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Opinions appreciated

So after 9 months of no insurance and horrible back/sciatic pain, I got my insurance and had my MRI and just as I thought, not good, not good at all. As I say I've got a major blow out at L4/L5, and as the MRI report states "severe spinal stenosis". I was in physical therapy at the time, I showed my physical therapist one of the pics from the MRI (prior to getting the report, the problem was obvious), she advised me to get into my primary ASAP, as this was NOT GOOD AT ALL. So I did, pretty much the same reaction from my primary. He said I needed to get into the surgeon ASAP, and called to squeeze me in as there were no appointments available for 3 weeks.
So my appointment was today, I had x-rays and brought them all the reports, MRI's etc... bracing myself for the word surgery (as the MRI shows the disc is pressed up on my spinal cord so much, there is not much room left, and the disc below is bad as well) I saw the surgeon's PA, who said she wants to first try injections before surgery, BUT wants to see me back in 3-4 weeks because of the severity of the disc. She also wants me to get in to do this ASAP because of the severity, and personally called the office that would preform the injections to get me in asap. But instead of getting the usually series of 3 shots, I will only have time for 2 before I come back to see her so she can see if they are helping reduce the bulge.

Now my questions are (and of course these are what I thought of AFTER the appointment):

1. I truly appreciate the "surgery is the last resort" concept, I would like opinions on is this just to say, we tried everything before surgery and I'm just delaying the inevitable?? As it's been 9 months since this has started?

2. Without getting another MRI, how is she going to know if this is working? Before I was told to stop physical therapy (because of the severity of the bulge) it was helping. I haven't been able to stand this straight or long in months, but that doesn't change the size or severity of the bulge. Let's say the shot's take away some or even all of the pain and numbness, is she going to consider that as "working"?? To me that's not fixing the problem, it's a bandaid. I understand the concept of the steriod decreasing the inflammation to allow your body to heal itself, but I'm wondering if this has gone on too long?

3. Are there any of you out there that have had injections on a severe hernation, that have received the shots and your body actually healed itself?? I would love to be more optimistic, but I feel I also don't want to kid myself that a surgery isn't going to happen in the near future.

I would appreciate any and all opinions and comments, I'm totally new to all of this besides my brother having 4 back surgeries. I never injured by back this is lovely genetics, although my brother is the only other one with this condition that we know of on either my dad or mom's side.

Thnak you in advance for all your help!!!!


  • Did they mention the words Cauda Equina Syndrome to you at all? Or tell you if there is a change in your ability to use your bladder ( empty your bladder or bowels) or a decrease in the flow of urine or ability to hold your bowels that you need to contact them right away? Do you have numbness in your groin area or insides of your thighs? Increase in numbness?
    I have had it twice- and like you , have severe lumbar spinal canal stenosis- my current diameter of my lumbar canal is 3.26 mm . And I have the dura adhered from L2-S2, so they are trying to hold off surgery until I either become paralyzed ( or they are otherwise forced to have to go to the OR) because of the large dural tear that I will have from this 2nd bout of CES- thanks to the bmp used for my revision surgery in 2007...
    I would ask specifically about the diameter of the canal and what they are hoping for from the injections. Depending on what the diameter of the canal is, I would think twice about the injections. For me, given the tiny amount of the canal that is allowing the nerve roots to descend, the risk is too great for me to have injections.
    And I would ask about the risk of CES....that is a surgical emergency and needs to be treated within 48 of onset to minimize the damage becoming permanent.
  • They did discuss this and so far none of these "sensations" have been present. But of course they did say IF this does happen go to the ER ASAP. At this point I'm starting to wonder, like you, are you waiting for me to become paralyzed?? While I appreciate the "surgery is the last resort" take on things, I just would like them to be realistic with me.
    So yesterday I went and had my first epidural injection, ouch! In the counseltation I asked the anesthesiologist who was preforming the injections his opinion on if he thought these injections would "treat" this or what the point of even doing this is. Based on the urgency to get me into all these doctors asap. He agreed that it looks like I will probably end up having to have surgery because of the severity of the disc bulge or herniation (it is measuring 1.16cm x 1 cm). So I asked what exactly was he then trying to accomplish if this isn't the "cure" for it. He said he just wants to try to calm it down as much as possible so that it doesn't get worse. I told him that I feel the way everyone is making this seem so urgent, that I'm at the point where I could potentially wake up one day with little or no use of my legs or Cauda Equina Syndrome the way everyone is making it seem. I'm almost apprehensive to move thinking, one wrong move and I'm done. He said it's not likely but it is a possibility. So I feel as I'm back at square one. What's the point of this?? and I'm curious how long they will hold off until doing surgery. To me, if it's as severe as everyone is telling me, then why wait until something really bad goes wrong? Thank you for your reply, I truly appreciate it, I apologize for going on and on, I guess I'm just venting and have alot of unanswered questions!!
  • Hi Megmac, I just has an epidural steroid injection on Sept. 6 for sciatica. I have had numerous injections since 1993 and never once was I told that it would treat the herniation but would hopefully give me pain relief and put off having surgery for awhile. I can tell you when I have a series of 3 one year I had complete pain relief for 3 yrs. Then scheduled another set of 3 which lasted a yr. and then lasted 6 months and finally 2 weeks and in 2008 had 2 more lumbar lamenectomies. I have not had much luck with injections since, only lasting a week or two at most. Sometimes they help with pain for long periods but sometimes not. I hope if you decide to try the injections that they work for you and you can "put off" surgery for awhile.

