Ask:
Surgery or wait
Dr. Joshua,
I recently had a back injury and saw a D.O. who ordered an MRI and put me on Prednisone. This is the first time I have ever injured my back or had any problems with my back. I'm 40 years old and in good health. The doctor seemed positive that surgery was not an option. My symptoms were severe pain in my right genital area, buttock, and leg with some difficulty urinating. After taking the the Prednisone for a few days, the pain and bladder issues have subsided and now I only have mild pain, however, I have numbness in my genital area and buttock. The doctor looked at my MRI results and suggested I see a surgeon. I don't understand that, my symptoms are improving and everything seems to be better. I thought it was always better to wait about back surgery to see if your body could heal itself? The following are the MRI results: Multilevel advanced chronic disc degeneration from L3 to S1, most severe at L5-S1 where there is a large posterior central disc extrusion with 5 to 6 cm of caudal migration and projection into the left lateral recess with pronounced ventral effacement of the thecal sac and dorsal displacement of all the sacral cauda equina. This pathology results in severe central spinal stenosis and severe left lateral recess stenosis with effacement of the left S1 nerve root at this level. When I questioned the doctor as to why the need to see a surgeon he just said that the MRI revealed more problems that he thought. I don't have any weakness and I don't have any symptoms on the left side (although the MRI suggests there are problems on the left). Do you see anything in this report that suggested a need to have surgery if my symptoms are improving? Thank you, Diann
Answer:
Surgery or wait
Basically, you describe what we call "cauda equina" symptoms, an indication for emergency surgery, because the symptoms may be irreversible. You should definitely follow your doctors advice and get a surgeon's opinion immediately - preferably a from neurosurgeon or an orthopedic surgeon specializing in spine surgery. Prednisone is not used for treating lumbar disc herniation.
Answer:
Surgery or wait
I'll make an appointment tomorrow morning. I guess I'm just shocked that I might need surgery having no history of back problems. I'll report back after consulting with the neurosurgeon. Thanks for your time.
Answer:
Surgery or wait
Good - please do report back, thanks
Answer:
Surgery or wait - update
It's been almost 2 weeks and things are progressing well. I have very little pain. I'm happy to report my bladder function is finally normal. The thing that's driving me nuts is the numbness and feeling like I am sitting on a brick on one side (the numb side). I have a follow-up appointment with the surgeon in 2 more weeks. I'm walking 1/2 mile 2-3 times a day, mostly out of boredom...but I think it helps. As for work, the physician's assistant requested that I not go back to work until I see the surgeon. I have a physical job, and since I can barely bend to tie my shoes, I'll follow his advise. Does this numbness ever go away?
Answer:
Surgery or wait
Thanks for the update, I'm happy to hear that you are recovering well. The extent of your recovery only time will tell. Numbness heals very slowly, and all we can do is wait and see.
Please keep us posted on your recovery
Answer:
Surgery or wait - Update
It's been almost 3 months since surgery and the surgeon released me today..yahoo!! I still have numbness, but it doesn't stop me from doing anything. I've been doing physical therapy and it has been a huge success. My therapist has really educated me on posture and exercise to strengthen my legs, pelvis, and trunk. She also has me on a good pool program and I feel great...no back pain at all. Just thought I'd share some good news and offer some encouragement to the forum members!