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When to consult neurosurgeon...

FarmgrrlFFarmgrrl Posts: 146
edited 06/11/2012 - 8:39 AM in Lower Back Pain
Hello all...

I'm having a pretty frustrating time here...I've posted a few topics re: ESI's, meds, etc. but now my next question is...

When should I finally just ask for a consult with my neurosurgeon?

My short story is that I started having back & leg pain again in the middle of September after having a micro-d two years ago. I've been seeing my pain management doc since the middle of October and have had two ESI's; my most recent one was this past Wednesday, Nov 11th. I have been on Zanaflex, Tylenol, Aleve & Vicodin (now I only have 3 left); I started Elavil last week but didn't tolerate the 25mg dose and I have cut down to 12.5mg but still haven't taken it long enough to see any benefits.

Since my ESI on Wednesday, I only experienced about 15 hrs of relief. I know it takes a good 3-7 days for the steroids to take effect but now I'm having increasing symptoms! Today is day #3 since my ESI. Most specifically I woke up this afternoon for work tonight and my left big toe was numb. I went to work, started experiencing spasms in my back and leg...it was decided that I should just leave because I could barely walk. (At that point I also broke out in tears...again). By the time I left work, the numbness spread to the top of my foot as well as my left calf. While waiting for my relief to come in, I had to lay down in an empty patient room because it was the only tolerable position. I got home, took two Zanaflex and a Vicodin and a lot of the pain eased up.

I'm feeling quite anxious about all of this...I asked the pain mgmt doc that did my injection on Wednesday as to when it would be a good idea to consult with the neurosurgeon and her answer was, "The last thing you want is more surgery because then you'll just have more scar tissue." This wasn't a very concrete answer in the very least. I have an issue with her statement because I don't see where it says I have scar tissue in my MRI report. Also, she looked at my MRI pics when I had my first epidural in October (no report was available yet) and she definitely saw the extrusion but said nothing about scar tissue. Now she is convinced that scar tissue is a big cause of my pain (I think she misready my MRI report) and wants to do a special procedure (epidural neurolysis) in lieu of another ESI. I can't find a lot of information about this procedure and I'm not too sure I want it done. I do trust this doc (she is the best at this in the area) but I am kind of weary at the same time...

Right now, I want to sit down with my primary pain mgmt doc and have her explain the MRI results to me. I want to request a neurosurgery consult just to hear what his ideas are because I don't see how much longer I can keep going on like this. I work 12 hours shifts, 3 nights a week as a nurse. I have had to leave work early now 2 out of the last five shifts I've worked. I have been contemplating asking for 8 hour shifts temporarily but if I need surgery then I'm just wasting everyone's time. If there is scar tissue, I want my surgeon to show it to me. From my understanding, if scar tissue is my issue shouldn't it have reared its ugly head in a long time ago?

Basically, I'm just really frustrated and the new symptoms are freaking me out.

Thanks for reading!


  • I would definitely get an appointment with your Neurosurgeon. You need to find out what is going on. Good luck.
  • I guess I just need a little reassurance that I'm not over-reacting....to me it seems I'm just getting worse at this point. I really don't want surgery unless I absolutely need it as I will probably lose my job and face financial ruin.
  • Called my PM doc first thing this morning...got an appointment at 12:20 this afternoon. I decided to call out from work since I haven't been able to go longer than 6 hours without Zanaflex and the spasms persist (though they've been a bit better since 6 am).

    I've worked up my list of questions & concerns for her as well.

    Keeping my fingers crossed that I find some answers today!
  • Regardless of what your PM doc has to say, I would still request a referral to see your neurosurgeon. This is effecting your life in a huge way and if getting reassurance from the neurosurgeon helps, then what's the harm. If the neurosurgeon reads your new films and determines that you need more surgery, then you validate your concerns. Either way it should be your choice and not the PM doc's.

    Sure there's always a chance that scar tissue is forming and even possible it is causing the problem. That doesn't mean that you shouldn't have it looked at by someone better trained to understand and deal with it.

    Just my opinion anyway.

  • Just got back from the PM doc...she said it before I even had a chance to ask...I've been referred to my neurosurgeon. She also prescribed a Medrol dose pak to see if I can get some short-term relief. Also got a work note for restrictions ("no bending, no twisting, no lifting greater than 10 lbs. Unable to sit, would suggest charge nurse assignment") Kind of laughing about the sitting...I have to sit some time but I guess her intent was no sitting for long periods of time.

    I asked her about the scar tissue and she said she didn't see it either in the MRI report but perhaps her partner had seen it on the films...I guess its a moot point now!

