Permanent Spinal Nerve Root Damage????

[amcareless]

Hiya,

My name is Anne-Marie, I am 24 years old and live in Western Australia.

After persistent sciatic pain for 8 weeks my back spasmed two weeks ago. I experienced left leg numbness/pins and needles down the outside of the same leg and foot that is still present today. I also have nill plantar reflex in said leg. I intermittently have excruciating cramps in my calf and posterior thigh despite the Diazepam the Drs have proscribed.

I have since had an MRI that shows a 7mm herniation of the L5/S1 vertabra impinging on the S1 nerve root and Thecal Sac.

The top Orthapaedic Spinal Specialist in the state tells me i need urgent surgery or i risk permanent loss of function/paralysis of the affected muscle.

I'm only 24 and the surgery will cost me $10,000.00 if i want the best surgeon to do it. I'm hesitant but the consequences as stated to me seem pretty serious.

Until these last few weeks the most serious illness i'd ever had was an ear infection and the only musculoskeletal issue had been persistent shin splints since i was around 17.

If any one could offer me a little guidance it would be greatly appreciated as there seems to be a lot differentiation in the research/journal articles i've found o the internet.

Thank you for your thoughts and your time,

Anne-Marie

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[Ironmike]

Conservative treatment, especially given your age would be my preference. If your symptoms are staying the same and not worsening, it suggests to me that maybe this can be managed without surgery. Have you been seeing a physio or any other such professional for rehab?

[amcareless]

Hiya Mike,

I attempted to see an Osteo but he stated that given my symptoms and MRI he wasn't willing to take me on. I've seen a physio twice so far, the first time only four days after my back had spasmed and the second time this morning. Upon assessment today the physio said she was extremely happy with my back as I had regained almost the full range motion I had previously lost. However I was unable to stand on the ball and toes of my left foot even when supporting myself by holding on to the back of a chair. When I asked her about the possibility of regaining this function she replied that she simply didn't know. :0(
My absolute preference is for conservative treatment however my visit today was not encouraging,

Thanks so much for your time,

Annie

[Ironmike]

Do you have any ability to move your ankle up and down at all? Not neccessarily stood on it, but lying down say. If it is a strength thing then it is reasonable to postulate that this might return with training, but if there is no movement at all (muscle is de-innervated) then it may be that surgery is neccessary. Has anyone mentioned what sort of nerve injury they think you have? Have the terms Neurapraxia or axonometsis been brought up? I would think that your injury falls more under the neurapraxia category meaning that once the obstruction is delayed then recovery is very likely within weeks. The difficulty is that whilst there is disruption and potentially a stopping of blood supply to parts of the nerve, these have the potential to degrade throug ischemia. I think this is why your consultant wants to get in there quickly to minimise the risk of permanent damage to that nerve. I think unfortunately it is a very difficult case to advise on, and a lot of it is going to come down to you and your beliefs about your treatment.

[physiobob]

Perhaps you can access some EMG studies to see the extent of dysfunction caused by the pressure on the nerve roots. This may assist to understand whether surgery is more or less a warranted option, despite us all wanting to try the conservative approach first. Peripheral dysfunctions are very hard to generalize in terms of recovery, even with surgery at this later stage. I have seen full recover with and without surgery in patients with similar MRI presentations. That said some have taken 12-18 months to begin the return of functional. Others have not had their function returned following surgery.

As an aussie myself I thought the national hospital system provided pretty good care in the orthopaedic areas, especially simple decompressions. Perhaps if surgery is a consideration you need not go private.

[amcareless]

Hiya Mike and Bob,

Thanks very much for all your support and knowledge. I've found one of the most difficult things over the last few weeks to be health professionals tendency to tell you what to/not to do without explaining the rationale behind their instructions.
I believe that's why forums like this are so beneficial to us laymans)

Mike: I've seen two highly recommended Physio's both with their masters in manipulative therapy who have refused to touch me apart from assessing my loss of fuction in my left leg. They both suggested i do some hydrotherapy but no more than once a week. I have no pain when i plantar flex but sharp pain in the back of my thigh when i dorsal flex my foot. I do have full range of motion though.

PhysioBob: Having worked in a public hospital for years myself, i had complete faith in the system and never signed up for private insurance.
Turned out this was a big mistake.

Case in point:
I presented to ED at a public hospital here in Perth, RPH, three weeks ago exactly. My back had spasmed, i was experiencing 10/10 pain and my left leg and foot was numb/ all pins and needles. They sent me home on analgesics and a letter for my GP instructing him to organise an MRI. I couldn't get in to see my GP until the following Tuesday. Over night and all the next day,Saturday, i experienced excruciating cramps in my left calf. These would last for about half an hour and occur at roughly two hour intervals. on Sunday, concerned that this meant my condition was deteriorating i represented at RPH ED. I was told not to worry as i Probably had a prolapsed disc and the cramps were a typical symptom of this. Again i was sent home with no investigations performed and no referral to a NEURO/ORTHO specialist.

On the Tuesday i saw my GP, at this point still in severe back pain, he told me GP's cannot organise MRI's, only CT's. Two days later i have my CT and the radiologist states i need an MRI. I called the offices of every NEURO/ORTHO Dr in the state only to be told they wouldn't see public patients. At this point i called in a huge favour from a friend who's Boss is an ORTHO surgeon. He reviewed my CT and requested the MRI for me. Upon seeing the results he stated i needed surgery ASAP. As i mentioned before i couldn't afford the $10,000 fee for going private and asked my GP to write a referral to SCGH ED, another public hospital in WA. I was reviewed by a Emergency Registrar who finally put through a referral for me to be seen by a Neurosurgeon.
Two days later i receive a phone call stating i have an appointment in four months.
Completely despairing at this point i call in another favour and have my friend's Boss write a referral to his friend, another surgeon, at a public clinic at RPH.
Post this I had an appointment to see a specialist in a matter of day's.
It's not what you know, or more importantly what your symptoms are, but who you know!
My appointment was this morning and the Consultant spent two minutes assessing me and the MRI and booked me in for surgery for two weeks time.

I think my story illustrates the gatekeeping/insufficient supervision of junior DR's in emergency and the effects of the FOUR HOUR RULE that was implemented over the last twelve month's in the hospitals here in WA. I'm fairly certain the FOUR HOUR RULE was trialled in the UK but just in case a quick explanation is that; ED Drs have four hours from the time of triage by the nurse to decide weather the patient should be discharged from ED or admitted to a ward. As in my case where further investigations and review by a specialist was warranted this is simply not enough time.

Without knowing people in the system i would have been waiting at least three months to be reviewed by a specialist, let alone have surgery! All the while not being able to attend work and conditionally deteriorating.

It concerns me that the administrators of our hospitals here in WA are more concerned with statistics than patient health/care and outcomes.

Thank you all again and i shall keep you updated post-op,

Annie

[Ironmike]

Please do post once you have had the op - I would be interested to hear how it has helped you. I think that given the pain that you have been in, in terms of your quality of life an invasive procedure is the best way forward. You could manage it conservatively, but there are no guarantees this will work, and you might be in considerable pain in the meantime. Sounds like people over here in the UK moaning about the NHS wouldn't be any better off in Oz!

[alophysio]

Hi amcareless...only received your message now.

let me know how things are going and if you want me to reply

sorry again- i don't know how i missed it...