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Neurology (Expert Forum)
Spinal surgery to relieve sciatica pain?
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Spinal surgery to relieve sciatica pain?
by Frankj, Jul 06, 2003 12:00AM
I am a 74 year-old male. I suffer from rather intense sciatica pain in my right thigh. The pain startedlate in 2002, and it occurs when I am standing or walking, but is much less intense when I am sitting or lying down.In January 2003 a neurosurgeon ordered X-Rays and MRI of my lower spine. According to his report, the X-Rays show left lateral listhesis of L4 on L5, and marked disc space narrowing with adjacent vertebral body sclerosis. The X-Rays also show moderate L3-4 disc space narrowing, as well as moderate L2-3, minimal L3-4 and marked
L4-5 spondylosis.The MRI scan demonstrates diffuse lumbar degenerative disease, and marked L 4-5 spinal stenosis, minimal LL3-4 stenosis and moderate L2-3 stenosis. The neurosurgeon concluded that I have 1) marked spinal stenosis with right lumkbar radicalopathy, and 2)diffuse lumbar spondylosis. He also felt that I was not a candidate for surgery at that time (but the pain pain is now much worse).
In March I saw I second neurosurgeon and he advised lumbar epidural injections. He gave me one inearly April and a second one in late May. In each case I had marked pain relief, which lated about five weeks. Also I take 440 mg of naproxen sodium twice daily, and obtain some pain relief. My questions are as follows. 1)Should I be considering surgery in the near future? If so, should I have endoscopic discectomy, or I would I need the more invasive open disc surgey? Will my condition worsen if I delay surgery? Would MR neurography be useful to pinpoint where a where the nerve is being pinched? Would phys therapy help?
L4-5 spondylosis.The MRI scan demonstrates diffuse lumbar degenerative disease, and marked L 4-5 spinal stenosis, minimal LL3-4 stenosis and moderate L2-3 stenosis. The neurosurgeon concluded that I have 1) marked spinal stenosis with right lumkbar radicalopathy, and 2)diffuse lumbar spondylosis. He also felt that I was not a candidate for surgery at that time (but the pain pain is now much worse).
In March I saw I second neurosurgeon and he advised lumbar epidural injections. He gave me one inearly April and a second one in late May. In each case I had marked pain relief, which lated about five weeks. Also I take 440 mg of naproxen sodium twice daily, and obtain some pain relief. My questions are as follows. 1)Should I be considering surgery in the near future? If so, should I have endoscopic discectomy, or I would I need the more invasive open disc surgey? Will my condition worsen if I delay surgery? Would MR neurography be useful to pinpoint where a where the nerve is being pinched? Would phys therapy help?
Doctor's Answer
by CCF-Neuro-M.D.-CS, Jul 10, 2003 12:00AM
The majority of the symptoms you describe are consistent with a diagnosis of lumbar canal stenosis. In general physcial therapy and conservative measures are recommended first. However, if you are having incapacitating pain, bowel/bladder dysfunction, or significant weakness of your legs then surgery may be indicated. However, remember that the goal of surgery would be to prevent the progression of the disease. The surgery itself may not reverse the changes which have already occurred. The endoscopic surgery can only be performed for a small disc resection, therefore if a more comprehensive decompression is recommended an open procedure may be performed. Unfortunately there is no way to predict if your symptoms will progress.
If you have not been evaluated by a Neurologist, it may not be a bad idea, and an EMG test can help define the damage which has occurred. I hope this information helps. Sorry for the delay in responding.
If you have not been evaluated by a Neurologist, it may not be a bad idea, and an EMG test can help define the damage which has occurred. I hope this information helps. Sorry for the delay in responding.
I am a 40 year old male,I had back surgery done on my back in April of 2002.This was a work related injury,I was a truck driver and a welder.I ruptured one disc, and herniated another one.
The effects it has had on my life are that I have severe pain in my left foot due to major nerve damage. The doc said I had RSD (Reflex Sympathedic Distraphy). The major problems that I am having are that when I urinate,move my bowels,and apon ejaculation while engaging in sex I have excruciating pain in my left foot.
The docs have pretty much said I have to learn to live with the pain because they dont feel that another surgery will help my pain.I am currently taking neurontin 1800mg per day for the nerves and 30mg of morphine for the pain.
I would like to know if anyone out there is suffering with the same problems, and what are you doing to cope with them.
Thank you very much... Javier