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Worse MRI results....what will happen next?
Spine Health | Last Active: Mar 5 3:19pm | Replies (32)Comment receiving replies
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!
Replies to "Like some others posting here, my husband (82, Diabetes, Cardiovascular issues, …) has had pain walking/standing..."
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@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