Serious Condition or Hang Nail?

My hubby, (56 y/o road construction worker for 35 yrs), has had lower back pain 5-6 years accompanied the last 6-8 months by numbness and weakness in legs and stumbling-tripping. Conservative treatment by family MD for over 2 years. May 8th MRI findings: Diminished hydration signal of disc material at all levels indicates disc desiccation and degeneration. T12-L1: Broad based posterior protrusion of disc material centrally; L1-L2 and L5-S1: Posterior bulging annulus fibrosis; L2-L3: Disc degenerative change; L3-L4 and L4-L5: Same as T12-L1 only mild plus L4-L5: Moderate facet arthritis and thickening of ligamentum flavum and narrowing mild narrowing of lateral recess bilaterally and neural foramen on right side related to posterior lateral protrusion of disc material; L5-S1: Posterior bulging annulus fibrosis. Neurosurgeon's interpretation: Mild to moderate spinal stenosis, discs probably not cause of neuropathy. June 24th Peri-vascular study normal. July 26th Nerve conduction study findings: (as explained by neurologist) Probes indicate overall mild to moderate neuropathy, suspected cause diabetes. Needle probes indicate significant spine generated neuropathy (left leg minimal reaction to either probes with increased voltage). Referred back to neurosurgeon with L5-S1 surgery recommended. QUESTIONS: 1. Why the lack of urgency - appts/studies a month apart plus have called surgeon twice only to be told he will review nerve study report and call us to schedule consultation, (we hand-delivered report to his office the day of study a week ago). Are we too impatient? 2. Are there other causes for neuropathy? Neurologist says no, but hubby's diabetes diagnosis within 1 yr and his 3/6 month average tests on high end of normal range. He has been told by family Dr. that the back pain could result in false readings for his daily results. 3. What about the other bulging discs? 4. What kind of surgery will likely be recommended? 5. What is prognosis? 6. Recovery? 7. I'm fairly confident he also suffers from undiagnosed sleep apnea as he is a heavy snorer and stops breathing for 30-45 seconds (if not more) numerous times every night. How will this effect his recovery/surgery? 8. What about the spinal stenosis? Footnote: Family history-Mother diabetes and neuropathy resulting in foot amputation. Father incapacitated by degenerative arthritis resulting in nursing home care at age 50. Any insight you can share would be greatly appreciated! Both hubby and I feel that his physicians' casual attitude seems to indicate his condition is not that big of a deal, but I'm WORRIED SICK!

[Kalvin]

1. Surgeons aren’t in the habit of accommodating people or inconveniencing themselves for anyone. Unless your  Husband was having severe spinal cord compression and or bowel and bladder problems, this would be considered an elective surgery and not urgent.
2. Diabetes causes neuropathies, but the nerve studies should be able to differentiate, and with the amount of degeneration your husband has in his spine it’s a pretty good bet that the spine is the source. About the diabetes, if you’re concerned about his levels, you might want to get his Endocrinologist involved in this.
3.That’s a good question. I don’t know the answer
4. I’m assuming it would be a fusion and maybe a laminectomy. Does he have sciatica, pain shooting down the leg into the foot? Is it on one side or both? I’m not sure about the type of surgery being recommended, and I don’t see anything in the report about nerve compression or moderate to severe foraminal or canal narrowing at L5-S1. Maybe there’s something I’m not seeing.
5. It’s hard to say, I don’t even understand the diagnosis.
6. Same answer as above
7.The surgeon and his staff need to be made aware of this, and prior to surgery, a nurse will interview him, for the sole purpose of finding out things like this. If they don’t, make sure they do.
8.That’s another good question. It’s not clear from this report where it’s the worse, I’m thinking L5-S1 but that’s just a guess. The stenosis is probably putting pressure on the cord and nerves and is probably causing his numbness, weakness and stumbling.

I don’t blame you for being concerned, but don’t rush into this. It’s serious business and you have to watch every thing they do, and question it if something doesn’t seem right. As far as those other levels and bulges that their not addressing, it could very well be that they feel these problems are not serious enough to worry about at this point, but I would definitely question them on it. Many bulges don’t cause symptoms, but the protrusions can cause problems, as well as the facet joint problems.

If I was you, I’d ask them to clarify his diagnosis and go over every single level with them, start at T12 and go to S1. And also very important, get at least 1 more opinion. He’s got a lot going on in there, although much of it might not be causing any symptoms but the overall diagnosis needs to be somewhat accurate. You don’t want him to have surgery, and not get substantial pain relief. This happened to me with my neck, I had 3 disc herniations, and the boy genius surgeon told me 2 of them weren’t that bad, now I have to go through it all over again.


Take Care