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My doctor is recommending spinal fusion for stenosis and instability, is he right?
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- čas přidán 18. 08. 2024
- 0:00 - Spinal fusion is a big step. How to know if your doctor's recommendation is correct.
00:32 - Neurogenic claudication is pain or heaviness down the legs with walking due to spinal narrowing (stenosis)
00:44 - Sciatica is pain in the legs due to compression of a nerve root, usually by a herniated disc.
01:45 - Neurogenic claudication is not typically associated with numbness or weakness.
03:08 - Urinary retention or frequency is the usual first sign of a neurogenic bladder due to spinal stenosis.
05:47 - MRI of the spine without contrast shows spinals stenosis.
06:38 - Interspinous ligament sprains are also a common cause of back pain after injury.
07:26 - The only definitive treatment for spinal stenosis is laminectomy surgery.
08:19 - Laminectomy should only be done using a minimally invasive approach.
09:07 - Spinal instability is demonstrated by flexion and extension x-rays.
10:16 - TLIF stands for trans foraminal interbody fusion.
11:15 - The FORAMEN is the name of the bony channel through which a nerve root exits the spine.
12:05 - Foraminal encroachment by a nerve root causes a radiculopathy (disorder of a nerve root).
14:15 - Neurogenic bladders are smaller than normal and never fully fill up leading to frequent emptying.
14:47- Paralysis is not a real risk of lower lumbar surgery. Nerve root damage and foot drop are more common.
15:34 - Spinal stenosis is a progressive condition that leads to neurological damage if left untreated.
17:35 - Low back pain is different than neurogenic claudication but it’s common to have both conditions at the same time.
18:39 - Most patients report increased range of motion after fusion surgery due to an open spinal canal.
19:54 - Spondylolisthesis is an abnormal translation of one spinal bone on another as distinct from spondylosis (arthritis) as well as spinal instability.
22:38 - Walk 10 min for exercise per day per week after spinal surgery.
Perfectly on point. I was delighted to hear 80% after three weeks!
Excellent! I needed these truths. I have learned that I have no choice but to have this surgery.
here too.
I feel a little better now. April 11th I saw a neurosurgeon for my already diagnosed spinal stenosis L3 L4 which developed after a spinal fusion on L4 to S1 in 2011. In 2019 my symptoms returned due to spinal stenosis at L3L4. He's told me he wants to do a spinal fusion at L3L4. I see him again April 23rd. I will get a more in depth description of exactly what the fusion will do to remove pressure on my spinal cord, but after listening to this I think I have a much clearer idea of how it will help. I do have neurogenic claudication. I can walk about 10 to 15 minutes before pain and numbness. I'm nervous to have it done, but I'm fearful not to. I'm a woman with an intense urgency to urinate and I'm usually only good for about 2 hours before I have to go again. Once in awhile I have bowel issues. I don't want to risk waiting any linger. My spinal fusion was done through my abdomin, but since L3L4 is higher they have to go through my back. I'm told this is more painful. I have to have it done. I will be 66 in June and otherwise pretty healthy. I want my life back.
Oh thank God for you Dr. Lieberman. 🙏🏾
Doctor; Your advice to others has prompted me to reach out for your help. Your explanations are always clear and concise. I’ve suffered for over 10 months with sciatica and low back pain. It’s worse in bed in the early morning and will mostly subside after getting up and moving around. OTC meds and supplements help and within in 2 hrs I feel pretty ok. I’ve done physical therapy; chiropractic and acupuncture and injection with limited relief. First an MRI showed disc bulges and spinal stenosis. Then an X-ray showed spondylolesthesis and mild scoliosis. Doctor said it’s a big problem and fusion is an option if injection doesn’t help. I’m a 69 year old active woman. This pain came on suddenly last December and I’m struggling with what to do and which spinal condition I should treat. I would value your advice as to my next step in getting relief so I can resume a relatively pain free life.
It seems like you're dealing with a challenging situation, being a 69-year-old with a 10-month history of sciatica and diagnosed with spondylolisthesis based on MRI and X-ray evidence. Sciatica can often be attributed to mechanical issues, leading to nerve root compression or inflammation. While you haven't mentioned a herniated disc, it's crucial to identify which specific nerve (L3, L4, L5, or S1) is affected for proper treatment.
If your sciatica hasn't resolved naturally within 10 weeks, considering structural solutions for the compression or inflammation might be necessary. Did your healthcare provider specify the affected nerve root? Understanding this detail can guide the appropriate treatment and bring relief.
For more insights and expert advice on managing sciatica and related conditions, check out my playlist on "herniated disc with sciatica." . I hope you find the relief you're looking for soon.
