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I Have Bilateral Artificial Hips And Degenerative Joint Disease With
Question: I have bilateral artificial hips and degenerative joint disease with lumbar stenosis, involvement of L5- to S1. I have developed pain when I sleep on my right side or sit even on soft surfaces. The pain radiates from right lower rectum to right lower buttock. Not sure my primary MD would know what is going on. What could be going on?
I have bilateral artificial hips and degenerative joint disease with lumbar stenosis, involvement of L5- to S1. I have developed pain when I sleep on my right side or sit even on soft surfaces. The pain radiates from right lower rectum to right lower buttock. Not sure my primary MD would know what is going on. What could be going on?
Brief Answer:
You are compressing the right lumbosacral nerves
Detailed Answer:
Good evening and my best wishes for you to find a way to improve the pain as soon as possible.
You are in all likelihood compressing the RIGHT SIDED sacral spinal nerves which are designated S1-S5 NERVE ROOTS and using the upper roots (S1, S2, and S3) form the the POSTERIOR FEMORAL CUTANEOUS nerve by your description which will cause pain you describe as well as numbness and tingling from the anal region radiating outward into the buttock region and then, down possible toward the upper thigh if you're feeling something there.
From your description it seems that the compression of the sacral nerves is more predominant and noticeable to you that any compression going on due to the LUMBAR CANAL STENOSIS though I don't doubt you have some degree of back pain and other areas of sensory discomfort or loss but the sacral plexus may simply be more EXPOSED to the mechanical fallout from laying on your right side.
S1, S2, and S3 are major nerves that provide sensation to the anal and buttock region radiating into the upper thigh so no doubt since that is being included in the osteoarthritic process of the lumbar canal stenosis then, it is likely that further degenerative diseases of the spinal column are involving the sacral nerves as well. This is a likely HIGHLY LIKELY explanation based on anatomical models that fit your clinical descriptions.
Your most sensitive imaging study would be that of an MRI of the lumbosacral plexus with attention paid to the RIGHT sided portion of the sacral plexus (the doctor ordering the study should specify this detail to the RADIOLOGIST so that they FOCUS on that area (both with the MRI machine as well as with their READ).
Obviously, the easiest fix to your problem is simply NOT TO SLEEP on your right side....well, I'm sure you must've thought of that plenty of nights! HA! But of course, how does one control which side they end up sleeping on....well, there are a few clever ways people have come up with and the first won't XXXXXXX you....people simply wedge themselves in the bed in such a way so as not to be able to come out of the left lateral position but propping stiff items against them such as pillows, blankets, and in some cases I've been told FURNITURE! The purpose of course, is make it very difficult if not impossible for the person to TURN to their right side.
A second tactic is to increase the CUSHIONING POWER on the right side of the body but this may not be a significant way to address the problem since it often takes a LOT OF cushioning of a particular part of the body which is for whatever reason thinned out or without adequate FAT PADS (they do degenerate as we age! Darn!). You really have to just find a way of either GAINING weight on your right side or prevent from rolling over on that side.
Some people have resorted to lying in a reclining chair and then, propping very stiff pillows and other items to block them from easily turning to their right (or left for that matter). It's almost the equivalent of mummifying yourself in the reclining chair so that you can't roll to your right side. Get the idea?
Medication will be poorly effective since it's only temporary and you'd have to take so much of it that you can damage your stomach and liver...so I wouldn't continue to really take the MOTRIN/IBUPROFEN/NAPROSYN train ride to any extent for this problem...it's simply not likely to work long term.
Physical exercises in order to beef up the muscles of the right thigh and lower back are a fine way to get more tone, a bit more muscle mass and sturdiness on the right hip and thigh areas to reduce compression of these sacral nerves.
