How many times is epidural given before surgery is considered?
Healthy 38M 5'8 165lbs. I had a lumbar injury at work in November 2020. First worker's comp doc did x-rays and I had physical therapy for 1.5 months that didn't help. MRI was requested after the first month of PT. MRI was ignored and I was discharged with permanent ongoing work restrictions of >10lbs lifting and limited bending. WC doc lied in her notes that I refused to attend pain management that she never recommended. She also tried to play the 'ol dirty card and blamed my back injury on dysautonomia, which my primary care doc had been treating me for for nearly a year before the back injury. He shot back with a letter that said that the dysautonomia has no bearing whatsoever on musculoskeletal injury or healing and that they need to treat my back injury separately.
Took me 4 months to get a spine specialist/ortho surgeon. His notes:
"Mild sciatic list. Forward flexion extension is limited. Straight leg raise testing reproduces back and buttock pain bilaterally. No pain with range of motion of his hips. Good strength in all muscle groups from L1-S1. No sensory deficits. MRI scan is reviewed with lumbar spine advanced degenerative changes noted at L4-5 with disc space narrowing. Did not see any evidence of any nerve compression at that level. The other levels are well-maintained. There is some edema in the endplates. Thoracolumbar spine reveals mild tenderness to palpation. Discussed treatment options with him today. He has not had improvement with physical therapy. He does have advanced changes noted at L4-5 that represent exacerbation of an underlying degenerative condition through his work injury. I recommend bilateral L4-5 transforaminal injections Continue his previous work restrictions. Diagnosis: Lumbar Radiculopathy."
He also added his own restrictions for alternating standing/sitting due to the tingling, pain and alternating numbness in my legs (e.g. sometimes a whole foot will turn number just by standing in place for a few minutes). I'm in a state where even if you have some degeneration, if your workplace duties exacerbate it, the law requires for it to be treated as a full-on injury. My lawyer has also stated that the employer is responsible.
I had those bilateral injections on 6/18. For about 3 days, the stabbing lumbar pain and tingling/sciatica down both legs went away. Incidentally, the odd bladder malfunction/bowel motility symptoms and lightheadedness from the 'dysautonomia' since December 2019 also went away for those 3 days. On 6/21, the stabbing lumbar pain came back, the sciatica and tingling came back down to the toes of both feet and my bladder/bowels started acting up again. My lightheadedness returned. We know that dysautonomia in and of itself is a set of symptoms, not a medical condition or disease specifically. The bladder and bowel pain feel like they are coming directly from my lumbar as some kind of referred pain.
So now it has been 7 months to this day since my back injury. The outside half (meaning separated by the tibia) of the full length of my calves have been numb on both legs 24/7 since November 2020. The epidural had no effect on them and dermatome maps show the L4-5 as responsible for that numb area on both legs. In addition, apparently the L5-S1 affects the bladder/bowels based on nerve charts. I obviously have some sort of nerve damage going on in my legs.
I go back to the doc in the morning for follow-up. Will he order more epidurals given that it only lasted for 3 days or will surgery be recommended at this point?
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You should also look at PT for your back issues before considering surgery. If you can find an osteopathic PT or one with that experience, it is better than the general PT offices. I have a hip that has bursitis and, finally, found that the combination of the shot to eliminate inflammation and then PT to strengthen muscles and improve flexibility was the trick. I have pirformis syndrome, so the stretches manage it very well, along with sciatica. I do have degeneration in my spine, but no pain there. I haven't had to go back for a shot in a couple of years.
I have had about 10 yrs of PT due to RSD,Broken back, spinal stenosis. Ect…
Re "How often are epidurals given" . . . I had four in my lumbar spine, each giving relief for a couple of months. When I showed up for my fifth, scheduled by the doctor's PA, the doctor said we shouldn't do it. Repeated treatments are less beneficial and they are "not without risk." She was proven correct when a relative had one that caused permanent incontinency. Her doctor tried everything within his ability and could not stop the unhappy development.
Also, I had a shot in my shoulder for a problem there and the shot caused more pain for a week than the injury had. For me, the less treatment the better. I take 1200 mg of Gabapentin, have no pain, and am trying to live with leg weakness.