@@BestPracticeHealth Yes, my doctors have indicated the problem is located at L4-L5 where the vertebrae has slipped out of place. I also have disc bulges at L2-L5; Facet arthropathy at L2-L5; Disc desiccation throughout. Spondylolisthesis at L4-L5 Grade 1. She said this problem doesn't heal on its own. The nerve and low back pain is worse in the morning upon waking. The sciatica usually gets better within 2 hours of moving around. I take anti-inflammatory vitamin supplements which seem to help. My doctor indicated if I want to do surgery it would be the Xlif minimally invasive. She indicated that surgery might not make the back pain go away but would help with the nerve pain. She suggested I try another injection sooner than later. I had an injection 1 month ago and got 1 day of relief. She said that confirmed they were in the right place but possibly another injection might give longer relief. The injection was painful as they hit the nerve and if I go for another I would be a bit anxious. Any advice you can provide would be helpful. Can I send you a copy of the MRI to review as I've seen you do on others? Thank you for your response and for the advice you provide to those of us suffering from back and nerve pain.
I had my L4/L5 S1 Fusion at Texas Back Institute in 7/23 its 7/24 and im still Dealing with pain,Bladder and Bowel issues i still have to use a upright walker because the nerves still haven't healed its a slow process because my workman comp insurance made me wait a year after i got hurt at work because they disputed my injury it that made the healing slowed,,so sir get that surgery ASAP waiting going to make it worse but everyone is different
My ap diameter is 6.2 at L4 and L5. I have refused surgery from fear. I am 77. You mentioned to this gentleman that he could die from this. This is something I had not heard before and I am curious what would cause death in this type of situation. Every two years at the MRI the central stenosis worsens. The facet joints are bad. I had ablation which did not help. Can you elaborate on what would cause death in this degree of stenosis? The neurosurgeon mentioned a staged procedure in his notes to my doctor. I also have foraminal stenosis. There is risk with surgery and it sound like without surgery. Thanks for clarifying
Hello, What are your thought on this MRI result? Is surgery the best option? If so, what type? Symptom left side sciatica, and developing spinal curvature.
Variable degrees of disc desiccation and loss of height from spondylosis. Scattered facet arthropathy. Details by level:
L1-2: Unremarkable
L2-3: Facet hypertrophy. No stenosis
L3-4: Disc bulge and facet hypertrophy. Mild spinal canal stenosis.
Mild right foraminal stenosis.
L4-5: Disc bulge. Superimposed disc extrusion measures 0.9 × 0.9 cm transversely and 2.2 cm
craniocaudally, extending inferiorly from
the parent disc essentially in the midline. Moderate to severe spinal canal stenosis. Most of the CSF around the cauda equina has been displaced.
L5-S1: Posterior annular fissure. Tiny left paracentral disc protrusion. No significant associated stenosis.
Conus terminates normally.
Included soft tissues are unremarkable.
Why does the Doctor say that Spinal stenosis could kill this gentleman? How?
I wonder about this as well?😮
It's sad to talk about... But as you lose the ability to walk and bladder control you are likely to be in bed. That puts you at risk for urinary tract infections that become frequent and then spread. UTI is a common cause of death in debilitated people.
I have been learning so much from watching your videos. Really helpful and insightful for what I may need. I have talked to a surgeon and have another appointment coming up with another one on the 4th of Jan. I have spondylolisthesis at L4/L5, stenosis at L3/L4 and two herniated discs. I want to do the least invasive procedure possible. I am a yoga teacher and want to make sure I can continue to practice and teach. How can I do one of these video calls with you so I can be more informed.
Thanks for watching! To be on the show submit a question to www.bestpracticehealth.tv. I'll look forward to meeting you!
I have submitted a video and my MRI. hopefully we will meet soon.@@BestPracticeHealth
Hey, I need a microdesectomy due to a large extruded herniated disk, the surgeon has told me I am at risk for reherniation and that it may end up resulting in a spinal fusion surgery if that happens. He stated that my disks are very large in size which is a concern. I do not want any metal plates and screws in my spine, let alone my body. I would like to move forward with the surgery but I am concerned that if the disk does not stop herniating that I may need this.
Odds are heavy you'll need more surgeries.. Go to Germany get disc replacement stop the disease from moving to more discs asap. Lp-Esp discs are the best in the world, single level you'll need around 30k
Hi doctor love your expertise ,I have the same problem like this man, I’d like to know the name of the spine specialist he is seeing. I live in Toronto too it is hard to get a good surgeon.and I would like to have a video chat with you how can I do it.I guess I should pay and that is fine. Please keep sharing your excellent expertise.
HI! Thanks for the note. My assistant can set you up to be on the show for a video chat. Please call her at 602 256 2525. Phoebe.