Here is a link that may give you a bit of an idea of the areas of the buttocks and anal region that are supplied exactly by the nerve roots I'm referring as being mainly S1 and S2. See if this diagram makes sense to you:
https://www.google.com/search?safe=active&client=firefox-b-1-d&tbm=isch&q=dermatomal+distribution+of+lumbosacral+plexus&chips=q:dermatomal+distribution+of+lumbosacral+plexus,online_chips:sensory&usg=AI4_-kTZSHpm_-S09xz1t1H61fSK5yM6hg&sa=X&ved=0ahUKEwjl7fzup5XjAhWOKs0KHfptCLAQ4lYIMygI&biw=1920&bih=944&dpr=1#imgrc=3a_maGGPfN0nlM:
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and TAKING A MOMENT to provide a few kind words of feedback with perhaps even stamp of a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 46 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
You are compressing the right lumbosacral nerves
Detailed Answer:
Good evening and my best wishes for you to find a way to improve the pain as soon as possible.
You are in all likelihood compressing the RIGHT SIDED sacral spinal nerves which are designated S1-S5 NERVE ROOTS and using the upper roots (S1, S2, and S3) form the the POSTERIOR FEMORAL CUTANEOUS nerve by your description which will cause pain you describe as well as numbness and tingling from the anal region radiating outward into the buttock region and then, down possible toward the upper thigh if you're feeling something there.
From your description it seems that the compression of the sacral nerves is more predominant and noticeable to you that any compression going on due to the LUMBAR CANAL STENOSIS though I don't doubt you have some degree of back pain and other areas of sensory discomfort or loss but the sacral plexus may simply be more EXPOSED to the mechanical fallout from laying on your right side.
S1, S2, and S3 are major nerves that provide sensation to the anal and buttock region radiating into the upper thigh so no doubt since that is being included in the osteoarthritic process of the lumbar canal stenosis then, it is likely that further degenerative diseases of the spinal column are involving the sacral nerves as well. This is a likely HIGHLY LIKELY explanation based on anatomical models that fit your clinical descriptions.
Your most sensitive imaging study would be that of an MRI of the lumbosacral plexus with attention paid to the RIGHT sided portion of the sacral plexus (the doctor ordering the study should specify this detail to the RADIOLOGIST so that they FOCUS on that area (both with the MRI machine as well as with their READ).
Obviously, the easiest fix to your problem is simply NOT TO SLEEP on your right side....well, I'm sure you must've thought of that plenty of nights! HA! But of course, how does one control which side they end up sleeping on....well, there are a few clever ways people have come up with and the first won't XXXXXXX you....people simply wedge themselves in the bed in such a way so as not to be able to come out of the left lateral position but propping stiff items against them such as pillows, blankets, and in some cases I've been told FURNITURE! The purpose of course, is make it very difficult if not impossible for the person to TURN to their right side.
A second tactic is to increase the CUSHIONING POWER on the right side of the body but this may not be a significant way to address the problem since it often takes a LOT OF cushioning of a particular part of the body which is for whatever reason thinned out or without adequate FAT PADS (they do degenerate as we age! Darn!). You really have to just find a way of either GAINING weight on your right side or prevent from rolling over on that side.
Some people have resorted to lying in a reclining chair and then, propping very stiff pillows and other items to block them from easily turning to their right (or left for that matter). It's almost the equivalent of mummifying yourself in the reclining chair so that you can't roll to your right side. Get the idea?
Medication will be poorly effective since it's only temporary and you'd have to take so much of it that you can damage your stomach and liver...so I wouldn't continue to really take the MOTRIN/IBUPROFEN/NAPROSYN train ride to any extent for this problem...it's simply not likely to work long term.
Physical exercises in order to beef up the muscles of the right thigh and lower back are a fine way to get more tone, a bit more muscle mass and sturdiness on the right hip and thigh areas to reduce compression of these sacral nerves.
