Lumbar nerve root compression

[Barbarazme]

I am a 56 year old female with a history of untreated chronic low back pain.  During the last 5 months I have experienced numbness in my right lower leg laterally and numbness between my right iliac crest and the top of my trochanter  The numbness has been permanent.  My mobility appears unaffected.  An MRI of the lumbar spine revealed:
1.  Disc fragment in the lateral recess of L2 on the right.  
2.  L1-2 and L2-3 discs bulge with facet osteoarthropathy.  There are type  III marrow changes on both sides of the L1-2 disc space.
3.  Moderately severe stenosis at L3-4 due to disc bulge, facet osteoarthropathy, ligament
flavum hypertrophy, and a bulge component on the right.
4.  L4-5 disc bulge with facet osteoarthropathy and moderate stenosis.
5.  L5-S1 disc bulge to the left narrows left nerve root foramen more than right.  The central canal
stenosis is moderate.  There may be a small protrusion in the left nerve root foramen as well compromising the exiting L5 root.
I also have multilevel cervical spondylosis with nerve impingement that causes paresthesia and discomfort with the simplest movements such as reading the newspaper or turning my head slightly to the left.  I am otherwise a healthy, active, athletic woman whose quality of life is being compromised by these conditions.  I understand that certain degenerative conditions are for most, inevitable.  But what is my best course of action?  Should pain level alone be my guide?  How

[CCF-Neuro-M.D.-JT]

Difficult to comment on an MRI I have not personally reviewed. But it sounds like the disk disease in the lower back is starting to push on your nerve roots causing pain and numbness. Generally speaking, if the problem is not too severe either by imaging studies or patient exam/history, then we see if there is improvement with conservative therapy with gentle stretching, NSAIDs, no heavy lifting and rest for about 6 weeks. If there is no improvement or the patient gets worse, then we think about surgical options. As you report that your life is being compromised by the symptoms, it may be time to consider seeing a neurosurgeon for a formal exam and review of the MRI.  Another option would be to get an EMG to see if there is ongoing nerve damage which could potentially lead to worsening pain, numbness, and weakness. Again, the "seriousness" of your symptoms, how you feel overall, and the degree of degenerative changes on imaging studies are what we use to guide us in determining the next step. Best of luck

[On the up side]

I am not sure if you are still checking in for posts, hope you are.  Just wondering where you live?  I know a really good neurosurgeon that works wonders with spines.  Let me know.

[orka43]

I have just had a Nerve Conduction test and my doctor says I have nerve damage in both legs. The left was 49--however, he would not explain to me what it meant. I have had 2 MRI, both showing (1)Spinal cord column Stenosis at C 4 & 5 # (3) MRI showed spinal cord column stenosis that included all of lumbar & Sacral areas. I now walk with a walker and have frequent falls. I have been told by my doctor that I will lose the use of my legs and will be confined to a wheelchair, when this will occur is unknown. I have had 4 Neurosurgery consults and all 4 doctors have refused to operate due to other multiple diagnosis. I have been on disabilty since 4-99 and have heart disease, lung disease, High blood Pressure, and the last of May, was diagnosed as a diabetic. Needless to say depression is also a diagnosis.
Does anyone have any suggestions as to how I am supposed to handle all od this? I was a Nurse for 35 years, telling my patients they would be all right......now I can not make myself believe "it will be all right." Thanks for listening....sorry this is so long, but these are the facts and I wish it was shorter........then  I wouldn't have all these problems. Thank you all for listening........orka43

[caynetina]

Terrible to hear all the pain you're in.  I suffer from cervical problems and most likely due for surgery in the winter.  My suggestion is don't stop looking for another opinion.  If you are deteriorating so much and so quickly then I would suggest an internal medicine referral and anaesthetic consult to really evaluate how much of a surgical risk would there be in comparison to the alternative of being wheelchair bound in the future.  Considering your options of you losing the use of your legs one would have to consider possible surgical solutions even though there are great medical risks.  Perhaps one of the neurosurgical consults you had were more favorable and you could re-approach the surgeon and discuss a full preoperative consult with the appropriate doctors to address your surgical risks would be very helpful.  Of course all of these doctors would have to work together along with you for a final decision.  Don't give up hope, there's almost always some doctor out there that would appreciate the technical challenges to help you out with such medical issues.  I've heard the Cleveland Clinic have great doctors if you're in the area, other than that I guess you'd have to approach large academic centres for the appropriate doctors.  Perhaps you being a nurse for such a long time can now help you network with other nurses around that you know or through a union to search out these doctors needed in your case.  Also, in the meantime make sure your depression is being treated so you will be able to have a clearer mind when it comes time to making such great decisions.  It took me for ever (4 years) for anyone to take my neck problem (3 large herniated discs & spinal cord compression) for someone to finally take me seriously.  I must have seen 10 doctors that all told me it was myosfascial and muscular in nature. So my point again is - don't give up, you obviously wouldn't have logged on to this forum if you were giving up - so keep at and be your own advocate.  Pursue those priors doctors to seek prior surgical evaluations.  Good luck and best wishes!