Why would an NP at a Neurosurgery and Spine clinic request more tests?

Posted by valleygirl1955 @valleygirl1955, 4 days ago

I recently had a new MRI done which showed the increased damage to my lumbar spine, especially L3,4,&5 on the left side. The NP that I saw at first at the Neurosurgery and Spine clinic suggested a round of nerve testing, which I did. Even though the nerve testing evidently showed nothing major amiss, the top of my left foot tingles when standing and the outer 3 toes on that foot tingle and go numb if I am laying on my back at night; even with pillows between and under my legs & knees. Now, after reviewing these new tests, the NP wants more tests. She is advising diagnostic lumbar injections at both the SI joint on the left side and L3,4,&5 areas; preformed at 2 different times. I cannot have the steroid part administered as I am highly allergic to all steroids so this would be possibly a half day relieve if any; and I have previously had the L3, 4, & 5 areas done some years back with no measurable relief at all. All the while my pain is getting worse and I am trying to do mild stretching and walking to help. I have asked for a round of PT, and as this would be the 1st thing to do if SI joint inflammation was suspected for the recent additional pain, but at my 1st appointment when all she looked at was the MRI, she said she didn't think PT would do me any good at this point. I don't know if my insurance will cover the diagnostic injection tests and I sure don't have the money to pay out of pocket. Also, I have no one to take me to this procedure and bring me back home. NO ONE! My insurance will cover taking me there and bring me back; but as it is considered a "surgery" the ride would drop me off and then when the nurses call the ride company when I am done with the procedure, it most likely will take between 4 and 5 hours to return to pick me up to bring me home. So, what, I sit in the parking lot all day; or if it's after they close, all night? Really???
This is the same Neurosurgery and Spine clinic that I went to about 6 years ago and at that time, when my back was not near so bad, the Surgeon wanted to do surgery right then. I decided to put it off as it was right about when Covid hit. Now my back is much worse and the NP (whom I never saw before) is playing games with numerous, redundant tests. In meantime I am in so much additional pain it is affecting my sleep and just about everything else. I am going to get a 2nd opinion; even though I have yet to have any opinion put forth; next month at an orthopedic spine specialist. Maybe there I will get some answers and if I'm lucky a bit of relief; whether that's through surgery or PT. I don't care at this point. I just need some relief. My pain medicine helps some, but it is getting to where the break through pain begins at less than 2 hours after taking the medication.
Sorry this is so long. I am just about at the end of my rope.
One other thing; the NP at the Neurosurgery and Spine clinic is extremely nice. If I was looking for a friend, she would be at the top of the list! But, I don't think she knows what she's doing. She was reading the nerve test report and basically stating that there was nothing there, and then she'd look back at the MRI and state just how severe the left side was. It can't be both folks!!! Maybe it was devine intervention when I did not follow up with the surgery 6 years ago at this place; even though the surgeon comes highly rated. I don't know. Has anyone else been subjected to so many tests; some which have already been preformed some years back, without ever finding out just what needs to be done to get even a bit of relief? Thank you.

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Valleygirl1955,
I think the NP wants diagnostic lidocaine injections to determine which level is causing pain. The relief from lidocaine won't last but six or so hours, but can determine which location among the possible would provide relief from a procedure, maybe ablation of the nerve.
I've had these diagnostic injections SI and Lumbar in the office under ultrasound without other anesthesia and was able to drive myself immediately afterward. Call the office and find out how the procedure will be done, and if you will be safe to drive afterward. If they numb your skin and advance the needle slowly releasing lidocaine on the way in, you shouldn't feel much of anything.
The nerve testing that was done shows nothing but the MRI reveals structural changes that likely impinge nerves.
Unfortunately, we repeat tests that have been done years back because it all can change.
If anything your post was not long enough. If you have the imaging reports esp the MRI you might upload it here.
They probably use bupivacaine not lidocaine.
What was the surgery that was delayed by Covid.
I'm so sorry you are experiencing so much pain and for so long. I hope you find relief soon.

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The surgery they wanted to perform 6 years ago was spinal fusion from L3 to S1. I can not drive in the city that I would have these diagnostic tests done, and besides, the last time I had them done, they put you out; not completely under, but out; and will only do if you have a driver. More money I suppose. I'm wondering if Medicare/Medicaid will even cover this now. If not, then I can not pay out of pocket. I barely meet my rent and utilities now. I know I'm not the only one in this situation.

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Am I wrong- NPs can prescribe meds and maybe order tests ? Though needle testing is something I know zip about….is it necessary, and if so -why ? What are the alternatives ?

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I have also had the diagnostic tests without sedation and was able to drive home. I think it depends on the doctor's requirements and they are not all the same. I think you are doing the right thing by getting a 2nd opinion from an orthopedic spine surgeon. I have similar problems at L3-S1 and surgery is recommended by my orthopedic spine surgeon. I am trying to make the decision as to whether I should go ahead. I hope you find some answers soon.

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When I began my spine surgery journey I had extensive testing done, including MRI, Myleogram, and a life size study of my spine. I know it is a pain, but excellent treatment requires information that is current and correct. I had disease and deformity at every level of my spine. I had excellent treatment over a twenty plus year period. I appreciate the doctor covering all the bases before surgery. Considering how horrible my spine was the outcome for most of the 7 different joint replacements was good. I wanted to keep going, as of today, I am still walking, with a cane but still upright.

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