Considering Laminectomy for Spinal Stenosis to relieve neuropathy pain

Hello. My husband had the M.I.L.D. Procedure done last month for his spinal stenosis. He had been in horrible pain. Now he feels great. Simple procedure, no stitches needed either.

10-12 years ago when these symptoms manifested, I saw an Orthopedic Surgeon. It was his diagnosis that I had inoperable spinal stenosis. I didn't see any red flags at that time he was well respected and a mature surgeon. The only odd thing I took from his visit was that he spent very little time with me. During my office visit his nurse brought me an Ipad with a lengthy "generic diagnosis discussion made by the surgeon". I just assumed that my diagnosis was very common. He maybe spoke to me for 5 minutes just clarifying that I had something akin to arthritis and that losing weight and stretching would be my only treatment option and that my activity would be limited and pain was expected. If you couple that diagnosis with the results from the nerve biopsy and my trip to Mayo I think we might all conclude that there was nothing I could do. This current evaluation and test (still pain free 4 days later) is eye opening and bordering miraculous for me. Keep in mind I went on disability 10 years ago and the neuropathy pain was the main factor. If this continues down a positive path it is life changing for me. I'll update more as I continue this path. But WOW this looks great!

I also have hypercortilism with growths on both adrenal glands. Doctor doesn’t remove adrenal glands because they both have growths and he do think it would help. Have they suggested medication for high cortisol levels. They have suggested korlym and recorlev but I’m not taking them because I’m scared of side effects. I’m undecided what to do. It’s worrisome.

I assume your adrenal growths are both producing cortisol. I would suggest that you see an endocrinologist. They can help you sort it out. The standard treatment is adrenalectomy or removal of an adrenal gland and growth. For me the one on the right AG was larger than the one on the left AG. Last summer I needed a partial nephrectomy to remove a cancerous growth from my left kidney. The surgeon took out the left adrenal gland at the same time. I still produce about 30% too much cortisol. Currently I'm involved in a drug research study at Mayo to help normalize it. The worst side effect of Recorlev is its cost; Holy Shmoly!

John, Volunteer Mentor | @johnbishop, dlydailyhope (@dlydailyhope)
I have been following the spine health forum along with the osteoporsis forum seeking answers regarding spine surgery. I am now seeking answers regarding neuropathy and permenant nerve damage resulting from spinal stenosis.
I am suffering from spinal stenosis, and degenerative spine disease. I have been living with debilitating pain from it in my lower lumbar for two years (I am 64). When this all started two surgeons said I was inoppearable, so I went down the path of pain management. That was getting nowhere, until 12 months ago I met an orthopedic surgeon who recommended laminectomy and spinal fusion from t10 to s1 to open up the spinal column to releive the stenosis.
It has been a long year coming to grips with this massive surgery, and just recently I decided to do it. I chose a neurosurgeon to do the surgery but he is postponing it for nine more months. In the past 3 months, my symptoms of neuropathy have become constant. Prior to 3 months ago it was intermittent and somewhat insignificant to me.
I met with a pain management doctor today and he recommended an epidural injection and hope we hit the spot. Possible ablation treatment later. But even if these treatments give me temporary relief, will the nerves continue to be damaged...even though I might not feel the pain, are the treatments only masking it while my body continues to damage the nerves? will these treatments delay permenant damage?
One year ago I didn't have this pain. Given the fact that over the past couple of months, the constant numbness in my feet, pain in my upper thigh to my knees and lower back pain, I want to avoid permenant damage to the nerves that are causing these symptoms. Is there anything I can do to prevent permenant nerve damage while wait to schedule the surgery? My neurosurgeon is putting me off for nine more months!?!? I can't wait that long while my nerves are shot to death waiting on him. I really need some help here.
I don't have any autoimmune diseases, I am not obese, don't smoke, take my daily 6 oz of wine (haha), but not an alchoholic. I am actually very healthy, except for the trifecta of problems in my spine.
Any input on this would be appreciated.

@berniej1
I like your name “Pet Detective” 😉

Did you have an accident or injury a year or two ago that triggered your current pain/symptoms?

Why did the 2 surgeons originally say you were inoperable?

