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Cauda equina compression on MRI but pain 90% better - do I need surgery?

stefan80sstefan80 Posts: 3
edited 04/12/2015 - 3:34 AM in Lower Back Pain
Am I likely to heal without surgery?

MRI from 1 week ago shows "prominent posterior disc prolapse at L2-L3 causing spinal stenosis and cauda equina compression". GP asked me to come-in urgently after seeing this report - I passed all neurological tests. No cauda equina symptoms - no pins and needles, no numbness anywhere at all, never had any bladder, bowel problems.

I am now waiting for an appointment with a neurosurgeon for an initial assessment and recommendation.

My pain was severe 3 months ago but is 80%-90% gone now - is this an indication that the prolapse may have been much bigger and has reduced, and potentially will continue reducing and thus I won't need surgery? I am surprised the MRI showed this a disc prolapse after i've already improved so much (and continue to improve, even if very slowly).

My pain became severe 3 months ago when I went to pick up something small off the floor. Symptoms were - radiating pain into my butt, groin, quads. I never had sciatica, and never any pain below the knees. Straight leg test was also negative - i could raise my leg without any pain. Bending forward, and sitting was completely impossible for 1-2 months. I was mostly in bed for weeks. Over these 3 months, the pain gradually went away and is now 90%+ gone. That said - the pain returns if I sit for too long, walk, or have sex. I am able to work from home so for the past 3 months I have done almost zero sitting - I converted my desk to standing desk and after I the pain was bout 50%+ better I started standing at my desk and taking frequent rests on my bed, horizontal (no sitting at all). Perhaps this helped.

I was also doing stretches, and some lower back strength exercises - though only in the past 1 month (before it was too painful).

Previous to this I had suffered with a milder variation of these symptoms for 4 years but usually after a good night's sleep the next morning I was pain free, and depending on my activity level the symptoms would get aggravated by the evening. If it got worse I eased of exercise for a few weeks which would usually help. Perhaps a disc bulge had been there for all that time and 3 months ago it became bigger and more pronounced.

There is nobody on the forum medically qualified to give advice, all responses will be based on members experiences



  • LizLiz Posts: 7,832
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    Spinal stenosis since 1995
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  • wbasmithwwbasmith Posts: 4
    edited 04/12/2015 - 9:52 AM
    I would not rush into any surgery. You are fortunate to have recovered as well as you have. There is the options such as cortisone injections and physical therapy you still have. I have used these and instead of 5 surg. In as many years I have been mostly pain free for 12, if that makes sense. Òne surgery makes the lower spine more suseptable to strain and injury. I wish I was aware of this when I had my first one. I would have been more cautious of how I did things . We take our backs for granted . Good luck in your findings but be cautious.
  • Your neurosurgeon should give you professional advice. I would ask what the risk of future degeneration / herniation is and whether or not stabilisation surgery is recommended. If you're still suffering symptoms when sitting, that might mean that the bulge is still there and you are compensating for it through your lifestyle changes. But, bending down for a small item again may put you back where you were before. As Wbasmith said, don't rush into surgery if you can avoid it as there are risks associated with fusion such as adjacent joint damage but, a successful fusion would remove the risk of spinal cord damage at L2-3 and let you continue on regardless. There are plenty of success stories as well as unsuccessful ones, with success rates running at about 70%. I'm no doctor, but I think L2-3 is a rare disc to herniate as it doesn't move as much as L4-5-S1 so you may be less likely to have problems with adjacent discs.

    Be guided by your medical professional, ask for a second opinion if you're not sure ( good doctors shouldn't mind this), and then make your decision based upon what they tell you and what information you can glean from sites like this.

    I had CES symptoms as well as horrendous leg pain and numbness in my left foot. I had a successful L4-5 fusion 7 weeks ago. The leg pain, numbness and the CES symptoms are gone. I have lower backache as a result, but I can live with that.

    Hope that helps. Please let us know how you get on.

    L5-S1 herniation. Both knee meniscus tear. L4-5 herniation - 2 x nerve block injections. L4-5 discectomy. L1-2 nerve block injection. L4-5 reherniation - TLIF fusion. 2016: L1-2 and L5-S1 retrolistheses and multiple facet joint degeneration.
  • Thanks for the comments. I have a quick update.

    I saw a neurosurgeon (private in the UK, still waiting on NHS appointment) and he advised that we wait and watch. His prognosis was optimistic, and said that given the progress I've made to date he believes I'm likely to recover without surgery. He advised physio and generally being careful i.e. no bending, lifting etc. He also advised a re-scan in 6 weeks.

    Interestingly, he said my herniation is small (though MRI was taken 3 months after the herniation happened, so he also admitted that we don't know what it looked like 3 months ago when it first occurred), however, size of the herniation really is relative to the size of your spinal canal. He said that I have a naturally very small spinal canal and therefore even a small herniation could be problematic. He said the space for the nerves looks "tight but not critical" and more importantly he said we need to treat my symptoms, not the MRI. Since my symptoms are minimal (in fact almost none by now) he said we need to watch and wait and no need to think about surgery at this time, despite tight view on MRI. I continue to avoid sitting - I sit maybe once or twice/week for no more than about 15 mins. Yes my social life suffers but I meet friends for walks or they come visit me at home. I work from home and using a stand-desk now, but still with very very frequent rests in a horizontal position.

    I *think* that I occasionally feel some weird sensations (kind of like heat) in my right foot, but I don't know if this is my head or not since they are very subtle, and they did not occur while I was in pain (or maybe they did but I didn't notice). And I could have always had those sensations, but prior to my disc herniation never paid attention to them. I don't know. I get this maybe one evening per week. I told the neurosurgeon, he said not to worry about this for now.

    I've started walking on a treadmill about 3-6 km, usually 2 days on, 1 day rest (plan to gradually increase). I do various of the popular core and butt strengthening. I have not experienced any pain during any of these. Couple of months ago I could not walk more than 10 mins without starting to get various pain.
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