Does my MRI indicate surgery is necessary to prevent paralysis?

[Teachmath1953]

I am trying to determine if my MRI findings indicate possible paralysis if I do not have surgery.  Currently I am managing pain with Oxycodone 10 325, am daily doing physical therapy, and try to fit in exercise in the pool at least twice a week.

Here is what my recent MRI had:

T12-L1:  Moderate loss of disk height and disk desiccation without spinal canal stenosis or foraminal narrowing.

L1-2:  Broad-based disk bulge noted.  This finding narrows the thecal sac to 5 mm consistent with a least moderate stenosis.  There is also secondary bilateral at least mild foraminal narrowing.  Mild facet arthrosis.

L2-3:  Mild loss of disk height and disk desiccation without spinal canal stenosis or foraminal narrowing.  Mild facet arthrosis.

L3-4:  Grade 1 anterolisthesis of L3 on 4 with broad-based disk bulge again noted.  Finding does again cause severe spinal canal stenosis, narrowing the thecal sac to 4 mm and displacing it to the left.  Severe facet hypertropic arthrosis is noted.  There is significant right-sided foraminal narrowing also noted.

L4-5:  Severe facet arthrosis.  No evidence of spinal canal stenosis noted, although there does appear to significant left-sided foraminal narrowinng.

L5:S1:  Bilateral L5 pars defects with at least grade 1 anterolisthesis of L5 on S1.  There is broad-based disk bulge with annular tear again noted.  There is secondary significant bilateral formaninal narrowing.

I have back pain 24/7, and am beginning to develop numbness in my left thigh, and nerve pain in my buttocks and going down the back of my legs.  Obviously my conditions did not develop overnight, but over a course of several years.

Is it the foraminal narrowing, the facet arthrosis, or the lumbar stenosis causing the pain?  I do not want to become paralyzed because I need the surgery and I refuse to do so thinking that "Conservative Treatment" is preferred no matter what.  I, however, am quite content to leave well enough alone if that is possible.

[Krishna Kumar, MD]

Dear Teachmath1953,

Thanks for writing in.

You have severe spinal stenosis at various levels in the lumbar region. Usually even with such a severe stenosis, people do not become paralysed. They may have some weakness of big toe, ankle etc and pain and numbness while walking.

The pain is due to facetal arthritis, foraminal narrowing and stenosis.
You may try epidural steroids/ transforaminal root bloc to reduce your symptoms. Many people survive without surgery accepting the pain and I am certain you would not become paralyzed, but you may have to live with the pain without surgery.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.


Best Regards,
Dr. Krishna Kumar

[pesca]

hi there,in nov 2011 i had surgery to my L4L5, to relieve my problems with the sciatica it has worked great,i had a spacer put in to open up the area for the sciatica nerve to run freely,i hope this is some good news to you, iam waiting on surgery on my c4c5c6, but trying to gain as much information on this type of surgery,as it is very delicate, hope all works out for you.

[Teachmath1953]

Dr. Kumar,
I appreciate your thoughtful reply.  I have been trying to evaluate just "how bad" things are.  As I mentioned in a post above, my current orthopedic surgeon wants to do a 3-level fusion beginning with L5-S1.  I am not in favor of that invasive of a procedure right now, especially since the anterolisthesis in both instances is Grade 1.
Currently I am investigating minimally invasive foraminotomy, and the possibility that it may relieve pain.  The Orthopedic Surgeon showed me all of the foraminal stenosis on my MRI.  He is of the opinion that a likely source of pain is from the disk slippage at L5-S1, hence his recommendation.
Because there are so many possible sources for my back pain and sciatica, I realize it may be difficult to isolate specific causes.
So I am continuing physical therapy exercises, good posture, walking and swimming.  Very fortunately all of that is decreasing my pain. In the near future I am going reduce and then eliminate the Oxycodone I use, which is up to 15mg 4X  (Maybe I should say, try to eliminate--and not get ahead of myself)
I read and reread the posts from the various back and pain related communities on this website.  This has been not only a very valuable source of information, but a source of inspiration as well.  Like everyone else facing a back surgery, I am terrified of "making a mistake," and gifting myself with chronic pain that is much worse.  On the other hand, if a surgery is necessary, then I want to be well informed.

[Teachmath1953]

I agree totally.  This surgeon wants to do a 3 level spine fusion.  At least in his opinion I am not in danger of paralysis in the near future.  I do spend time researching the procedures, and what people say about them.  That is good advice you are giving.  Although he has ordered a CT scan, I do not plan to have a surgery at this stage, perhaps next summer, if my condition continues to worsen.  I am a teacher with some time off in the summer.  However, from what I read, healing after open back surgery can take a considerable amount of time.  Thank you for your response!

[czlc89]

Second, or even third opinion is always best. if you do decide to operate, make sure you research everything about the procedure ahead of time so that you know what questions to ask- spines products like Medtronic Infuse, got implanted in a number of people before doctors found out what was wrong..