Neuroforamina narrowing

[Alaynea]

I was diagnosed with moderate to severe spinal canal narrowing and moderate right and severe left Neuroforamina narrowing in my L4/L5 and S1. I am going to go and see a neurosurgen in a few days. My question is, what can be done about this? Is surgery the only option? What will they do in surgery? Can this cause me to be parylized? I have alot of pain and numbness in my legs and lower body. I have had unstable stoles and I am wondering how bad all this really is?
Thank you

[sam the cat]

I had surgery for severe neuroformania narrowing on 12/21/00.  This was a L2 to S1 level (I was told a four level lamenectome and foraminectomy were done).  I have not improved and have gotten worse.  There are two crushed discs (one was trimmed and is now bulging) and herniated/bulging of two discs in this area.  I had a nerve conduction test and was told it was normal, howerer, I am unable to see written results because my request was refused. I can not sit, stand, bend forward, climb stairs, drive, lift bend etc. without pain.  The pain is constant, but severe when in bent position.  I have back pain, muscle spasms in both lets, numbness in both legs to the outer sides of chin bone.  I am now getting burning sensations and electrical waves from lower spine to feet and my left leg has given out completely on several occasions and was numb from the knee down.  The most recent my/ct done last June 2001 was done with insufficient dye and the disc areas are not as clear as the my/ct taken in 1999.  My doctor referred me to pain management; this was denied by the insurance company.  My last visit was 11/28/01 and the doctor requested a repeat of my/ct and told me he would personally review results with me concerning possible surgery and he could not guarantee I would be free of pain after surgery.  This request has also been denied by the insurnce company.  I was sent for an IME on 12/03/01.  After a ten minute visit, no physical exam other than check reflexes, arm (not even in question re pain etc), and checked heart. Questions revelent to the accident were not discussed etc. I did fill out a five page questionare, but after a three hour ride in a cab, I could not even remember my own attorneys name when asked and can honestly say that I was numb with pain.  I have copies of the reports and he said I failed the slump test.  Go back to work, do not lift over 45 pounds, injuries were not related to accident (I was hit by a utility trailer on right side, bounced of upright schaffolding leaning against a wall, twister 1/4 turn to my left and cruched between schaffolding and utility trailer. I am on SSD since 4/17/99.  I feel lost/depressed/in pain/fearful of my future. What can be done?

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

Fortunately, the spinal cord in most people ends at L1-2, which is higher than the level of your narrowing, so from that standpoint your spinal cord is relatively ok.  However, there are still little rootlets thay come down from the end of the spinal cord that can stilll be impinged upon and cause symptoms. Also, the foraminal narrowing (which means the bony canal that your spinal nerves go through) can certainly cause you pain and weakness in your legs if it's too narrow and pushes on the nerves.  Usually, if the MRI results are not severe (as determined by the surgeon or neurologist) and the symptoms are not too bad, meaning there's no bowel or bladder incontinence and you can still walk ok, a conservative approach is tried. This means rest, physical therapy, light duty at work, and anti-inflammatory meds. If the MRI is concerning and the symptoms persist or worsen, the surgeons will in many cases remove a part of the vertebra (spine) to relieve the pressure on your nerves.

Your options really do depend on what the MRI looks like and your neurological examination as well as the degree of pain and weakness you are experiencing. Permanent weakness could potentially occur if you have severe nerve compression and did absolutely nothing for it for a while until the nerve is too bad off to regenerate. Another option would be to see a neurologist and get an EMG. This can help localize the problem further and show how severe the nerve compression is. Sounds like you are on the right track with your neurosurgery appointment. Talk to your doc about your concerns. After they review your films and examine you, they should be able to help you explore your options on a more personalized level. best of luck.