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severe nerve root stenosis at L4-5 with moderate central canal stenosis, consequences?
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Doberhaus posted:
About a month and a half ago I woke up unable to stand on my right leg as something was stabbing grade 8 knives into my butt. Over the next week it got steadily worse until I could only walk in a stooped over position. Internist sent me to pain management and gave me oxycontin and oxycodone for break through and sent me for an MRI ---servere formaninal stenosis on the right with moderate central canal stenosis, moderate stenosis on the left, severe facet arthritis on both sides, as well as grade 1/2 anterolisthesis. Pain management doc was most concerned with the weakness in my leg, in ability to press up with the foot, and weakness to raise the leg up while sitting. Also I had some numbness in the front of the leg. He did steroid injections at three levels and I have an appointment in about another week for a repeat. He told me that depending on how I did I might need surgery.
He added gabapentin to my meds and i am still titrating the dose up with that.

So here is my question. My pain is better and I am trying to see what happens if I reduce the oxycodone a little. However, my leg is still very weak --it feels like it might want to just give out when I walk even though i am using a staff..
So is this some kind of nerve damage? If steroid injections have reduced the nerve stenosis will this heal itself? OR does this mean that the damage to the nerves is still there and I still might need surgery to decompress the nerve root even if my pain is less?
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davedsel57 responded:
Hello and welcome. I'm sorry to read about all you are going through but fully understand.

Please be aware that we are not doctors in this community, but lay people who have back pain and spinal problems. The assigned Experts rarely reply to posts due to their busy schedules. However, I can share my opinions based on my personal experiences. The symptoms you describe do sound like nerve damage to me.

For a treatment plan and prognosis, you will need to speak to your pain management specialist and/or spine specialist. They will probably want to do more diagnostic testing such as a nerve conductivity test to see exactly what is causing your symptoms.

Please keep us updated. I pray you can get the right treatment and relief soon.
Click on my user name or avatar picture to read my story.

Blessings,

-Dave
 
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trs1960 responded:
Along with what Dave said I would ad that I don't recommend shorting yourself on the meds. At this time to try and win the battle, keep in mind the war ahead.

With the impingments all aroundyour lumbar "servere formaninal stenosis on the right with moderate central canal stenosis, moderate stenosis on the left, severe facet arthritis on both sides..."

Lumbar stenosis: Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebra . This is usually due to the common occurrence of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis or a tumor.

The steroids reduce inflamation so if the pressure on the nerves is reduced by antiinflamatory action such treatments may be succesfull. If it was a trauma related injury this may relieve the pressure, the drugs will manage the pain and with time you may heal. If it's due to degenerative disc issues then it may just buy you some time until more invasive fixes are needed.

As for the pain meds, I say follow your doctors orders precisely.
1. You don't want to let the pain cycle setup shop and turn traumaitc pain into chronic pain.
2. Waiting for the pain to flare up to use opiates is the wrong way to use them. It makes you much more likely to become addicted and makes the drugs less effective. If you wait until your in pain and then take a drug your brain goes the Pavlavion route and senses the opiate as a reward for sensing pain. It will get good at sensing pain so you will give it drugs.

If you want to reduce the drugs talk to your doc.

Best of luck,

Tim
 
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Doberhaus replied to trs1960's response:
Thank you for your reply. I am a 66 year old woman with a a history of back pain going back several decades. I have had two radiofrequency ablations in the L4-5 region and in one case they drained a cyst that was putting pressure on the nerve (that was the severe face arthritis part of my MRI report). These bought we up to a year and a half of relief each time --until the nerves grew back. And yes I have degeneartive disc disease (as noted in other parts of the MRI report) and that no doubt is part of the root cause of my back problems. However, this latest episode is different as my pain management doc said. So this brings up an important question. I always hear that we need to try conservative treatment first and ONLY if that does not work should more invasive "corrections" be tried. However, I am not getting any younger. It sounds likely that this is going to happen again even if I get over this episode and eventually get back to being able to become as active as previously but for how long before it happens again and maybe I am too old for surgery? I hear that back surgeries don't have that great a record of success particularly in cases when there are several things wrong with the back (facet disease, bulging disc, etc. as in my case).

Thanks for the advice on the pain drugs. I had the feeling that I should only take them when they were absolutely needed and I should do without unless the pain was really bad. I was starting to feel guilty about not hurting as much as I was and thought that meant I needed to reduce them.
 
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trs1960 replied to trs1960's response:
You're absolutely right. These things you need to talk to your doc about.


...out the door.
 
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trs1960 replied to trs1960's response:
Just got back...long day.

Sounds like you've been batteling for awhile. Seems that you and your doc have a good grasp on diection to find the the physical aspects of your injuries and it sounds like you have a good relationship wit him. That is the key ritght there and many pople are still looking or goof dor to partner with.

I know what you mean about getting older. I'm only 52 (almost) and my last back surgerory took me a good 18 months to recover. I was about to throw in the towel and my doc told me that between getting older and having mulitple spine surgeries the healing process takes longer each time.

18 Months on an RFA is what I've been told is about nominal..or perhaps within a normal curve.
I can't add anything to what you and your doc are working on and If I gave you an internet diagnose you should laugh at me and run.

What I told you about the drugs thats true, but if you feel like you can be comfortable manage with a lot less medcation and can't get into to see the doc soon, what I've been told to is to back off on the mg/hr or increase the time between doses. In this manner you're still taking the drug using a schedule and not waiting for the pain signal to drive your behavior.

Best of luck and let us know how things go..

Tim
 
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mellycooper replied to trs1960's response:
What kind of surgery did you have? My doctors are recommending a fusion and I cannot deal with such a long recovery time!
Trying to figure things out!


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