Worse MRI results....what will happen next?

@denman55 The doctors need to determine if your pain is related to your spine or if it is related to a different problem in your leg, ankle or some other disease. It could also be connected to a problem in the brain. I'm not saying that to scare you, but someone I know with leg pain as a first symptom and walking difficulty was diagnosed with brain cancer. That is where the impulse originates before the signal is sent to the leg and you take a step. If they find something on spine imaging to connect the symptoms, you'll get a diagnosis after they can study the imaging.

Thank you, I appreciate your reply very much.

Have you done the PT route yet? You should exhaust all non-surgerical options first. The decision will be between you and your surgeon depending upon the degree of pain and discomfort. I had similar symptoms and findings and had fusion surgery because I couldn’t stand the continuous leg pain and cramping.

In 2022, I went to see a physician at a Spine & Sports Medicine facility. He prescibed Physical therapy, Acupuncture, and Chiropractics. I also had a total of 4 Epidural steroid injections - plus Trigger point injections, none of which have helped. I had a MILD procedure and also had the SPRINT PNS SYSTEM for 2-months. My entire (R) leg is in pain, from the butt, thigh all the way to my ankle. I can barely stand, walk or sit without pain. I have now been referred to a Neurosurgeon who I see next week.

Like some others posting here, my husband (82, Diabetes, Cardiovascular issues, …) has had pain walking/standing for several years which has worsened, but was attributed to blocked femoral arteries. He had a right femoral endartectomy in 2018. In September 2023, the vascular surgeon suggested he should have his back looked at because blood flow to legs looked ok. EMG in October 2023, and orthopedic doctor suggested injections. Instead husband opted to continue PT. In December PCP and therapist suggested injections would be worth a try. Saw orthopedic doctor in February 2024, who ordered MRI. 2/29/24, after MRI review, referred to spine surgeon who we will see 3/5/24.
Main issue of concern is spinal canal narrowing that is affecting compression of the cauda equina nerve roots. Looking at the MRI, the spinal canal at L4-5 was barely visible.
He is not having bladder/bowel issues which I understand is one of the main issues related to cauda equina nerves.
So…questions.
1. Googling leads me to laminectomy being likely .. correct? And advisable sooner rather than later?
2. Would a neurosurgeon consult be advisable? Or second opinion in general?
3. How concerned should I be about spine surgeon being board eligible vs. Board certified. Dare I ask him why? 😉
4. How concerned should I be about the effect of his other medical issues on the surgery? I assume he will need clearance from cardiologist and other specialist?

Thanks for any advice!

@lcl44 You are asking good questions, however the choice of what procedure is right is not something you can find of Google. That must come from a trained specialist who will also take into account any other health issues. I expect that he will need clearance from cardiology because of being placed under anesthesia during surgery. As far as reading the MRI, it depends on where the slice was taken as to how much you can see of the spinal canal, so don't worry about that. You also need to understand in 3 dimensions what plane that slice was taken to understand what you are seeing. The surgeon knows how to read and interpret the MRI and should be willing to explain it to you and show you where the issues are. The doctor will understand this in a much deeper and more detailed level than you will, but should give you a basic understanding of spine anatomy.

As far as choosing a surgeon, I always looked up everything I could about a particular surgeon I was seeing and when I find things likes awards from presenting literature at a spine surgery conferences, or that my surgeon had a full undergrad scholarship, and is regarded by his peers for excellence in medicine, then I know I am in good hands and that he worked to achieve that excellence. I saw 5 spine surgeons before I came to Mayo, and they all got the diagnosis wrong, and they disregarded clues from my symptoms that they didn't understand. I found medical literature with cases like mine, and with that in hand, I asked a surgeon at Mayo to take a look at me. I also look at state medical board websites to see if there has been any disciplinary actions against a surgeon. You can call your insurance company. They should know who the better surgeons are, and also look at the medical facility where they practice. There are ratings on US News and World Report for doctors and hospitals. A surgeon with good experience is probably board certified. If they are stating that they are board eligible, I wonder why they have not taken the exams for certification, but then are stating this as a qualification.

It is always advisable to get several opinions from surgeons before deciding on spine surgery, and that would be best if you can go to different medical facilities. Often surgeons know each other from working at the same place or conferences, so you may get a less biased opinion at another hospital.

Jennifer

Jennifer:
Thank you for your helpful response, especially the pointers to researching surgeon expertise and qualifications.
I Google mainly to get an understanding of terminology so I can ask reaasonably informed questions. We thought the PA who explained the MRI findings to us did a pretty good job but your caution about knowing which plane the slice is from was helpful to know.
I have a bit of familiarity with cauda equina, since my brother (in England) underwent surgery for the condition a few years ago, but the finding for my husband came as a bit of a shock,
Thank you again!

Good morning. Jennifer is a terrific source of perspectives. I echo her points about multiple opinions and choosing the best docs at the best facility with the best equipment. You seem like you're comfortable with online research and I believe there's great information available to help you make informed choices.

I had three spine surgeries (all planned) in 2023. One thing I learned is the decision to have surgery is seldom absolutely clear-cut. Rather, I saw the decision as one of personal risk management. (1) One risk is related to indefinite-surgery-deferral which could result in permanent and uncorrectable nerve damage. (2) Risk two is having the surgery and dealing with an arduous recovery (pretty likely, actually) with ultimate outcomes that are unknowable ahead of time. Was the surgery worth it? You might ask...

The question is: which risk do you feel the most comfortable with ... understanding there is no absolute way to answer these questions. It can be frustrating! Keep digging. Never give up. The best answer for you will become apparent, I believe.

Thank you, too, for your advice. I’m trying to not get ahead of myself with this, as sadly I often do. Let’s just see what this surgeon says first, one part of me is telling the other! I found this interesting to read.
https://www.spine-health.com/treatment/spine-specialists/how-select-a-spine-surgeon
You risk(1) is exactly what I am worried about w.r.t the cauda equina nerve issue. I intend to ask what is the usual timeline for how this condition develops. Is it gradual or might something precipitate an emergency situation (E.g. loss of bladder/bowel function)?
Since my husband was reluctant to even try injections, you can imagine his enthusiasm for surgery after he has gone through bypass surgery, unblocking femoral artery, and removal of part of his pancreas .. just to name the main ones. He is a lot better at not trying to predict the future than I am! 😉

You’ll need to obtain clearance from the cardiac doc and whom ever else your husband is seeing for his other conditions and whether he is stable enough for the procedure. Yes the bowel and bladder issues are a great concern and that alone should want him to follow through but at 82 I understand his reluctance too. Rehab can be what you make it but it is an essential part of healing from back surgery. I wish you both luck in deciding.