I had back surgery through my stomach a year ago. I have the same pain they tried a pain stimulator trial didn't work made it worse. Now they want to try another one but different. Had a emg said nerves are healing but slowly? What do I do.
Figure out why you are still having pain. Often, it's the facet joints in the back after a fusion from the front.
Hi Dr. I’ve seen 5 surgeons. None of them have satisfied myself with their explanations which has prolonged me getting anything done. I cannot wait anymore I am getting this surgery soon but I still want to know more. How can I meet with you to go over all if my images?
Cute baby picture! Are they yours? Drop you question at BestPracticehHealth.tv and we will get you on the show. I'll look forward to meeting you!
My doctor wants to do a decompression and fusion. Couldn't I just get a laminectomy?
It depends on the specific condition. If you are treating spinal stenosis alone, then a laminectomy by itself is the right operation. However, if you are treating grade 2 or higher spondylolisthesis along with stenosis, then a laminectomy with fusion is the appropriate approach.
Hello Dr. I'm Mrs India and I've been on your show. I have "Bilateral Neural Foraminal Spinal Stenosis" according to my MRI written report. I'm STILL suffering from a very painful back and can't walk! According to my MRI I too have "Bilateral foraminal neural spinal stenosis!" Pleaae tell me should I go to neurosurgeon? Dr. Baig needs to know and PLEASE tell me because my family isn't ready for me to die and I must update my living will! Am I going to die? The burning of the nerves didn't work. So should I have a laminectomy for my spinal stenosis? 😢
I can't remember the last time I heard of a patient dying during spine surgery. There was one, but that was over 20 years ago. If anyone has heard different please let me know. But the clearance measure done for surgery make it very safe.
@@BestPracticeHealththe patient seldom dies during surgery. It's the days-weeks-months after the surgery that can get you. Correct me if I'm wrong but I've researched 1 in 30 spinal fusion patients die within the first 3 to 6 months post fusion
Really well explained and thanks , I'm is a similar situation . I've been postponing it for both physical and mental on my end . I know its a heavy surgery . L5- S1 is bone on bone , I was denied from my old insurance company 10 years ago but now its time . Implant is now out of the question for not having enough space from the front , Now I'll be having a fusion . My pain isn't heavy but like here in the video I have deterioration of the nerves , extreme tightness, also Lost a lot of muscle in the left leg and calf . Hamstrings get large knots like a baseball on both legs . I'm 54 , Super sportive . Surf , Beach Volleyball , mountain bike ect . Very active and want to be able to still train with my son who's 15 . Would love to have a chat or even video about my situation if it will help others , I'm 16 day post operation and still on the fence ? Jan 16th 2024 I have my surgery here in Barcelona . Maybe its nerves but need to go in thinking positive . Thanks for your video and great Professional input....
You are so welcome! Hang in there. If you want to chat feel free to submit a questions on BestPracticeHealth.tv.
Wow!
How acute is the stenosis to go for operation..?
It depends on your symptoms. If there are no bowel or bladder issue, then weeks to months.
I have spinal stenosis operation soon
Is there a web source to find the best doctors in my area for lumbar surgery??
Out goal is to have them up on Bestpracticehealth.tv soon. Until then, call my office (602) 256 2525 and as Phebe for help.
Hi Dr...Another Canadian..Could you tell me an average price for laminectomy without fusion...???.No back.pain..Just a nag of a right leg sucking my joy of life....Thanks in advance.👍🏼🇨🇦🙄
The cash price varies widely and includes the surgeon, facility, anesthesia, and preoperative studies. I don't know a reliable rate now. You can call PS&J for that at 602 256 2525 and they will walk you through it.
In Canada it is covered by ohip
THIS CHARACTER NEEDS HIS LICENSE REVOKED. IS HE FOR REAL?
Hello, What are your thought on this MRI result? Is surgery the best option? If so, what type? Symptom left side sciatica, and developing spinal curvature.
Variable degrees of disc desiccation and loss of height from spondylosis. Scattered facet arthropathy. Details by level:
L1-2: Unremarkable
L2-3: Facet hypertrophy. No stenosis
L3-4: Disc bulge and facet hypertrophy. Mild spinal canal stenosis.
Mild right foraminal stenosis.
L4-5: Disc bulge. Superimposed disc extrusion measures 0.9 × 0.9 cm transversely and 2.2 cm
craniocaudally, extending inferiorly from
the parent disc essentially in the midline. Moderate to severe spinal canal stenosis. Most of the CSF around the cauda equina has been displaced.
L5-S1: Posterior annular fissure. Tiny left paracentral disc protrusion. No significant associated stenosis.
Conus terminates normally.
Included soft tissues are unremarkable.