sobering to consider another surgery, the surgical options for lumbar decompression have advanced considerably over the past few years.

I had a completely desiccated disc at L5-S1, likely due to my work as a physical therapist working with spinal cord and head injury (heavy lifting, pushing, pulling). I had bowel and bladder compromise which demanded surgery and significant edema of the vertebral body/bone marrow. I underwent a straight forward micro-disectomy with excellent results (immediate post-operative neurological improvement was evident). I declined a suggested fusion at L5-S1. I believe that my body heals best with less intervention. Sure enough, the two vertebral levels fused naturally over the course of two years. The post-op recovery was somewhat challenging in regaining full ankle plantar and dorsi-flexion, and I hit a wall with afternoon with fatigue for several months. All and all, not bad.

For all of the health issues that I content with, I can say unequivocally that my lumbar spine has given me no heartache since the micro-disectomy. I hope the same for you if you undergo the procedureS.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16796
   Posted 7/12/2018 6:24 AM (GMT -6)   
Nancy, I think getting in with NS is an excellent idea. The numbness & such is not good. Your friend gave you some great information. Nerves are tricky & she is right about letting it go too long. I have seen this before, people either afraid of surgery or just refused to do anything. By the time they got around to the surgery, they had waited too long & the nerve damage was permanent. This happened to a friend of mine, she walks with a really bad limp. The nerves became so damaged. She knew going in the odds were not in her favor, but at least the surgeon was able to fix the mechanical part.

The injections are like putting a band-aide on the problem. If they work, its temporary. Then you get into issues with the steroids having the potential of causing even worse problems. They are not a long term fix at all.

Keep us posted please.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 7/13/2018 2:15 PM (GMT -6)   
Good news! My referral to neurosurgery came through. On August 1 I’ll be meeting with Dr. Brara (the neurosurgeon who performed both of my cervical spine surgeries). It will be interesting to hear what he recommends. I have complete faith and trust in him and right now plan to go with whatever course of action he advises.
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 8/9/2018 4:42 PM (GMT -6)   
OK, here’s the latest update: I met with Dr. Brara on 8/1 as planned. He spent a lot of time asking questions, checking my reflexes and going over the MRI from every angle -including top down, which was quite interesting. He said at this point due to my deficiencies and increasingly limited mobility that surgery was my best option. It would be a decompression, realignment, and fusion of L4-5 and decompression of L5-S1. Before surgery, however, he ordered a new MRI to review my cervical spine so he can see the precise correction and alignment of C3-T2 from my surgery in 2015. This MRI is on for 8/23. His surgery schedule is 6 weeks out right now so I’ll have an exact date for surgery after he sees the MRI. My next step is to re-read “Prepare for Surgery - Heal Faster” by Peggy Huddleston, the book that helped me tremendously deal with undergoing surgery and subsequent healing from the 2015 laminectomy and fusion. I’ll post again when I have the surgery date.

(Seashell)
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Date Joined Dec 2012
Total Posts : 890
   Posted 8/9/2018 5:14 PM (GMT -6)   
Nancy:
You have given this considerable thought and have benefited from top notch neurosurgeon consultations.

Your neurological symptoms have been troubling and have not improved with conservative management. You’ve done what you can do to avoid surgery.

If it helps you at all . . . I had a L4-L5-S1 decompression about 8 years ago due to a desiccated disc at each level with associated neurological loss. The recovery was not bad. The compressed nerve roots “pinked up” nicely with good restoration of nerve function. I woke up from anesthesia and felt immediate relief. I hope the same for you.

We will be here for you, standing by your side.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 8/9/2018 6:45 PM (GMT -6)   
Thank you for the good words and encouragement, Karen. I do appreciate it. I really feel connected to and supported by my Healing Well family!
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16796
   Posted 8/10/2018 7:55 AM (GMT -6)   
Nancy, I am not surprised at all about the surgery recommendation. With the findings on the MRI & your physical symptoms no surprise at all. It sounds like you have an excellent neurosurgeon. It is wonderful to read about the time he spent explaining everything in detail. I am certainly impressed.

I have no doubt that you will do well. You handled your neck surgery extremely well.

Please keep us updated.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Post Edited (straydog) : 8/10/2018 7:22:45 AM (GMT-6)


Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 8/10/2018 3:03 PM (GMT -6)   
Thank you so much, Susie! Dr. Brara said that although this is a major surgery, its much less complex than the 2015 operation. I hope to do at least as well recovering as I did back then - if not better. smile
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

Post Edited (Birder Nancy) : 8/10/2018 2:08:35 PM (GMT-6)


Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 8/31/2018 9:52 PM (GMT -6)   
OK, I’m in the home stretch. I had my pre-op appointments last Wednesday and am all ready for surgery, which is on for Tuesday, September 4th. I’ve been re-reading my book (Prepare for Surgery Heal Faster) and listening to the meditation and relaxation tapes. I feel calm and prepared. I need to report to the hospital at 6:30 A.M. (yikes!) on Tuesday, and the surgery will happen about 8 A.M.

I would love it if you will think of me at that time and send along your thoughts and good wishes! It really made a difference when I had the laminectomy and fusion of my cervical spine back in 2015. Thank you all in advance!

My hubby Dan will be there with me and my son Kelly will be coming out from CO to help out once I get home from the hospital - probably in 3-4 days.

I’ll post back here later next week and let you all know how it went and how I’m feeling. It may be a strange thing to say but I’m really looking forward to this surgery. I want to regain the quality of life I had before this latest episode sidelined me.

I’ll be back here soon!
- breast cancer 2000 (DCIS: stage 0 non-invasive)
- endoscopic carpal tunnel surgery, both wrists: 2005, 2006
- cataract surgery 2009, 2011; right eye then left
- emergency surgery to remove gall bladder 2010
- right posterior cervical thoracic decompression w/micro-discectomy 2013
- 7-level C3-T2 posterior cervical laminectomy and fusion; with titanium hardware: 2 rods, 14 screws 2015

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16796
   Posted 9/1/2018 10:39 AM (GMT -6)   
Nancy, it sounds like you have your plans in place for next Tuesday. Try to relax as much as you can over the weekend, in other words do something nice for yourself!!

We will be sending many healing thoughts & prayers your way. Looking forward to hearing surgery went well.

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 890
   Posted 9/1/2018 6:47 PM (GMT -6)   
Nancy:
Gotcha on Tuesday’s calendar. Sending healing energy and a dozen lucky lady bugs for a successful surgery and gentle recovery. Thinking of you.
Karen

Mercy&Grace
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Date Joined Jun 2013
Total Posts : 1729
   Posted 9/1/2018 7:20 PM (GMT -6)   
You are in my prayers.

Birder Nancy
Regular Member


Date Joined Mar 2015
Total Posts : 77
   Posted 9/9/2018 1:59 PM (GMT -6)   
All went well on Tuesday, though surgery took longer than expected due to extensive work rebuilding my lumbar spine. I wentinat 8:30 A.M. and came out at 2:30 P.M.

Pain is bearable. I’m taking 1- 10 mg oxy every 4 hours.

Heres the write-up Dr. Brara gave me:

Bilateral Laminectomy L4 + L5

Stenosis worst at L4-5 junction of right L5-5 facet

Small synovial cyst

Right TLIF bone graft

Bilateral foramenotomies at L4-5, S1

Pedicle screw fusion and screws at L4-L5-S1

Bone graft over transverse processes of L4 L5 S1

(I just copied and pasted from his notes)
I’ll post more later when I’m not so tired/scrambled.
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