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just diagnosed with spinal stenosis-lumbar

Hi,

I am a 66 year old male, generally in very good condition. In August I moved a couch. a few hours afterward I had severe pain in my left leg. Having pain when I stand or walk, in various places below my knee. It is very debilitating. I had been seeing a phyisical therapist who had been treating mostly my hip for the last two months, with assorted exercises. There has been very little improvement, so I went back to the orthopedic doctor this week, who order an MRI.

The MRI indicates spinal stenosis- lumbar. Here are the major impressions.

1.Mild discogenic disease at L3toL5.
2.Focal left parcentral protrusion at L4-L% measuring 3-4mm AP which narrows the left lateral recess and may be affecting gthe descending nerve roots.
3.Severe facet arthropathy at L4-L5.
Moderate to severe acquired central spinal stenosis at L4-l5

I saw the physical therapist today who focused more on the spine.

I just made an appointment to see a neurosurgeon to manage my situation.

I hear from others that a conservative approached is appropriate, continuing with physical therapy, but I have very little knowledge of what needs to be done, or the best way to go about treatment. I am hoping for advise and help by others, more experienced with this at this forum.

What type of doctor should I see now? I'm also interested in seeing an excellent doctor. I live in Southern CA, just south of Long Beach, however I am willing to travel if necessary.

Thank you very much for your help.

Ira
66 years old

Here is an additional post that I made at that time

"Since I last posted, I saw a pain management doctor at ucla.......I had an epidural on 2/11...I think that there may have been some minor success....I had also continued to do physical therapy stretches until 3/9/10.

On 3/9(tuesday afternoon) I had an flair of severe pain that lasted until that sat morning 3/13........(part of the flair which concerned me a lot was that I was unable to mechanically turn to the left in order to get out of bed)

Also I had another epidural scheduled for Thurdsay March 13th.......on Wed, march 12th, I received results back from a annual blood test from my primary care physician. It showed that my bun and creatine blood levels were elevated...the primary doc thinks that it's due to an antiinflamtory that a doc had prescribed, oxaproxim/600mg 2 times a day(sp), as a result of this blood test my second epidural was cancelled.........today, I retook these blood tests hoping that my numbers will normalize.

I stopping doing stretches from 3/9 until today 3/22...I started doing them again today.

I wonder, if anyone knows the optimim amount of time between epidurals?

Any other comments are appreciated"

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Comments

  • I am so sorry to hear of all the issues you have going on in your spine. As far as what type of doc to see, the most important thing is that they are a spinal specialist. It is always advisable to exhaust all of the conservative treatments available before ever attempting surgery. Surgery holds no guarantees and I have seen many that actually had worse pain after surgery. Have you considered seeing a Pain Management doc? I saw many docs in the beginning but a PM was the one that was the most help to me. They have several conservative treatments that can be tried. Good luck and please keep us posted.
  • Welcome to Spine-Health. There's a wealth of knowledge on this website and the forum is a great place for support, info and friendship.

    I would suggest you find a fellowship-trained spine surgeon (can be an ortho or neuro), someone who only works on spines. One place to start searching is on the Find A Doctor area of Spine-Health - there's a button at the top of the page. You can also ask for referrals from members here, but we aren't allowed to post specific institutions or doctor's name publicly. So someone will need to send you a private message with any referral information.

    I'm not a doctor and certainly can't tell you what needs to be done to make you better, but I can tell you that when the word severe is included in your MRI, you definitely need to see a spine specialist. Almost all spine surgeons will try conservative measures before anything invasive.

    I know that stenosis can be a very painful condition, as I have it myself at L4/5. According to your MRI, you also have severe arthritis in your L4/5 facet joints (facet arthropathy) which is probably contributing to your difficulty in standing and walking. Please keep in mind that I'm not a doctor so I can't diagnose your condition, but I have the same facet issues and have the same difficulties with standing and walking.

    Anyway, please keep us posted about your search for a doctor and what therapy they suggest. Feel free to PM me if you'd like to talk or vent. Spine problems are very difficult and everyone here understands the frustration and pain that comes along with them.

    Take care,
    Cath
  • hopeful and optimistic said:

    The MRI indicates spinal stenosis- lumbar. Here are the major impressions.

    1.Mild discogenic disease at L3toL5.
    2.Focal left parcentral protrusion at L4-L% measuring 3-4mm AP which narrows the left lateral recess and may be affecting the descending nerve roots.
    3.Severe facet arthropathy at L4-L5.
    4.Moderate to severe acquired central spinal stenosis at L4-l5
    Just a patient and not a doctor here, either, but you've made the right choice by making a neurosurgeon appointment IMHO.

    In my personal, non-professional opinion, nothing you've got is going to be significantly, positively affected by PT. The parcentral protrusion at L4-L5 sounds like something that happened when you moved the couch and that would result in your current symptoms. Everything else seems to have grown on you over time, including the degenerative disease at the same location that probably opened the door for the disc to run through it. You could have had this degree of stenosis for quite a while; sometimes there are no symptoms and thus no treatment required and I don't think it would present with the degree of urgency that you are describing.

    I would ask what the doc thought the source of the arthropathy was; are you diabetic? Have gout? Or is it reactive arthropathy indicating a bone infection, which, given its location would probably relate it to the couch moving incident. If your stenosis is isolated to that one space I might be inclined to wonder if the arthropathy might have caused it.

    All of these issues except the degenerative disease could have gotten their impetus from the single domino that is the couch. The disc at L4-L5 is mildly desiccated, and that allows it to slip through an opening that it was never intended to go through and wouldn't have if the disc had been normal. This results in reactive arthropathy, an infection which gnaws at the bone, causing the stenosis.