Here is a link that may give you a bit of an idea of the areas of the buttocks and anal region that are supplied exactly by the nerve roots I'm referring as being mainly S1 and S2. See if this diagram makes sense to you:
https://www.google.com/search?safe=active&client=firefox-b-1-d&tbm=isch&q=dermatomal+distribution+of+lumbosacral+plexus&chips=q:dermatomal+distribution+of+lumbosacral+plexus,online_chips:sensory&usg=AI4_-kTZSHpm_-S09xz1t1H61fSK5yM6hg&sa=X&ved=0ahUKEwjl7fzup5XjAhWOKs0KHfptCLAQ4lYIMygI&biw=1920&bih=944&dpr=1#imgrc=3a_maGGPfN0nlM:
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and TAKING A MOMENT to provide a few kind words of feedback with perhaps even stamp of a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 46 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
You are compressing the right lumbosacral nerves
Detailed Answer:
Good evening and my best wishes for you to find a way to improve the pain as soon as possible.
You are in all likelihood compressing the RIGHT SIDED sacral spinal nerves which are designated S1-S5 NERVE ROOTS and using the upper roots (S1, S2, and S3) form the the POSTERIOR FEMORAL CUTANEOUS nerve by your description which will cause pain you describe as well as numbness and tingling from the anal region radiating outward into the buttock region and then, down possible toward the upper thigh if you're feeling something there.
From your description it seems that the compression of the sacral nerves is more predominant and noticeable to you that any compression going on due to the LUMBAR CANAL STENOSIS though I don't doubt you have some degree of back pain and other areas of sensory discomfort or loss but the sacral plexus may simply be more EXPOSED to the mechanical fallout from laying on your right side.
S1, S2, and S3 are major nerves that provide sensation to the anal and buttock region radiating into the upper thigh so no doubt since that is being included in the osteoarthritic process of the lumbar canal stenosis then, it is likely that further degenerative diseases of the spinal column are involving the sacral nerves as well. This is a likely HIGHLY LIKELY explanation based on anatomical models that fit your clinical descriptions.
Your most sensitive imaging study would be that of an MRI of the lumbosacral plexus with attention paid to the RIGHT sided portion of the sacral plexus (the doctor ordering the study should specify this detail to the RADIOLOGIST so that they FOCUS on that area (both with the MRI machine as well as with their READ).
Obviously, the easiest fix to your problem is simply NOT TO SLEEP on your right side....well, I'm sure you must've thought of that plenty of nights! HA! But of course, how does one control which side they end up sleeping on....well, there are a few clever ways people have come up with and the first won't XXXXXXX you....people simply wedge themselves in the bed in such a way so as not to be able to come out of the left lateral position but propping stiff items against them such as pillows, blankets, and in some cases I've been told FURNITURE! The purpose of course, is make it very difficult if not impossible for the person to TURN to their right side.
A second tactic is to increase the CUSHIONING POWER on the right side of the body but this may not be a significant way to address the problem since it often takes a LOT OF cushioning of a particular part of the body which is for whatever reason thinned out or without adequate FAT PADS (they do degenerate as we age! Darn!). You really have to just find a way of either GAINING weight on your right side or prevent from rolling over on that side.
Some people have resorted to lying in a reclining chair and then, propping very stiff pillows and other items to block them from easily turning to their right (or left for that matter). It's almost the equivalent of mummifying yourself in the reclining chair so that you can't roll to your right side. Get the idea?
Medication will be poorly effective since it's only temporary and you'd have to take so much of it that you can damage your stomach and liver...so I wouldn't continue to really take the MOTRIN/IBUPROFEN/NAPROSYN train ride to any extent for this problem...it's simply not likely to work long term.
Physical exercises in order to beef up the muscles of the right thigh and lower back are a fine way to get more tone, a bit more muscle mass and sturdiness on the right hip and thigh areas to reduce compression of these sacral nerves.
