M.I.L.D. surgery + 4 months therapy no relief

Posted by murphyjoe @murphyjoe, Mar 3, 2024

After years of walking hunched over because of spinal stenosis I had the Mild Invasive Lumbar Decompression procedure done. After three months of physical therapy and one a month of aqua therapy, I still can not walk up right and pain free. Is this normal and I need to give therapy more time?

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@bayhorse

@jenniferhunter, yes, the surgeon was (how shall I say politely?) a jerk. The problem with MILD -- the ligament scraping procedure -- is that only pain docs do it and surgeons as a class disdain it. A pain doc will tell you surgeons hate it because it takes money out of their pockets; patients who might be told they need surgery (fusion, laminectomy, etc.) are often going for MILD in order to put off having surgery. When successful, MILD is supposed to give relief for up to 5 years... that's 5 years of lost patients to surgeons. So it's hard to trust a surgeon's opinion about the procedure. Problem is getting a good second opinion from another pain doc. In my case, when shots, ablation, etc., won't work, and when drugs aren't tolerated, MILD is what's left. So pain docs may recommend it, whether I should have it or not!

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@bayhorse Would you be a candidate for a surgical procedure other than MILD with a spine specialist? Are there other procedures that you would consider?

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Hi, @jenniferhunter. I have spoken to two surgeons (spine specialists), and both say that with my osteoporosis, they would not do surgery. Likewise, because of the osteoporosis, I cannot have steroid injections (epidurals). I have also been told that ablation does not work with my kind of stenosis. I am trying to get an appointment with a neurosurgeon here; he picks and chooses his cases, and I am waiting to hear whether he will see me. But my impression so far is that no one wants to put pins and screws in my spine because they worry about the bone being able to hold them. No one has discussed laminectomy with me, I'm guessing for similar reason, but the pain specialist who looked at my MRI told me that because I have a disc out of alignment, laminectomy could destabilize my spine. I hope to ask the neurosurgeon about that. (Fingers crossed that he sees me.) So this is not really about what procedures I'd consider as much as it is about what procedures are really do-able. And unless I've been misled, MILD seems to be the leading candidate.

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@bayhorse

Hi, @jenniferhunter. I have spoken to two surgeons (spine specialists), and both say that with my osteoporosis, they would not do surgery. Likewise, because of the osteoporosis, I cannot have steroid injections (epidurals). I have also been told that ablation does not work with my kind of stenosis. I am trying to get an appointment with a neurosurgeon here; he picks and chooses his cases, and I am waiting to hear whether he will see me. But my impression so far is that no one wants to put pins and screws in my spine because they worry about the bone being able to hold them. No one has discussed laminectomy with me, I'm guessing for similar reason, but the pain specialist who looked at my MRI told me that because I have a disc out of alignment, laminectomy could destabilize my spine. I hope to ask the neurosurgeon about that. (Fingers crossed that he sees me.) So this is not really about what procedures I'd consider as much as it is about what procedures are really do-able. And unless I've been misled, MILD seems to be the leading candidate.

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@bayhorse I understand. That is a problem when any hardware screwed to the spine puts you more at risk of fracture due to osteoporosis. Sometimes surgeons have patients on bone building drugs for a period before spine surgery. From what you said, it's a lumbar problem, right? I don't know if lumbar fusions can be done without hardware and have a patient in a body cast. My cervical fusion was without hardware (only a bone disc) and I stayed in a neck brace until fused. I hope you do find a willing provider with a solution.

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I have been on Tymlos 2 years and still am in the classification of severe osteoporosis. I'm trying to decide whether to risk Prolia next. The choices are all pretty awful.

Yes, I have lumbar stenosis at 3 levels in addition to the slipped disc. Even if my bone density improves further, I am 73 years old, have heart disease and 3 autoimmune illnesses, and am struggling to stay active in spite of the pain from the stenosis. But it's an uphill battle and I'm not doing great at maintaining strength because exercise hurts. Aaargh... I also was just told that weight lifting would compress the spine and that I would need to do all weights from a seated position. I found this very discouraging.

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@jenniferhunter

@bayhorse I understand. That is a problem when any hardware screwed to the spine puts you more at risk of fracture due to osteoporosis. Sometimes surgeons have patients on bone building drugs for a period before spine surgery. From what you said, it's a lumbar problem, right? I don't know if lumbar fusions can be done without hardware and have a patient in a body cast. My cervical fusion was without hardware (only a bone disc) and I stayed in a neck brace until fused. I hope you do find a willing provider with a solution.

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@jenniferhunter, I replied a minute ago but forgot to include your tag. Answered your question about my stenosis (yes, lumbar), etc. Thanks for your good wishes. BTW, love the pic with your horse. I gave up riding when I was told I had osteoporosis, and lately think that was a mistake. Work with, on & around a horse kept me very strong! But my horse had a shoulder injury and stumbled some -- I was good at anticipating and preventing it, but the risk of going down with him scared me. Wish I'd been braver!

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@bayhorse

@jenniferhunter, I replied a minute ago but forgot to include your tag. Answered your question about my stenosis (yes, lumbar), etc. Thanks for your good wishes. BTW, love the pic with your horse. I gave up riding when I was told I had osteoporosis, and lately think that was a mistake. Work with, on & around a horse kept me very strong! But my horse had a shoulder injury and stumbled some -- I was good at anticipating and preventing it, but the risk of going down with him scared me. Wish I'd been braver!

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@bayhorse A couple thoughts.. You can also simulate riding by sitting on one of those big therapy balls (or an air filled cushion version of that on a chair) and if you rock back and forth as if you were on a horse, you would be working your core. Your feet stay on the floor.

For exercises, have you tried the stretchy bands that physical therapists have or elastic bands? Those provide resistance without adding weight.

My mom has severe osteoporosis and it didn't take any effort for a bone to break in her foot causing a fall that broke her pelvis, and a few years later, a compression fracture of the spine. Those are long recoveries when that happens, so you need to be so careful to prevent it.

Another thought... walking in a warm water pool for resistance against the water if you can safely navigate a pool and locker room.

I had an old horse who tripped a lot. He had been a free horse and given away because of this problem. He did improve with better hoof trimming, but got worse when he was older. A few times when older, he fell on both his his front knees when I was on his back, and somehow, I managed not to fall off with him dumping me forward over his head. I really learned to ride balanced because I never knew when he was going to loose his balance. I did have to retire him, and I got a younger horse that I ride. The old one is gone now and is the one on my avatar picture right now.

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I have lumbar stenosis. I have had sciatica for many years. For 4 years I get steroid injections. They always helped. On a Friday last month I went to my spine doctor to get the results of my MRI. The stenosis had advanced just a little. He explained about Mild surgery. I decided yes, let’s try it. Two days later as I finished changing the sheets on my bed, I had to push the bed against the wall about 5 inches. Bam! It was like a knife slicing from my right buttock to my ankle. For the 3 weeks before my surgery the pain was off the charts! I had to get a walker because walking, standing and sitting were impossible. I had my Mild surgery two weeks ago today and nothing has changed. I am thinking of having endoscopy spine surgery. What do you think?

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