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Dr Brims
Dr Brims, U.S. Licensed Physician
Category: Medical
Satisfied Customers: 9053
Experience:  MD
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foraminal stenosis.L5-S1 annular bulge with superimposed small

Resolved Question:

foraminal stenosis.L5-S1 annular bulge with superimposed small focal posterior central disc protrusionn effaces the ventral epidural fat.Bilateral bulky facet deg. changes appear more pronounced on the left.Combined findings ressult in mild to moderate central spinal stenosis,moderate to severe bilateral articular zone compression and mild left foraminal narrowing.A L4-5 posterior decompression and fusion with BMP and instrumentation is the procedure he wants to perform. When i question if surgery shouldinclude the problems areas noted on the MRI above and below these areas his response has been "oh I think we can get away with just L4-L5".Going through this major surgery concerns me and especially if all the areas are not addressed during the operation.I have expressed this several times with the same response.I do not want to have to undergo this major procedure more than once. What would you suggest to your patient under these circumstances? I was approved immediately through Soc.Sec and continue Wk comp but have neuropathy,pain tingling from mid back,sciatica,hip with tingling,numbness in right entire leg and back and at times severe right groin pain.I have researched laser spine surgery and endoscopic surgery but WK comp will not pay
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Brims replied 2 years ago.

Dr Brims :

Hello, welcome to Justanswer, I will try to assist you with your medical question, and any medical information you seek

Dr Brims :

With the symptoms you have described, I think surgery is your best option

Dr Brims :

I work in orthopaedics, and the symptoms you have will likely get worse over time

Dr Brims :

it will likely eventually lead to muscle weakness and wasting

Customer:

up to what level of the spine noting the MRI would you suggest?

Dr Brims :

Based on your symptoms, L4-L5 for sure, not L5-S1, it does not say anything bout L3-$, so I assume it is normal

Customer:

L2-L3 ,L3-4 AND L5-S1 WERE LISTED WITH MY INITIAL RESPONSE PER MY REPORT

Dr Brims :

I see, then I must be missing the initial part of the report, because it did not show up, is the part you typed under the "impression"

Customer:

EACH SPINAL SECTION REPORTED SEPARATELY IN THE INITIAL REPORT SUBMITTED

Dr Brims :

That means the whole thing did not show up in your post

Dr Brims :

Do you see the part that says "impression"?

Customer:

I CAN RESEND THOSE SECTIONS NOW L2-L3 MILD ANNULAR BULGE.FACET DEG CHANGES.L3-4 ANNULAR BULGE AND BULKY FACET DEG.CHANGES.WITH MILD CENTRAL SPINAL STENOSIS AND SUBARTICULAR ZONE COMPRESSION.L4-L5 ANNULAR BULGE WITH SUPERIMPOSED RIGHT FORAMINAL AND EXTRAFORAMINAL BROAD-BASED DISC PROTRUSION IN COMBINATION WITH BULKY FACET DEG. CHANGESSEVERE CENTRAL SPINALSTENOSIS AND SEVERE BILATERAL SUBARTICULAR ZONE COMPRESSION WITH MILD RIGHT FORAMINAL STENOSIS THE L5-S1 IS SHOWN IN MY POST FROM THERE

Dr Brims :

Thank you for that

Dr Brims :

The findings from L2-L3 are not serious and do not require surgery, it would not benefit you to have any surgery from L2-3

Dr Brims :

Findings in L5-S1 are also not changes that would require surgery

Dr Brims :

Any surgery done in those areas would make your quality of life worse if done now

Dr Brims :

The problem lies in the L4-5 region

Dr Brims :

Are you there?

Customer:

YES WHAT ABOUT L3-4?

Dr Brims :

L3-4 shows some mild changes, and they are not severe enough for surgery at all, not even close, 50% of the population have those changes on an MRI

Dr Brims :

Also, if an MRI was done on 100 people, about 50% will show many of the changes you have , apart from the L4-5 changes

Dr Brims :

Are you still there?

Customer:

WOULD I NEED CORRECTION AT SOME LATER TIME WHEN YOU RESPONDED ABOVE THAT MY QUALITY OF LIFE WOULD BE WORSE IF DONE NOW. ALSO WILL CONTINUE TO HAVE BACK PAIN DESPITE THE SURGERY INDICATED? I AM A SURGICAL NURSE AND KNOW PERSONAL FRIENDS WHO HAVE HAD TO HAVE REPEAT SURGERY AND/OR EPIDURALS AND PAIN MEDS. HAVE YOU SEEN BETTER RESULTS WITH THE NEWER PROCEDURES OUT NOW? I WAS VERY ACTIVE BEFORE THIS INJURY ACTUALLY WORKED 2 NURSING JOBS,WENT TO THE GYM 4-5 DAYS A WEEK AND HAD AN ACTIVE SOCIAL LIFE.I PARTICIPATED IN WALKS FOR CANCER AND KIDNEY DISEASE AND WAS a TRAVEL NURSE ALSO.MY LIFE HAS DONE A 360 DEGREE TURN AND HAVE HELP THAT COMES IN. I WANT TO STAY OPTOMISTIC BUT WANT TO KNOW WHAT I AM FACING AHEAD ALSO

Customer:

YOU ASKED ABOUT THE IMPRESSION ON THE BOTTOM OF THIS REPORT AND IT READS MULTILEVEL LUMBAR DEGENERATIVE SPONDYLOSIS

Dr Brims :

From your MRI and symptoms, it is unlikely you will need surgery later

Your back pain will likely resolve with surgery, the newer procedures have not shown better results

There is an excellent chance that surgery will improve all of your symptoms

Customer:

COMPROMISES CENTRAL NERVE ELEMENTS MOST PROMINENTLY EFFECTING L4-5 AND L5-S1 AS DESCRIBED ABOVE

Dr Brims :

Okay, thanks for the impression

Dr Brims :

From everything you have told me, I think the scheduled surgery is the best option

Dr Brims :

I mean the posterior decompression and fusion

Dr Brims :

BMP just aids bone fusion/healing

Dr Brims :

Are you there?

Customer:

YES I AM HERE

Dr Brims :

Did you understand my replies?

Customer:

YES AND I APPRECIATE YOUR FEEDBACK

Customer:

WHAT KIND OF RECOVERY TIME HAVE YOU SEEN IN PRACTICE?

Dr Brims :

Recovery time is 8-12 weeks

Customer:

THEN REHAB TIME?

Dr Brims :

Rehab time can be anywhere from 4-12 weeks on average

Customer:

SO I SHOULD PLAN FOR APPROX 24 WEEKS? I WILL NEED TO NEGOTIATE STAIRS IN MY HOME ALSO

Dr Brims :

You should plan for 8-12 weeks, during the rehab time you will not be incapacitated

Customer:

BUT WILL BE GOING TO THERAPY DURING THE REHAB TIME,IS THAT CORRECT?

Dr Brims :

Yes, that is correct

Dr Brims :

It may be very short ,sometimes 2 weeks

Customer:

THANK YOU AND I WILL SIGN OFF NOW,GOOD NIGHT!

Dr Brims :

You're welcome,

If you have other questions at another time you may request me by starting your question with "for Dr Brims"

Please let me know if you have any other questions or concerns on this topic

If not, please click the green ACCEPT button to end this chat session

Dr Brims, U.S. Licensed Physician
Category: Medical
Satisfied Customers: 9053
Experience: MD
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