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Foraminal L4-5 stenosis, considering XLIF with partial facetectomy

bpreisbbpreis Posts: 2
edited 07/10/2015 - 4:53 AM in Spinal Stenosis
Hi All,

This is my first post here. I'm here to poll the community for advice and wisdom regarding treatment of spinal stenosis, specifically bilateral foraminal and lateral recess stenosis at L4-5.

About 3-4 years ago I began experiencing general lower back pain, radiating down into hips and butt. No leg or foot pain or numbness. About 1.5 years ago, I experienced a disc herniation at L4-5, which was determined to be inoperable as it was a lateral herniation (left side) based on x-ray. Constant aches continued in the same areas: lower back, primarily left side, radiating down into my left hip and butt.

I requested an MRI and was diagnosed with lateral recess and foraminal stenosis of L4-5, affecting both sides, but primarily left side, which was consistent with the pain. I have had two rounds of epidural cortisone injections: round 1) transforaminal left side only; round 2) transforaminal left and right sides. Second round of injections was on both sides due to acute pain starting up on the right side and confirmed with a second MRI.

I have consulted 3 different surgeons here in Austin, TX. First surgeon recommended conservative treatment with no possibility of surgery (by him). Second surgeon recommended continuing injection therapy until I had trouble walking, at which point I'd be a candidate for surgery. Third surgeon recommended an XLIF with partial facetectomy on left side to decompress the nerve root.

Where I'm at today:
I have trouble sleeping because it is difficult to find a comfortable sleeping position. Trouble standing and sitting for longer than half an hour, so I'm constantly adjusting positions at my desk job. Sharp pain in the first few degrees of bending forward, shifting side to side, or trying to roll in my desk chair side to side. Pain is usually worse in the morning (like 5 out of 10) with significant trouble putting on underwear and pants, but tends to abate as day goes on (like 3 out of 10 when triggered by bending, shearing, etc).

Emotionally, I'm more irritable due to the pain and uncertainty of how to deal with it longterm. It's affecting relationships on the job and socially. It also seems to be causing some depression, so it's not just a biomechanical problem, and I feel that this is where all the surgeons I've consulted get a failing grade, as it does not factor into their equations.

As of this morning, I now have a surgery scheduled with surgeon #3 in August, but I have a few reservations that I'd like to clear up before jumping on the operating table:

1) In all three consultations, I was asked to perform some basic tests such as walking on my heels or toes, lifting my feet with pressure applied to the top of feet, sensitivity to touching along leg inseam (cauda equina test?). I have no measureable numbness or pain in my legs or feet. But I have triggered numbness in left leg once or twice by shifting my weight around artificially.

Does lack of pain/numbness in legs/feet indicate that I should wait for surgery in spite of constant pain in hip and butt area radiating from left lower back?

2) If I'm still able to maintain about 50% of my previous activity levels, such as hiking, cycling, traveling, should I consider waiting until I'm further incapacitated before taking on the risks of surgery?

3) What *are* the risks of surgery? I'm assuming worst and rarest case is paralysis. But aside from that, how rare is nerve damage with an XLIF, insertion of a cage, and facetectomy? And how longterm is nerve damage -- can the body completely heal from accidental nerve damage where a nerve is not completely severed?

Long story short: I can still hike, jog (slowly), ride an upright bike, but I have constant pain that is affecting me in all areas of my life. I am 38 years old and I am normally a very fit and active person but have been slowed down significantly by stenosis and am considering surgery, but am also afraid of the risks.

Any advice would be appreciated. Thanks!


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  • EventurerEEventurer Posts: 1
    edited 10/05/2015 - 8:17 PM

    I am curious where you are at with your back issues. I seldom post but was compelled to reach out to you because of the similarity in our pain symptoms. After 9 years of increasing discomfort and many conflicting options and solutions from multiple doctors, I opted for back surgery 4 weeks ago. While the jury is still out I can say with conviction that 50% of the pain is gone 60% of the time which is in and of itself a victory. I am happy to share more if you would like more information about my surgery experience.

  • SavageSavage United StatesPosts: 5,427
    edited 10/06/2015 - 5:10 AM
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