Why am I being sent to a Nuerosurgeon

[jyager]

Greetings,

Back in February of 11 I was sent for a MRI for lower back pain, here are my results,

TECHNIQUE: Sagittal T1, T2 weighted fast spin echo and stir. Axial T2 and T1
images are obtained through the lumbar spine without contrast.

FINDINGS:

The sagittal images show scoliosis of the lumbar vertebrae. The vertebral body
heights are maintained. Bone marrow signal intensity is within normal limits.
No abnormal signals in the cord.

There is desiccation of discs at T11-T12. Small right paracentral disc
protrusion is noted. There is probable mild right neural foraminal stenosis. No
significant spinal canal stenosis.

Desiccation of disc is also seen at T12-L1 with minimal bulging disc. No
significant spinal canal stenosis or neural foraminal stenosis.

L1-L2: No significant disc bulge, herniation or central stenosis is present.
The neural foramina are patent bilaterally. The facet joints are within normal
limits.

L2-L3: No significant disc bulge, herniation or central stenosis is present.
The neural foramina are patent bilaterally. The facet joints are within normal
limits.

L3-L4: Minimal facet arthropathy is noted. No significant spinal canal
stenosis or neural foraminal stenosis.

L4-L5: Minimal bulging disc and facet arthropathy is seen. There is mild
spinal canal stenosis and minimal bilateral neural foraminal stenosis.

L5-S1: Minimal bulging disc and moderate facet arthropathy is noted. There is
no significant spinal canal stenosis or neural foraminal stenosis.

S-I joint: Negative.

IMPRESSION:

Mild degenerative change of lumbar spine

I was first told I have minor arthritis. I went through 12 weeks of physical therapy that only agitated my lower back pain. A few months after going to PT my pain started to get worse. It traveled to my thighs, hips and down my legs. The pain in my legs at times was worse then my back. After this they sent me to a PM Dr. who did 2 facet pain injections. The first one seem to help a few days, but then the pain came back and the second didn't help one bit. My GP said he would pull the new Back/Spine specialist aside and ask him to quickly look at my MRI. A few days later I got a call from scheduling to go see a NeuroSurgeon. My question now is why. Since they say that my back pain is from minor arthritis why are they sending me to a Neurosurgeon. I don't want to be told from another Dr. that there is nothing they can do for me. My acid indigestion has been acting up since I've been taking ibprofen like its candy, but that is the only thing that mildly helps my pain.

[Narble]

To add to what's been said, neurosurgeons and orthopedic surgeons both treat back problems surgically. So your PCP was probably looking for an informed opinion, which unfortunately you didn't get.

As often happens, you have to keep chasing the diagnosis. I've been doing this with spinal/neural problems for 10+ years, seeing neurologists, physiatrists, et al., having an EMG (not fun, as JGF25 said), EEG, lots of blood work, etc. In the process, I've been tried on a variety of meds, some of which have helped. I'm due for another round of PT starting later this month, plus a consult with a neurosurgeon to discuss a cyst on my lumbar spine.

It is very frustrating to do all this, but I keep at it because the alternative is worse. Don't doubt your own instincts about the doctors you see, and have faith in your own ability to advocate for your needs. Good luck.

[JGF25]

Have your formally seen the back/spine specialist or was that person just consulting on the MRI results?  If not, I'd go back to square one and start with that person.

I went to a back specialist and I was told that in order to help my herniated disc and the sciatic pain that went with it I should strengthen my core muscles so that my back muscles aren't doing the bulk of the work.  So I went to pilates class.  It actually did help. Then I went on to bootcamp class.   Of course you have to keep doing it.  I did strengthening exercises for a couple of years but then the vacuum cleaner fell down the basement stairs and I tried to catch it.  Needless to say, my back hurt too much to go to class!  Now I feel ike I've lost all the core strength I had gained.  

I do have a question though, have they done an EMG to determine the degree of stenosis that is leading to the leg pain?  The EMG is not fun, I will tell you that up front.  But it is a way for them to see how badly compressed the sciatic nerve is.  How much damage is going on.

I'm sorry to throw out yet another doctor to you but you can't just sit there in this kind of pain eating advil.  We have to continue to be proactive because nobody else is going to do it for us.  Personally, I don't like the neurosurgeon's response.  He should have looked at the results and said, "you don't really need to be here, but rather here" and given you some idea of where to go next.  

Best of luck and let me know what you find out.  I'm so sorry you are going through so much pain.

[jyager]

Thank you for your response. Unfortunately the appointment was pointless. The Dr asked me the same question I was asking "Why did they send you to me." So now here I am in pain (which seems to be spreading) and no answers or solutions for me. I'm not quite sure what I am going to do next. :(

[JGF25]

It appears that you have a number of disc herniations in varying degrees along with some spinal senosis which leads to compression of your sciatic nerve and that God awful pain that goes down the legs.  The pain that you can't point to and say "it hurts here" you just know it hurts!  Bring your reports to the Neurosurgeon.  Have they done an EMG to see how bad the nerves are affected?  Maybe the Neurosurgeon will suggest that.  It is no picnic by a long shot but it gives them a wealth of infomration to work with.  I woldn't let them operate until all other avenues have been exhausted.  Good luck and keep us posted!