I have been seeing a neurosurgeon for over 3 months now and he's been running tests like crazy- MRI's, and the latest a myelogram/CT scan.
When I went to my last appt yesterday to get the results from my myelogram/CT he told me that whatever I have is not his area of specialty and that I need to see someone else. Since I originally went there for back/cervical pain, you think he might have told me this 3 months ago. Anyway, I would really appreciate someone's opinion about what my test results might mean. I am a 38 year old, female, with 2 children ages 6 and 8.
CT Post Myelogram Lumbar:
L3-L4: Grade I anterolisthesis w/ marked degenerative disk and facet hypertrophic changes. Central/bilateral paracentral extruded disk fragment, which is migrating superiorly, resulting in severe stenosis of the thecal sac. There is an additional right foraminal disk protrusion w/potential compromise of the right L3 nerve root.
L4-5: Congenital narrowing of the spinal canal, moderate degen disc and facet changes and ligamentum flavum hypertrophy. There is a disk bulge, resulting in moderate/sever narrowing of the thecal sac and narrowing of the entry of the bilateral lateral recesses w/potential compromise of the bilateral L5 nerve roots.
CT Cervical Myelogram
C4-5: Mild degen changes of the disk and facets, ligamentum flavum hypertrophy and a disk bulge, resulting in mild/moderate narrowing of the thecal sac. There is a left posterolateral osteophyte and disk protrusion resulting in truncation of the left C5 nerve root.
C5-6: Mild degen changes of the disk and facets, uncovertebral arthrosis and ligamentum flavum hypertropy resulting in mild/moderate narrowing of the thecal sac and mild bilateral foraminal narrowing.
C6-7: Same as C5-6.
Any ideas- doc suggested not to do surgery but then again, it's not his specialty, so????
Having both cervical and lumbar problems is a double whammy. I have a long history of lumbar problems, so I can comment on that. I agree that your neuro should have helped you along faster if he couldn't help you, but you'll find that back pain is very difficult to diagnose and most doctors hesitate to proceed until all the tests are in. That doesn't make it right, that's just the way it is.
First of all, no good surgeon is going to rush into surgery until the other avenues of dealing with your pain has been tried.
Now, your lumbar myelogram is very telling. Even though you're only 38, you have degenerative disk disease with facet changes. As we age, our disks dry out and lose their elasticity and, by sitting a lot, the vertebra press down and flatten them or cause them to bulge. The flattening means that the padding between each vertebra is disappearing. The disk bulges cause pressing on the many nerves around the disks.
You have a disk fragment which is migrating causing severe stenosis and you also have a disk protrusion which could start pressing on a nerve root on L3. The L4-L5 shows almost the identical disk bulge, except it potentially could compromise both L5 nerve roots.
These are very serious changes in your spinal column and having two small children is probably not going to help with your battle. I have similar symptoms to yours and surgery was not indicated in my case because of the placement of my good and bad disks. However, since you also have cervical issues, you might be wise to begin thinking about long-term treatment.
I would go to another neurosurgeon and try to find one who does work on all areas of the spine. The good news is that you now have some pictures of your spine you can show. Most doctors want their own shots also, so don't be surprised if they want you to have x-rays or an MRI done. There are also pain management doctors that find combinations that work on your pain, but they do not perform surgery.
The degenerative disk disease does not get better as you age, but there are many ways to treat the pain. There are pain medications (great if you don't get hooked on them), facet injections (which can help numb the area), nerve blocks (they do exactly what they sounds like), radio frequency ablation and, last, but not least, the new field of laser spinal surgery.
Don't give up hope, because the fight has just begun for you. Most people who don't have back pain (even doctors) have a difficult time understanding how painful it can be. So, be patient with people who think you just have a little pain that will probably be gone in a day or two. And, if you have had two kids, then you are an old pro now at handling pain. It's just that back pain can be so debillitating and disrupts your whole life.
On another note, I hope you have insurance to pay for any expenses you pile up while seeking a diagnosis. It can get very expensive when they start suggesting all the tests, procedures and surgeries.
Yes, my back is a disaster considering i'm fairly young with no injuries to my back ever. I guess the reason that I am considering surgery is because I know that as I get older it's just going to get worse. Temporary fixes are just that- temporary. Heck, i'm not even on pain meds- my last dr gave me darvocet- lol. That was a joke! I have great insurance- the only problem with it is finding a good doctor that can do what needs to be done. I just sent my results to a doc 50 miles away as I only have 30 to choose from in a 100 mile radius. All I pay is $25 for a hospital stay. Can't beat that, but I also want the BEST surgeon I can get.
Again, though, thanks for the chat- it's really appreciated!
I am about to have my 7th back surgery over 27 years. I cannot believe you actually went to a "neurosurgeon" who then told you it was not his area of expertise. As a neurosurgeon, then what is?
You need to find an expert at an university based hospital or someone who really knows his/here stuff since you are young to have degenerative disc dissease which I have but I am 64.
UVA has great Neurology/Spine department in Charlottesville, VA.
Alot depends where you are - you need to go to very qualified specialist no matter how far away- this is your life
I am wondering about the test itself. Any replies??? I have some back pain and can't do all my usual activities. Its been for days and radiologist said to wait, sometimes theres some pain. What do I do???
Have the physician who is going to do the procedure explain everything to you, before the procedure. There are slight differences in the procedure, but in general:
The actual placement of the dye is through a lumbar puncture. This can be done while lying on the side (usual position) or in a seated position (on the table). The puncture is done in the lower back, because the actual spinal cord ends at the level of L1, so there is little danger of hurting any nerves.
The area is palpated by the doctor, to determine the landmarks. This can be pretty deep pressure, but it's not bad. He/she usually marks a little spot with a pen on your back.
The area is then cleaned and a drape placed over the area.
Now, the skin and subQ tissues will be injected with numbing medicine (usually Lidocaine or Marcaine). This might sting and pinch. It is the same medicine used in the dentist office. But it only lasts for a few seconds. Then the area will be numb.
Then the doctor will place the needle used to inject the dye into the epidural space. You will feel pressure, but it should not hurt. If it does, tell the physician, he/she can give you more numbing medicine.
Also, be sure to tell the physician IF you feel any type of electrical shock to your legs. Don't jump or move, just tell the doctor exactly where the shock went to. The needle will need to be adjusted a little.
Once in the correct position, the dye is injected. You will most likely not even know that it was injected. Rarely, some patients will feel pressure or a warm sensation.
The needle is removed, drapes taken off, the back cleaned, and a bandaid applied.
You will then usually to laid flat and the x-rays and CT taken.
Post procedure protocols vary a little, but most of the time they want you to lay flat for a little while. Then, you can go about your usual activities. The area of the lumbar puncture may be a little sore, just from the minimal trauma of the injection. Some people have no pain at all and some have to take some tylenol or put a heating pack/ice on the area for a little while.
Overall, except for the numbing medicine it should not hurt at all.
Again, have the doctor or nurse involved in the procedure go over it with you. But, you should do fine. Good luck.