    All of the problems appear to center around the L4-L5 disc bulge which is described as a protrusion rather than a herniation. If that's the case, you could conceivably get back on the road with an easy, in and out endoscopy and some antibiotics.

    Again I emphasize, this is all guess work on my part; I'm a kitchen designer, not a health care professional. I'll be interested in knowing how it comes out, and like the other members here will be sending up good thoughts for you.

    TitanNeck



    The information provided by members of Spine-Health should never be considered as formal medical advice. It is recommendations based on member's personal experiences only. This can vary from person to person, so do not take comments as medical rules. Edited by moderator Paulgla
  • Titan NeckTo my knowledege, I am not a diabetic or have gout. I eat a low fat diet, and have done exercise almost every day which consists of a lot of walking, with the Sierra club and at the gym, and general resistance training. My weight is at a normal level. About 15 years ago I was rear ended and my neck was messed up. Apparently, I had arthritis in my neck. I've been doing and am doing exercises that I learned in physical therapy for this condition.

    Please help me out, talk to me about an endoscopy.... Is that an injection in the back.........how long will the benefits of this last? Do I still continue with physical therapy?

    JJ Grey, Would a pain medicine doctor bring something that the neurosurgeion cannot? When , and how would I go about seeking one; do I coordinate with the neurosurgeon.

    Cath, Thanks for the sympathy. The pain and debiliating condition is unique to me, frustrating and awarkward. Currently, I made a trip to New Jersey visit my elderly Mother who was just treated for a serious disease. I wanted to come earlier when she was going for her operation, but I was not able to because of the severe pain that I feel when I walk. Of course, like others here there are a lot of situations that I come across which are different than what I did as an able bodied person. I'm sure that others who post here have come across the same situations, and worse.

    Generally, I am positive and am going on with my life, no matter what happens here.
    Ira
  • Sorry to see that in your quest for answers it only presented you with more questions and confusion.

    PLEASE keep in mind that Spine Health members are not docs and many are Internet Diagnosticians.

    You are doing the right things by seeing your doc and getting a referral to see the neurosurgeon. See what the neurosurgeon has to say and go from there. If he feels that your case warrants surgery he will let you know. If he feels that you might benefit from trying conservative measures, once again he will let you know.

    Unfortunately when we hurt like crazy and we search for answers on the Internet, it can very quickly spin our head in more directions than we thought possible. A hands on diagnostic examination by a qualified spine specialist (neurosurgeons fall into the category nicely) is a very important early step in finding out what needs to be done or not done.

    I wish to welcome you to Spine Health. A place where there are many friends to be found and many shoulders to lean on for support.

    "C"
  • I wish I was in such good shape. An endoscope would enable a surgeon to perform a microdiscectomy. Instead of doing an open surgery they go through a tiny incision and basically "trim" off the part of the disc that's protruding. As I understand it, in cases where the pain presents in the leg, this procedure can result in immediate and permanent pain relief. My cousin had one; she got up out of her hospital bed as soon as she woke up and was pain free. In fact, at the risk of over-sharing, this is how my hysterectomy was done, too. Laproscopically.

    You asked about a shot, and yes, you could potentially get some relief from a shot, and that's probably what the NS is going to want to do first. The idea with a shot is to reduce the inflammation so that whatever's damaged can heal itself. That's never actually happened for me or anyone else I know who got lumbar shots, but I don't know everybody, so there might be people out there who only had to get one or two shots and were done.

    A lot if your answer depends on which is the chicken and which is the egg, IMHO. That's why your NS has a seven figure income and I work for a big box retailer. 8} You have everything in your favor for a simple solution that's more or less permanent. At 66 you're able to move a couch. You watch your diet and are in generally good health for a person twenty years your junior, and your entire problem appears to be isolated to what is essentially, one disc space. The rest of us should be so lucky.

    Call my wreck of a neck TitanNeck... :''( :''(

    And always remember, kitchen designer, NOT MEDICAL PROFESSIONAL. I'm aware of sounding like I know more than I might; when my dad was in two different ICUs for a total of about six months, several doctors assumed I was a doctor or a nurse because I can speak the language correctly most of the time.
  • edited 01/20/2014 - 1:48 PM
    I hope that all is well with the posters who were here for me..........Thank you.

    Thanks to input by one of the posters that stood out at that time, John Blunt I saw an excellent pain management doctor at UCLA. I received two epidurals and changed physical therapists to one who had a certificate in backs.

    The first epidural did not have much effect, but the second one kicked in and at that time I felt 95 percent better. I did not go for a third one. I regularly did the physical therapy that I was shown by the physical therapist; I still do. I. feel 100 percent better

    I changed my exercise routine from what I had been doing; some days, I swim either free style or back stroke---no breast stroke. I walk a lot and have gradually increased my walking to four miles, which I do about 6 times a week.... I do not walk on a tread mill, but in a Nature Center on earth. I wear top brand hiking shoes for support.

    For the first year. at the gym I did not lift or use any machines for weights, but now I use machines only for weights that do not affect my lower back.

    I do not lift heavy things that confront me in life circumstances.

    I watch what I eat, mostly vegetarian diet and I lost 25 or so pounds that I gained due to the spineal stenosis. My blood pressure numbers and lipid panel shows great improvement.

    I do not have any pain.

    I am able to go on with my life

    I hope that this will be helpful to those who read this.

    Ira

  • Nice to see you back again and to read that you are doing so well. Just so you know, spinal stenosis is not caused by or worsened by weight gain, it is a narrowing of the areas where the spinal nerve roots exit the spine at each level or of the spinal canal where the spinal cord passes through.
    It's great that you are able to walk so far and doing it several times a week and the swimming helps ......
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