What does your cervical, thoracic and lumbar MRIs show that would benefit from surgery? Do the reports show impressions of disc bulges or herniations, bone spurs/osteophytes, hypertrophy (overgrowth of bone), ligamentum flavum (thickening/buckling of ligaments lining the spinal column), spondylisthesis (vertebrae slipping over lower vertebrae), spinal cord/thecal sac flattening (myelopathy spinal cord compression injury), etc.?

Do you have any scoliosis curvature in spine and do you have osteoporosis?

Have you seen a neurologist for EMG/nerve conduction studies of upper and lower limbs to see if you have pinched/compressed spinal nerve roots (radiculopathy) or nerve damage in muscles? Have you had the small fiber neuropathy skin punch biopsy?

EMGs can detect communication/signal disruptions outside of brain/spinal cord but not good at measuring what is going on in the brain/spinal column. For example, I had a “normal” EMG for my legs when I had severe spinal stenosis l4-l5, degenerative disc disease and neurogenic claudication causing lower back/hip/buttock and bilateral leg/foot pain, weakness and numbness that would be intermittent then constant. My symptoms started over 10 years ago but progressively worsened.

My understanding is that if your spinal cord is damaged/injured (like with myelopathy which I have), it may be permanent and progressive so the goal is to relieve pressure from the spinal cord. I am having another ACDF surgery on c6-c7 in May to remove the herniated disc from my spinal canal which is putting pressure again on my spinal cord. My lumbar decompression/fusion surgery on l3-l5 opened up space around my spinal cord and nerve roots which allowed them to heal. I no longer have the back/hip/buttock/leg or foot numbness from the neurogenic claudication. It was a very painful surgery due to cutting through muscle and bone but after 6 months, I am much better. It can take a long time for nerves to heal if they are injured by compression/pinching. If a nerve gets fully severed, that is when I believe it may not be possible to heal. The pain signals come from the disrupted communications from brain to body and body to brain.

My orthopedic spine surgeon would schedule me for surgery in 2 weeks if I wanted to and my insurance approved. Why your neurosurgeon has pushed you out so far does not make sense at all. Why are they delaying? Why did they say you should wait so long?

Keep in mind that orthopedic spine specialist surgeons and neurosurgeons are both qualified to do spine surgery. The reason I went with my orthopedic spine specialist is because of his qualifications and reputation/ratings/reviews plus I figure that someone trained in the structure and mechanics/loading of the spine would be good to make adjustments to my spine. It is to me sort of like hiring someone to build your house with a strong foundation and then making modifications or additions, working around and protecting electrical wires vs. an expert electrician building around the wires.

You may want to get a couple other opinions from different neurosurgeon and orthopedic surgeons who are highly regarded and able to do surgery, if recommended, much sooner. You should not have to suffer so long. Spinal injections may or may not help and only give temporary relief of joint inflammation putting pressure on surrounding nerves/nerve roots/blood vessels.

@berniej1
I should have mentioned that both my cervical and lumbar decompression/fusion surgeries relieved my pain significantly and some weakness improved over time (headaches/neck and shoulder, back, and hips). I still have residual weakness and balance issues due to my injured spinal cord (myelopathy) in my cervical spine due to misdiagnosis/delayed diagnosis over 5 years. I had some doctors think I was a hypochondriac when I was actually suffering with many symptoms due to my spinal cord being compressed and injured. Doctors are human, make mistakes, can miss things and not put puzzle pieces together properly, can be arrogant/ignorant, may not care to make patients’ quality of life better, etc. which is why it is so important to educate and advocate for ourselves.

@berniej1, I also have degenerative disc disease which I'm sure plays a part in my lower back issues. I don't have the pain that you experience but I do have lower back aches which makes it difficult for walking any distance. I also have neuropathy in my feet and lower legs but only the numbness and some tingling.

@jenniferhunter started a discussion on Myofascial Release Therapy which I think might be helpful and she may have other suggestions on your back surgery plan. Here's the discussion:
-- Myofascial Release Therapy (MFR) for treating compression and pain:
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
It's great to hear that you are very healthy as I'm sure that also plays an important part with any surgeries you may have. Did your neurosurgeon give any reasons for postponing the surgery for nine months?

I do get real lasting relief from "facet injections" on my lower back for back pain. After doing this 3 times over 2 years they switched to nerve ablation and that also worked well. I still have some residual pain but it's not debilitating. I actually play a little golf.