Brief Answer:
Lumbar spine radiculopathy involving L1-L5

Detailed Answer:
Your symptoms are consistent in description and anatomic location with where the upper lumbar spinal nerves are located and distribute when discussing L1, L2, and L3. The MRI report actually implicates every disc level from L1-L5 and again, your symptoms without the knowledge of what the MRI shows map out very closely to exactly what one would expect in terms of the affected nerve roots being squeezed or compressed.

The GOOD NEWS is that the spinal column MRI demonstrates the cause to NOT BE anything egregious or serious such as a mass lesion in the form of a tumor, hemorrhage, or blood clot impinging the nerve roots because this would be very unwelcome news to be sure and would likely result in an emergency or urgent visit to the doctor depending upon other symptoms.

The BAD NEWS is that you have the ENTIRE LUMBAR SPINE involved with arthritis is likely of the OSTEOARTHRIC type which is one of the more difficult types of bony degenerative diseases to treat entirely effectively. There are many good conservative treatments but pain and ambulatory difficulties will be at the center of complaints and perfect medication to completely quell these nerves that are being squeezed is not yet at our disposal. Many medications that we use cause side effects that can affect the ability to drive, carry out cognitive tasks at work, and be fully functional while taking the medication. Injections are often less than adequate and some folks complain of rapid wearing off effects. The use of regular steroids and anesthetics itself puts people at risk for thinning of ligaments, bone, tendons, and muscle tissue which can actually exacerbate baseline pain.

Electrical stimulators such as vagal nerve and other devices can be helpful but again, there are limitations in some individuals with how much relief is actually imparted and at some point many devices seem to have less and less of an impact leaving patients with reduced options. Physical Therapy and other forms of conservative treatments such as aquatherapy, massage, acupuncture, and, thermal interventions can work for a while but sometimes patients find themselves battling through pain just to complete these tasks. In other words, the perfect set of treatments, medications, and interventions have yet to be developed or discovered, but often times IMPROVEMENT using a combination of all these methods can be hoped for and actually realized with patient cooperation and dedication to following through with doctor's instructions....despite there still being pain and discomfort present while doing these things.

There is no 1 particular level of the spine that can said to be likely the CULPRIT of the MOST PAIN....in your case, every level is affected and all are NECESSARY in terms of good health and stability for you to be pain free and fully functional. I think this is a difficult set of circumstances since most surgeons prefer not to operate when more than 1 or at most 2 levels of the spinal column are involved. However, perhaps a good orthopedist or even NEUROSURGEON with specialization in lumbar spine procedures could assess your complaints and through examination and testing using EMG/NCV studies come up with a likely "worst" part of the spine which MAY respond to a procedure.

If you did wish to submit for such a procedure I would highly recommend looking at a technique referred to as MINIMALLY INVASIVE LUMBAR SPINE SURGERY where the surgeon uses something on the order of a small arthroscope that goes into the back at the appropriate levels allowing them to perform very delicate and precision types of repairs without having to do what was once conventionally a very complex and risky procedure since it never seemed to result in more than a 50/50 success rate of any sort. And even when it was considered a 'success'...often times the results were short lived and things either had to be redone, or other areas had to be addressed.

That is not to say that in this case the same potential complications couldn't happen but if you can find a surgeon who does undertake these minimally invasive procedures the chances of rambunctious complications is at least much less in the hands of an experienced operator. Please be wary of those who would try and sway your hand to go for complex procedures (cash paying clinics looking for up front payments and places that try and impress you with the latest technologies of lasers and other "advanced" techniques to operate). Such clinics may not have your best interests at heart and are simply looking to get you in the door for a go around....I've seen this happen time and time again. What you're looking for is a place (clinic/hospital) and a surgeon with a great track record as far as the patients are concerned and also recognized as highly experienced (preferably someone who practices in an ACADEMIC SETTING) that also is willing to TALK TO YOU about risks and benefits....not just send the office secretary in, the PA, or the NP, to get your signature on the waiver forms, and then, schedule you for the next day. You want a good surgeon willing to take time, show you what's going on and what the overall surgical plan is going to be before just jumping feet first without really telling you what could go wrong with the procedure.....After all, it's the entire lumbar spine that has been affected. This by itself makes surgery not very attractive as a first option....however, depending on what else is going on with respect to strength in the lower extremities, sensations, falls, etc.....it could very well be indicated and even the best option....don't know. I hope you read and RE-read some of what I've imparted to you as it comes from a number of years of seeing what happens to patients in these situations and what seems to be the best route of action and what seems to be the worst and again, acting out of desperation based on pain or problems with ambulation can be a huge risk for post-interventional complications.

