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Decision Making for Stenosis L4-L5 and L3-L4

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Unread 11-12-2012, 04:48 AM   #1
flavioarg
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Default Decision Making for Stenosis L4-L5 and L3-L4

I have a serious stenosis L4-L5 and a significant stenosis L3-L4.
This is clearly documented by CT and MRI imaging. My back pain is still moderated but I have leg weakness, some leg pain and right leg loosing functionality (loss of some muscles use). In addition I have cold lower legs and feet practically all time and especially at night numbness in my feet.
I am evaluating what possibly to do and I need help from people with similar experience. I have seen 3 neurosurgeons here in Italy offering different approaches to my problem.
The first just collected data and diagnosed the situation but is not actually suggesting action a part from wait and see.
The second is suggesting a decompression doing a two levels laminotomy (fenestration) of the lamina (total anesthesia procedure).
The third one is proposing a surgery (epidural anasthesia) with not predefined end point (in due course he will decide accordingly to the situation he sees on fenestration alone or laminectomy with fusion and instrumentation.
I know a couple of patients recently treated by the last one and both ended with fusion and instrumentation.
No one of these surgeon gave me a clear review of the risks and of the probabiblity of negative outcomes.
Could anyone suggest me a minimal risk strategy to proceed from this point ?
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Unread 11-13-2012, 01:54 PM   #2
Leesa
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Oh boy. First I would do LOTS of research on your condition. Secondly, do you have copies of the report of your MRI? Can you post it here? We'd like to see it for ourselves in order to really advise you. It would really help alot. If you don't have it, can you get it? I dont' know what the laws are there, but here you're entitled to them BY LAW. Actually they ARE yours. But I don't know how they think of that there.

If you do have it, please post it here, would you? We'd really appreciate it, so we can properly advise you.

Hope to hear from you soon. God bless & take care. Hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



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Unread 11-19-2012, 07:39 PM   #3
flavioarg
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Quote:
Originally Posted by Leesa View Post
Oh boy. First I would do LOTS of research on your condition. Secondly, do you have copies of the report of your MRI? Can you post it here? We'd like to see it for ourselves in order to really advise you. It would really help alot. If you don't have it, can you get it? I dont' know what the laws are there, but here you're entitled to them BY LAW. Actually they ARE yours. But I don't know how they think of that there.

If you do have it, please post it here, would you? We'd really appreciate it, so we can properly advise you.

Hope to hear from you soon. God bless & take care. Hugs, Lee
Leesa do you mean the written report of the radiologist or the MRI files ?
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Unread 11-20-2012, 07:41 AM   #4
Leesa
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Yes, the written report of the MRI -- to you have that? It would tell us exactly what they found on the MRI.

If you have that, can you post that here? It would help alot. Hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
.................................................. ...............Orestes
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Unread 11-20-2012, 11:00 AM   #5
bretd
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Quote:
Originally Posted by flavioarg View Post
I have a serious stenosis L4-L5 and a significant stenosis L3-L4.
This is clearly documented by CT and MRI imaging. My back pain is still moderated but I have leg weakness, some leg pain and right leg loosing functionality (loss of some muscles use). In addition I have cold lower legs and feet practically all time and especially at night numbness in my feet.
I am evaluating what possibly to do and I need help from people with similar experience. I have seen 3 neurosurgeons here in Italy offering different approaches to my problem.
The first just collected data and diagnosed the situation but is not actually suggesting action a part from wait and see.
The second is suggesting a decompression doing a two levels laminotomy (fenestration) of the lamina (total anesthesia procedure).
The third one is proposing a surgery (epidural anasthesia) with not predefined end point (in due course he will decide accordingly to the situation he sees on fenestration alone or laminectomy with fusion and instrumentation.
I know a couple of patients recently treated by the last one and both ended with fusion and instrumentation.
No one of these surgeon gave me a clear review of the risks and of the probabiblity of negative outcomes.
Could anyone suggest me a minimal risk strategy to proceed from this point ?
Flavioary, Have any of the doctors mention a Laminectomy, I had one L4-L5 and had some success. It was not a major surgery, the do put you under and I believe it was one night in the hospital. All and all not to bad recovery. This is a good site to get helpful hints and view points from people in similar situations. But I would not get medical advice from someone other than a doctor. And I would not have anyone interperat mri images who is not a radiologist.
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Unread 11-20-2012, 02:49 PM   #6
Leesa
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Jeez Bretd, didn't you ask me to interpret yours?
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
.................................................. ...............Orestes
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Unread 11-20-2012, 06:29 PM   #7
bretd
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Originally Posted by Leesa View Post
Jeez Bretd, didn't you ask me to interpret yours?
Was'nt me, You really should'nt give advice or interpet these medical records without being a doctor or radiologist. People go to school for years to learn how to read these things, what if you told someone something that was'nt true. Its a slippery slope.
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Unread 11-20-2012, 06:59 PM   #8
ginnie
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I sure agree with Leesa. Until I had a positive direction, and understood all the risks I would not proceed. Maybe even another opinion. I had the fusion which turned out OK, but it took two surgeries to do it. I also would not submit to any proceedure until I know exactly what they were going to do. I hope it all turns out OK for you. ginnie
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Unread 11-20-2012, 07:03 PM   #9
ginnie
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Heart Hi Bretd

Don't worry. Leesa may not be a doctor, but she has researched more than anyone I know. Also the patient doesn't follow Leesa, they are just getting a laymans opinion. I got my results read by Leesa as well. Turned out everything she said was right on the money. When I was in a panicked state about my MRI, it was Leesa who read the report while I cried. Personally I am glad she is on this site to help all of us. Lets be supportive of all the information people bring to the table on Neuro Talk. I can also tell you my doctor would not have been as patient with me as what leesa was. ginnie

Last edited by ginnie; 11-20-2012 at 07:04 PM. Reason: spelling
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Unread 11-22-2012, 09:18 AM   #10
Colin Street
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I think there is a lot of difference between interpretation (clarifying the meaning) and advice (suggesting the right course of action). I will stick to recounting my own experience which is that my symptoms were burning legs and poor mobility as a result of stenosis. I had a spinal decompression operation with laminectomy. Recovery was not difficult but there was little improvement so the best that can be said is that my condition has been stabilised. The post-op diagnosis was myelomalacia = softening of the spinal cord.

Seems to me reading lots of posts here that although many back conditions seem on first reading to be similar, outcomes vary enormously. Probably not very helpful, but maybe there are no easy answers.
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