- When did this first start?
- Was it the result of an accident or trauma?
- What doctors have you seen?
PCP, Neurologist, Physiatrist, Spine Surgeon
- What Conservative treatments have you had? Which ones?
Meloxicam (2 months), PT (2 months), Epidural injections (2 x 2 L4 and L5)
- What diagnostic tests have you had? And their results
MRI of lumbar 2x. One test summary seems more "severe" than the other. See below:
MRI test September:
At L4-L5, there is a diffuse annular bulge that mildly narrows central canal. Disc osteophyte complex and facet hypertrophic change results in moderate severe left and mild to moderate right neuroforaminal narrowing.
At L5-S1, there is a diffuse annular bulge with superimposed right subarticular disc protrusion extending to the right neuroforamen. This results in mild central canal narrowing. Disc osteophyte complex and facet hypertrophic change results in moderate bilateral neuroforaminal narrowing.
MRI test October:
L4-5: Disc bulge flattens the ventral thecal sac. Bilateral facet
hypertrophy and T2 hyperintensity within the facet joints. No spinal
stenosis. Mild bilateral foraminal narrowing.
L5-S1: A broad based disc herniation, with greatest AP dimension of
4 mm in the right lateral recess, contacts the right descending S1
nerve root. Bilateral facet hypertrophy and T2 hyperintensity within
the facet joints. No spinal stenosis. Mild bilateral foraminal
- What medications are you currently using?
Gabapentin (2700 mg per day, 900mg 3x a day)
- Has surgery been discussed as an option?
Yes. By the neurologist and physiatrist.
- What is your doctor’s action plan for treating you?
In limbo land now. I've exhausted the conservative treatments and physiatrist said he would get me a 2nd opinion.
I've been having back pain since mid-summer and eventually progressed to numbness on the top of my left foot. This led me to the first MRI in September (they originally thought I had MS when I showed up with vision problems and numbness). I left the ER/hospital with a cane for walking because I sort of drag my foot so I know where the ground is as I can't feel it. Moving on, I went to a neurologist and they did more tests, which cleared everything except for the spine issue. He suggested I see a spinal surgeon and start PT. First day I start PT, they try to traction. I felt a electrical/shooting/tingling pain in my left big toe and foot and they stopped and let me go. Come 2 days afterward, I'm unable to move my left big toe and go to the ER again. This led to the October MRI's. They find I'm hyperreflexive as a result of side effects of drugs. They release me. I see my neurologist again and he suggests seeing a spinal surgeon. I see the surgeon and he says there's nothing he can do for me as I'm too young and everything seems mild. I see my PCP and he refer's me to the Physiatrist. The Physiatrist says we'll try epidural injections at L4 and L5. I get those done, and there is a mild improvement in my leg symptoms (numbness, muscle spasms) but doesn't help big toe/foot/and back pain. I get another round of injections and they don't work either. He refer's me to the same spinal surgeon I saw back in October. Today, the surgeon said the exact same thing.
So, now what? I have a toe that doesn't work, and believe me that your big toe does a lot of work when walking which is the reason I'm still with a cane. I'm going to get a second opinion as I think the spinal surgeon's thoughts are "tainted", meaning he doesn't want to change his mind and prove that he was wrong in the first place. I need a fresh set of eyes, and maybe a fresh set of MRI's.
Is there anything else I can do? I've had the toe and ankle weakness for almost 3 months now. I'm starting to get concerned about permanent nerve damage. The longer I wait, the more concerned I get and I think the longer the nerve will take to repair after surgery (if I have it). Am I stuck with a cane the rest of my life? I've even tried 800mg ibuprofen 4x a day WITH the meloxicam for a short period to see if it is inflammation - which it obviously isn't as that didn't work AND the ESI's didn't either.
Diagnosed w/ Lumbar Stenosis 10/1/14