  • BkinsBBkins Posts: 364
    edited 09/07/2012 - 3:57 AM
    A lot of insurance companys will not allow surgery until you have gone through a gauntlet of procedures and tests. This may be part of the reason for having the injections done. Makes no sense to make a patient go through all this when they really are in need of surgical intervention.

    Good luck
  • Well it's now Friday and I had the shots Wednesday, I understand they do not work overnight, but I am feeling nothing really, the same pain if not a little more of a different type of pain, still waiting to see if anything good comes out of this. I know this is totally different, but towards the begining of this my primary had me on steriod pills, the first round, worked like a charm!! But of course when it wore off, I was back to square one, so we tried a second round, which was like taking nothing at all. A few weeks after, I went back yet again (this point no insurance and could only afford my primaries office visit charge) he suggested yet another dose of steriods but this time doubled it. NOTHING, not a minute of relief or change. I'd love to stay optimistic, but I just have this gut feeling this is going to do nothing. And I sure as heck do not want to go through the pain of those injections again for nothing! So yet again I'm waiting patiently to see what that next appointment brings. I guess I just don't understand the "putting off surgery for a while" what benefit do I get from doing that?? If nothing is bringing me relief and if it has to be done at some point, my opinion is I'd rather just do it and get it done and over with. Sitting around worrying whether or not this is or isn't going to happen is just one more thing added to the list. We all know it's not going to heal itself, so why wait until it gets so bad you can't function. Sorry, I'm just on a rant now, but come on, I'm not a doctor my any means, but I'm also not an idiot.
    Bkins- I have thought about the insurance aspect of it as well, which is one of the reasons I'm not opposed to getting the injections, this way I can say :I have tried it all". We all know the insurance companies run the doctors which is such a shame but it is what it is. But I'd almost rather have the doctor tell me this straight up then try to convince me there is a chance these injections may calm things down enough and my body will heal itself. Again, I'm not doctor but I have common sense and I you see the MRI, we've done past the point of healing itself, so save your line for someone else and just tell me straight up. But as I was speaking with the doctor who did the injections, when my physical therapist saw the picture from my MRI she said get into your doctor now, don't even wait until next week, so I did. So when I see my primary, pretty much the same reaction, to the point he called the surgerons office to get me in that week, even though they were booked. I go to the surgeons office, same reaction, I need to go get these injections asap, she called that office to squeeze me in. It's like red flags for all these doctors and a major sense of urgency that I now feel one wrong move, turn, bend, or twist and I'm done, loosing control of my legs or bladder. But instead of fixing it before it gets to that point, lets try this first (even though we know it won't work) just to say it didn't work. It's enough to drive a person batty!!!!
    Thank you both for your comments, support and advice. I'm sure you know it's hard for people to relate if they aren't in the situation and even a little comment or your own story or advice makes me feel like there are other people out there that understand and can relate. I appreciate you both! Thank you!!
  • backbback Posts: 190
    edited 09/07/2012 - 5:43 PM
    You do realize that there is a chance that the steroid injections could calm things down. It is possible for you body to absorb the herniation. Unfortunately, you need a lot of patience when you have problems like this.
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