All the best.


If I've answered your questions satisfactorily would you do me the largest of favors and CLOSE THIS QUERY with a few words of positive feedback

This query has utilized 33 min. of research and response time on behalf of this patient.

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Brief Answer:
Have heard of procedure but no patients who've done TRIOJECTION

Detailed Answer:
I have researched this offered noninvasive technique for patients who I've seen where no intervention or conservative management currently available has provided satisfactory relief. However, the studies I've looked at over the past several years since becoming aware of this technique are not impressive in terms of how they are performed, reported, and the conclusions that are drawn.

In addition, in my opinion, I cannot recommend this technique or intervention as being superior to standard of care for a number of reasons:

1. Chemonucleolysis of a disc causing compression does not treat the underlying cause of what is at the root of why the disc herniated in the first place. Nor does the procedure add or improve stability of the spinal column at the point where the disc in question is supposedly causing the pain. In my opinion, this therefore, at best is more likely to provide short term relief of compressive pain for several weeks, maybe several months, and maybe several years. But the process that produced the hernia in the first place (osteopenia, mechanical issues with the spinal column, degenerative arthritis) is still there and likely to continue its course which means that sooner or later the pain will return and since the disc was "dissolved" by this procedure and nothing was done to stabilize or buttress the column pain will return and it can possibly be more intense.

2. I've not been able to find any information on how the TRIOJECTION system can guarantee that its "disc dissolving" ozone does not LEAK out into good surrounding tissues which then, one could imagine have negative effects and impact on disc, muscle, tendon, and bone in the area. This will clearly contribute to future risks of more instability of the spinal column if good elements of support and strength were weakened by the procedure. This may be one of the big hurdles in front of the MINIMUS SPINE folks to get FDA approval.

3. Studies that have been done and the procedure itself (though not new by any means) has only been performed on a small number of people and therefore, notwithstanding the claims of statistical significance of conclusions from individual small trials cannot really be extrapolated to large populations in any reasonable fashion.

4. I believe that the concept of NONINVASIVE reduction or complete dissolution (IF THAT'S ACTUALLY WHAT HAPPENS) has merit in theory but there needs to be a supporting procedure or interventional plan that follows if the spinal column is to regain its stability that it loses when this procedure is all said and done. I do not see them addressing this aspect of things.

For all these reasons I have not been able to recommend this procedure to any of my patients (not to mention the costs involved to travel outside the U.S. and procedural costs for which insurance is unlikely to pick up) as being head and shoulders above anything else that can be done here in the U.S. Right now, I am very partial to the minimally invasive surgical techniques being used more and more followed by solid physical and aquatherapy. Of course, proper exercise and nutrition as well as lifestyle improvements (smoking cessation, etc.) are tantamount to maximal success in order to strengthen paraspinous muscles and circulation so the body can offer maximal support against failing spinal columns which then, can lead to failing discs, and of course, pain and weakness in limbs.

Cheers!

Again, if my responses have satisfactorily addressed to your questions would you consider CLOSING THIS QUERY with several comments of positive feedback and I hope answer other questions for you in the future...aside from being able to find some long lasting relief for your condition.

This query has utilized a total of 72 min. of research and response time on behalf of this patient.

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