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RN with Cerebral Palsy & Severe Left Lateral Foraminal Stenosis L5-S1

I suffer from spastic cerebral palsy although I am quite ambulatory. I had an intrathecal baclofen pump, but I broke the catheter. I had the pump removed, but I developed a CSF leak which was surgically closed.

I also have levoscoliosis with severe left lateral foraminal stenosis at L5-S1 with osteophytes confirmed by MRI in 2007. At that time, I was having low back pain worsened by prolonged sitting with mild sciatic symptoms in the left leg. I was diagnosed with left sacroiliac joint dysfunction causing low back pain which was confirmed by SI joint injection and that pain was completely relieved through a simple physical maneuver with my legs.

Nevertheless, I was also having mild left leg sciatic symptoms which were felt to be attributed to the lateral foraminal stenosis.. The sciatic pain was relieved through physical therapy and low dose lyrica 50 mp PO three times daily.

Recently, I began having burning pain going down my left leg with numbness & tingling to the bottom of my left foot after prolonged standing with low back pain and stiffness. Those symptoms were relieved after sitting for a few minutes The burning pain with numbness & tingling appears with less and less time standing and is now encompassing my entire foot as well as moving up the outside of my lower left leg.

Had 2 epidural steroid injection which provided mild relief for about a week & a half. I cancelled the third epidural injection in order to investigate a lateral foraminal steroid injection. Next, I had a follow-up MRI of the lumbar spine done recently.

The pertinent MRI results are:

"L4/L5 level, disc dessication and a small broad-based posterior disc protrusion remains similiar in appearance to the prior study. There is bilateral facet joint hypertrophy as well. Mild central canal narrowing and mild bilateral neural foraminal stenosis are seen."

"At the L5/S1 level, decreased intervertebral disc height and a posterior disc osteophyte complex complex are similar in appearance to the prior study, There is mild enhancement in the intervertebral disc likely related to degenerative change. The previously seen annular fissure involving the the intervertebral disc is no longer demonstrated' Note is made of hypertrophy involving the epidural fat at L5/S1. Mild central canal narrowing and severe left-sided neural foraminal stenosis are present. Mild right-sided foraminal stenosis is seen. The foraminal stenosis is similar to the prior study. The amount of epidural.fat deposition appears increased."


The spine surgeon (orthopedic} and the pain management doctor both see mild progression on the MRI since my MRI in 2007. The spine surgeon's PA has said they would consider surgery using a screw to keep the lateral foraminal opening widened and stated that it would involve a fusion since the screw would have to be attached to additional hardware (if I understood correctly).

However, they deferred to me about the need for surgery at this point. I refused surgery since my pain is not constant and is clearly triggered and worsened by prolonged standing. The PA suggested increasing my lyrica to 75 mg PO three times a day which we did about two weeks ago. He went on to say that we could increase the lyrica to 100 mg PO three times a day if necessary. He also said that they approve of the idea for a lateral foraminal steroid injection.

Thus, I am scheduled to have the lateral foraminal steroid injection in about one week from today. Wish me luck! Hopefully, that injection will be both therapeutic as well as diagnostic Have been doing better this weekend. Perhaps that will be a continuing trend.

Thank you for listening.
Calm Seas
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Comments

  • LizLiz Posts: 9,656
    edited 03/16/2014 - 11:10 AM

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Thank you Liz! The injection does seem to have helped, but it may not have resolved the underlying problem.
    Calm Seas
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  • sandisandi Posts: 6,269
    edited 03/31/2014 - 6:08 AM
    Unfortunately, when you are exhibiting symptoms that are worsening, and it involves the nerve foramina, unless you relieve the compression on the nerve, you risk permanent damage.
    While the steroid injections may provide some temporary relief, they will not correct an anatomical problem, which is the compression of the nerve.
    I don't know too many of us who wanted to undergo surgery, but there are certain instances where it becomes necessary, and the correction of an anatomical problem is one, and the compression of a nerve or the canal is the other. The longer you wait, the less likely it becomes for the nerve to recover.
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