Here is a link that may give you a bit of an idea of the areas of the buttocks and anal region that are supplied exactly by the nerve roots I'm referring as being mainly S1 and S2. See if this diagram makes sense to you:
https://www.google.com/search?safe=active&client=firefox-b-1-d&tbm=isch&q=dermatomal+distribution+of+lumbosacral+plexus&chips=q:dermatomal+distribution+of+lumbosacral+plexus,online_chips:sensory&usg=AI4_-kTZSHpm_-S09xz1t1H61fSK5yM6hg&sa=X&ved=0ahUKEwjl7fzup5XjAhWOKs0KHfptCLAQ4lYIMygI&biw=1920&bih=944&dpr=1#imgrc=3a_maGGPfN0nlM:
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and TAKING A MOMENT to provide a few kind words of feedback with perhaps even stamp of a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 46 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
You are compressing the right lumbosacral nerves
Detailed Answer:
Good evening and my best wishes for you to find a way to improve the pain as soon as possible.
You are in all likelihood compressing the RIGHT SIDED sacral spinal nerves which are designated S1-S5 NERVE ROOTS and using the upper roots (S1, S2, and S3) form the the POSTERIOR FEMORAL CUTANEOUS nerve by your description which will cause pain you describe as well as numbness and tingling from the anal region radiating outward into the buttock region and then, down possible toward the upper thigh if you're feeling something there.
From your description it seems that the compression of the sacral nerves is more predominant and noticeable to you that any compression going on due to the LUMBAR CANAL STENOSIS though I don't doubt you have some degree of back pain and other areas of sensory discomfort or loss but the sacral plexus may simply be more EXPOSED to the mechanical fallout from laying on your right side.
S1, S2, and S3 are major nerves that provide sensation to the anal and buttock region radiating into the upper thigh so no doubt since that is being included in the osteoarthritic process of the lumbar canal stenosis then, it is likely that further degenerative diseases of the spinal column are involving the sacral nerves as well. This is a likely HIGHLY LIKELY explanation based on anatomical models that fit your clinical descriptions.
Your most sensitive imaging study would be that of an MRI of the lumbosacral plexus with attention paid to the RIGHT sided portion of the sacral plexus (the doctor ordering the study should specify this detail to the RADIOLOGIST so that they FOCUS on that area (both with the MRI machine as well as with their READ).
Obviously, the easiest fix to your problem is simply NOT TO SLEEP on your right side....well, I'm sure you must've thought of that plenty of nights! HA! But of course, how does one control which side they end up sleeping on....well, there are a few clever ways people have come up with and the first won't XXXXXXX you....people simply wedge themselves in the bed in such a way so as not to be able to come out of the left lateral position but propping stiff items against them such as pillows, blankets, and in some cases I've been told FURNITURE! The purpose of course, is make it very difficult if not impossible for the person to TURN to their right side.
A second tactic is to increase the CUSHIONING POWER on the right side of the body but this may not be a significant way to address the problem since it often takes a LOT OF cushioning of a particular part of the body which is for whatever reason thinned out or without adequate FAT PADS (they do degenerate as we age! Darn!). You really have to just find a way of either GAINING weight on your right side or prevent from rolling over on that side.
Some people have resorted to lying in a reclining chair and then, propping very stiff pillows and other items to block them from easily turning to their right (or left for that matter). It's almost the equivalent of mummifying yourself in the reclining chair so that you can't roll to your right side. Get the idea?
Medication will be poorly effective since it's only temporary and you'd have to take so much of it that you can damage your stomach and liver...so I wouldn't continue to really take the MOTRIN/IBUPROFEN/NAPROSYN train ride to any extent for this problem...it's simply not likely to work long term.
Physical exercises in order to beef up the muscles of the right thigh and lower back are a fine way to get more tone, a bit more muscle mass and sturdiness on the right hip and thigh areas to reduce compression of these sacral nerves.
