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Don't know who to trust? Neurosurgeon, Psyhiatrist, GP

edited 11/09/2015 - 8:07 PM in Chronic Pain
Here's my situation: constant & severe pain in lower back, butt, hip, tailbone (mostly on right side) legs ache, toes tingle & both feet numb & hurt with sciatica on right side- can't walk without assistance (cane or hubby) and can't stand more than 10 min. or so. Immobile. Had pain since early May. Female age 45. Tried physical therapy, 2 epidurals, steroid pack, muscle relaxers, Norco, Percocet.

MRI shows: L4-L5 broad based disc bulge with osteophyte & foraminal disk protrusion, minimal narrowing of spinal canal, mild right foraminal narrowing Disc degeneration. L5-S1 mild right & minimal left foraminal stenosis due to broad based disk bulge with osteophyte and hypertrophy of the facet joints.

CT scan w/fluid shows: L4-L5 Grade 4 - contrast leakage along the outer third of the annulus - 45 degrees right posterior & lateral aspect, L5-S1 Grade 4 - contrast leakage along the third of the annulus - 75 degrees along the posterior right lateral aspect. Mild posterior bulging in conjunction with degenerative changes. Foraminal stenosis. Mild degenerative endplate changes along the right aspect of L5-S1 and mild L5-S1 height loss.

Neurosurgeon wants to do fusion of L5-S1 claiming I have bone on bone. He doesn't believe discectomy will solve butt & back pain. My Physiatrist & General Practitioner don't believe surgery will help at all and that I should try additional shots for pain management. My Physiatrist is also referring me back to a neurologist to have neuropathy pain better evaluated. The first one I saw did not do a thorough evaluation. She's concerned about possible MS or diabetes. It's so hard to know who to trust and are desperate for pain relief. Would appreciate any suggestions.


  • LizLiz Posts: 7,832
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    Liz, Spine-health Moderator

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Hi Brave heart, sorry to hear of your pain. Did the GP and pys explain why they didn't think surgery would help? I've found that different health care professionals give different opinions and it's difficult to make a decision. I think you should try to find another opinion from a surgeon if you have doubts about surgery as it's a big operation and also to be clear on what is definitely causing your pain before you make a decision. I've always tried to find out as much as possible about the implications of each option before deciding. You may also want to ask why they suggest fusion of L5S1 if bulge is L4. My understanding (albeit maybe limited) from my surgeon is that a fusion of L5S1 could put more pressure on L4. I'm sure others who have had a fusion will be better equipped to answer this though. Good luck.
  • Thank you Lily. I've seen 2 neurosurgeon since this posting and they both said no surgery. I guess I have several issues going.g on and no one knows for sure the real cause of my pain. Ugghhh
  • SavageSavage United StatesPosts: 5,427
    You being referred to neurologist sounds like very good idea.
    My pain management Doctor is also neurologist.

    He did a variety of tests not done by others. In my case, the EMG showed much of what was not understood before.
    Being under pain management has been most helpful, also.

    He is able to prescribe necessary meds/treatments and has plans B, C...for future, to keep the edge off the pain and keeps me out of the ER for pain control.
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • I, too, have been offered many differing opinions throughout the years. At one point I was set up for a four or five level lumbar fusion (can't remember). The doctor wanted to resched the day before the surgery because he had not bothered to read my file and caught something he wanted to address. I cancelled completely.

    I have been in pain management for 11 years. I switched PM docs after the first one had apparently done all that she could do. My new PM is brilliant and had done some injections the other doc never did (there are so many different types and locations for the injections). He has gotten to know me and my issues and has been spot-on with injections lately.

    My spine has deteriorated into a crooked mess and I am so glad I did not have the surgery. The pain is still constant but I often think it could have been worse if I'd had the surgery. Keeping the injections updated is key for me.

    Due to the problems with radiating pain and such, it took a really good PM doc to zero in on the problem area that nobody else had been able to do. I have some of the same symptoms that you do. After 11 years in PM, my new doc gave me an SI injection that helped tremendously. He has also done RFA, lumbar, neck injections, etc. It is impossible to stay ahead of the pain when there are numerous problems, but you can only address one area at a time.

    The decision to have or not to have surgery is a very personal, difficult decision.

    Wishing you well.
    Scoliosis and other problems at every level.

    2013: C-5 to C-6 ADR
    2014: C-5 to C-6 fusion/revision of failed ADR
    2014: Total hip replacement, right

    Cancelled multi-level fusion - fear being more crippled and in more pain.
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