    Now I just have to manage to get in touch with a human at the NS office!

    Overall, I am relieved but this starts a whole new chapter in this sequel...
  • Well, I'm sorry you're starting another chapter in your story, but isn't that the way of a spiney? There seem to be volumes when it comes to our spines.

    Are you going back to the same neurosurgeon who did your micro-d? Is s/he a spine specialist?

    I'll be rooting for you to finally find what you need to help you move forward. Do you have a date to see the neuro yet?

    I'm be anxious to hear what the surgeon says. So please keep us posted.

  • I felt like I was doing so well with my back for the past two years...I'm past the point of having a pity party though :) Since surgery, I only needed to do the steroid-muscle relaxer-Vicodin cocktail once which was this past Febuary (which was much better than I had done before my micro-d until I re-herniated September of this year).

    I do plan on seeing the same NS again. My surgeon has been doing this for 25+ years though I know he doesn't strictly do spines. I checked him out before my last surgery and he comes highly recommended (I asked one of our pediatric NS about him too and he gave me the thumbs up). I was pleased with my care and results last time. While we do have a medical school here, they do not have a teaching program for Neurosurgery but he is one of the attending surgeons at the Level I trauma center here. Of course, I will see what he recommends. If he's thinking of fusion, I will of course get another opinion if that's the case!

    The 'bad' news is that the earliest I can get into see him is Nov 30th because of the Thanksgiving holiday next week. I know many people have to wait a lot longer so I'm not complaining...promise! :)

    Will definitely keep everyone posted!

    Now I have to see how I can manage to keep my job with just 3 weeks of FMLA left til June...

    BTW, are you not headed for some surgery yourself?
  • Sorry you have to wait so long for your appointment. The waiting sometimes is harder than anything else we have to go through.

    As far as your surgeon, I was only curious. If you have confidence in your surgeon and really like him (especially if you've previously been treated by him), that counts for an awful lot. I've had my surgeon for over a year and I have so much confidence in him that whatever he says goes. I never even get a second opinion. Some might find that questionable, but when you have the right doctor and are 100% confident in his ability, knowledge and skill, then it's just a waste of time and money to go anywhere else.

    Yes, I'm scheduled for a TLIF on Jan. 6. I'm so looking forward to it...NOT! But, whatta ya gonna do? Like I always say - once a spiney always a spiney.

    Now, my sister-in-law is convinced that I can be cured by doing yoga like she was, so I might try that first. LOL

    Take care Christine.
  • Hi Cath,

    I'm having trouble trying to reply politely to people's suggestions for treatment...different people at work have suggested: pilates, yoga, the chiropractor, the new Sketchers shoes, vitamins etc. I just wanna scream, "IT'S NOT GONNA WORK!!!" LOL I know they only mean the best but some of them are kind of stubborn when I try to tell them that I have a nerve compressed in my back by an EXTRUDED disc! Nothing like those suggestions is gonna be able to make it pop back into place and cure me right now...no less, yoga and pilates are the last thing I wanna do, no less, can I do it right now? If this was just a pulled muscle, I'd be all over it!

    May I ask what has led to your fusion?

    Take care,

  • I've actually gone about a year with no nitwit suggestions, so I feel lucky. But just recently, my hubby's boss and his wife swore that there was a PT at their church that could cure ANYBODY's sciatica. They were really pushing for me to go to her until my hubby told him that it was way past that.

    Then came my sister-in-law who told me that yoga cured her back problem. When I asked her if she had an MRI, I can't remember how she put it, but in a nutshell she tried to make it sound like she was the braver sole not to even get an MRI, that she took care of it herself. Some people's kids...don't they get it that if there was anything that easy to fix this problem that I wouldn't be discussing it now? I'd be fixed already.

    My back pain (lower back, hips, and pain down the back of both legs to the knees) started last February. In June, I went to my surgeon for a cervical follow-up x-ray and they sent me for a lumbar MRI.

    I've tried facet joint injections, ESIs, and a nerve block, all without long-term or any success. So, my surgeon suggested the TLIF because it's the only procedure that will have a chance to relieve all three symptoms. The main problem is coming from stenosis and bad facet joints (I also have a diffuse disc bulge) and they'll fuse the facet joints and clean out the space where the stenosis is to make more space for the nerves. I also assume he'll do something about the disc, but that's on my list of pre-op questions. He also said that it may end up being a PLIF, depending on what they find when they get in there. I haven't researched the difference yet, but I think it's the hardware.

  • Farmgrrl said:
    Hi Cath,

    I'm having trouble trying to reply politely to people's suggestions for treatment...different people at work have suggested: pilates, yoga, the chiropractor, the new Sketchers shoes, vitamins etc. I just wanna scream, "IT'S NOT GONNA WORK!!!" LOL I know they only mean the best but some of them are kind of stubborn when I try to tell them that I have a nerve compressed in my back by an EXTRUDED disc! Nothing like those suggestions is gonna be able to make it pop back into place and cure me right now...no less, yoga and pilates are the last thing I wanna do, no less, can I do it right now? If this was just a pulled muscle, I'd be all over it!

    May I ask what has led to your fusion?

    Take care,

    Howdy Christine,

    Pretty name, I like it better than Farmgrrl! :-) At any rate, I too have run into what you describe. One of my employees was almost "insistent" on acupuncture! Like Cath said "have you had an MRI? The disk is on the nerve, and though I appreciate your input and concern, it is not going to take that puppy off of it!" The next day he suggested traction! Well, a week later he was offloading some bales of contraband (law enf.) and he "pulled" something in his back. The sad of the ironic? 3 weeks later he had back surgery with a disk replacement! Where was his acupuncture and traction now! He has become a "Hey leave her alone, I know, there are times surgery is it!!" Strange how that happens eh?

    People though they mean well, when we have "something" (disk, bone spurs, spacing problems, overlap etc.) people can't see it, don't understand the really bad possibilities if we are in a minor read ender, game over!!! Scary just to type that!!!! People just don't get it Christine!! *HUG* Please don't kill the uneducated, but caring ones!!! :-)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks Brenda! Actually, farmgrrl is my nickname all the way back from high school so I have always used it as my username for boards like these...

    The funny thing is that I am a nurse and therefore work with a whole bunch of nurses but I guess it takes a "spiney to know a spiney". Of course, we work with kids so the worse we usually see are actually fusions (we call them "scoli repairs") but nothing else save for a few NS paitents that have had laminectomies for tumors. I do know a couple of nurses though who have back issues as well and have seen the same PM/physio's that I see. They definitely get it!

    It is amazing how much more aware and cautious I've become...I got so used to feelng "normal" for a good year and half. I've been put on a 10 lb lifting-restriction now at work which will be fun since I do take care of kids.

    In the meantime, I will try not to hurt anyone if they offer me another cure...LOL

  • Ouch Cath! I'm sorry that is not a "simple" disc issue for you!

    Haha...if yoga was the cure all I would need to do is throw one of my DVD's in and *poof* I'd be fixed too! I actually had an exacerbation 3 days after completing a 10 week summer yoga class in college. I was much more flexible after finishing the class but I still managed to make my back angry after cleaning my house. :)

    I'm waiting to see what the NS has to say but I'm 99% sure we're gonna be heading towards a second micro-d. I've been feeling OK except we just went on a 2 hour grocery expedition to Wal-mart (this is the most activity I've done since going home early Sat. night) and my back is aching! All I did was walk and point at what I wanted! No cart pushing, no reaching or bending. No sciatic pain, just lower back ache which I guess is just butting its head in to remind me that I do have DDD too! That part has been manageable for years now, its just the sciatic/disc issues that affect me greatly. I'm just hoping that my back will behave with these steroids on board so that I can get through work this week and weekend (I'm working 4 12-hour shifts in a five night span, ugh!)

    I've thought about looking at the different fusions but right now I'm going to try to hope for the best...again! (I had my hopes set that my pain would subside and that the ESI's would work but that hasn't panned out too well LOL)

    What are you doing while you wait for surgery? Are you able to take meds for relief? Are you able to work?

  • If I walk for five minutes at a store like Wal-Mart, Home Depot, etc. I set off a chain of misery. Most of those big box stores have concrete floors that are just really hard on those of us with lumbar issues.
  • Oh, those hard floors will just kill you. I can't walk far in them either without major pain issues.

    Christine, I sent you a PM.
  • I didn't think about the hard floors even though I consciously wore my good sneakers!

    Happy news though...my sciatic pain is still at bay right now, took my last dose of steroids today. Now I guess I just have to wait & watch to see if and when it comes back. I'm secretly hoping it stays gone so I can cancel the NS appointment but I've already started with some tingling again in my big toe & foot. After working two nights in a row, I'll take that. Lots of aching though in my back all the way up to my shoulders but the Aleve & Zanaflex are keeping it under control for now.

    For now, I'm keeping my fingers crossed!
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