Here is a link that may give you a bit of an idea of the areas of the buttocks and anal region that are supplied exactly by the nerve roots I'm referring as being mainly S1 and S2. See if this diagram makes sense to you:
https://www.google.com/search?safe=active&client=firefox-b-1-d&tbm=isch&q=dermatomal+distribution+of+lumbosacral+plexus&chips=q:dermatomal+distribution+of+lumbosacral+plexus,online_chips:sensory&usg=AI4_-kTZSHpm_-S09xz1t1H61fSK5yM6hg&sa=X&ved=0ahUKEwjl7fzup5XjAhWOKs0KHfptCLAQ4lYIMygI&biw=1920&bih=944&dpr=1#imgrc=3a_maGGPfN0nlM:
If I've provided useful and helpful information to your question could you do me a favor by CLOSING THE QUERY and TAKING A MOMENT to provide a few kind words of feedback with perhaps even stamp of a 5 STAR rating if you feel so inclined?
Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 46 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is this something that can be surgically corrected or treated with an epidural steroid injection? I have had these injections in the past.
Is this something that can be surgically corrected or treated with an epidural steroid injection? I have had these injections in the past.
Brief Answer:
Would counsel getting more info on what's up BEFORE surgery or injections
Detailed Answer:
Good morning young lady. How are things in the Lone Star State today? I know....you're in a bit of pain, right?
Typically, something like lumbar stenosis is NOT something I would recommend you do surgery on right away without getting more information on what's going on. When it comes to spinal canal STENOSIS at any level (cervical, thoracic, lumbar) there is GOOD news and BAD news.... The Good news is that for most individuals once you've got narrowing of the canal it generally doesn't get worse. In other words, it doesn't progress. The bad news is that surgical decompression can be a bit tricky since results vary widely in terms of success rates for the procedure. For example, if a person suffers with numbness, tingling, and pain in the lower extremities because of the lumbar canal stenosis then, often times success after decompression using a laminectomy can treat the symptoms with consistent results when done by an experienced surgeon. Healing and rehabilitation in different individuals can be another problem (obesity, diabetes, cigarette smoker, other comorbid medical conditions). But the surgery itself for pain management IN THE LEGS can have good outcomes most of the time.
It is not considered a procedure of choice, however, when it comes to dealing with the more commonly complained of problem of pain in the BACK and especially if that back pain is triggered or worsened by activity using the back. In another words, people who complain of back pain that radiates or paresthesias that come on after they've been doing a lot of lifting, bending, stooping, or squatting do not seem to have nearly as much success when they get something like LUMBAR CANAL STENOSIS decompressed using available procedures. It's not fully been clarified why it has so much better a track record in relieving pain and discomfort in patients who have mainly or only symptoms in the legs and below as opposed to low back pain which is either chronic or activity dependent. So that's one thing that needs to be taken into consideration.
Also, as a neurologist my approach to people with such symptoms that you describe is to get MORE INFORMATION before jumping into any surgical procedure. I want to be sure that the OBVIOUS problem that we are told exists on a scan (canal stenosis, nerve root compression, facet arthropathy or spurring, etc.) can really be LINKED to a person's symptoms. Believe it or not, just because a person has a bulging disk...or even a HERNIATED disk in the back doesn't always mean that they are suffering from symptoms. There was a study done that I recall reading where they had just done screening MRI's of people's backs who had NO COMPLAINTS of any pain, numbness, tingling, imbalance, falls, etc....nothing...just people who were completely symptom free of back or leg symptoms. They imaged their backs and found a full 40% of them had some type of pathology that was caused by arthritic degeneration, overuse of the back, excessive curvature of the spine, bulging disks, and even herniated disks. Yet they were symptom free.
So again, what you SEE or what you are TOLD by a radiologist often times is only partially relevant....or perhaps in the study I mention above....TOTALLY irrelevant to the symptoms a person brings to the table. And that is why I will put patients through at least MRI's of the back (or neck) along with either plain X-rays or CT scans which can help increase the sensitivity and validity of reads. You don't need gadolinium contrast for such studies. That way we get a very good read radiographically of what's going on. Then, we put those results together with the very thorough neurological exam that has already been performed on the patients so that clinically I am satisfied that if they're complaining of pain, numbness, tingling, or any other odd/bothersome symptom that it is present ANATOMICALLY where it should be found to be consistent with wherever the radiographic anomaly lies. Make sense?
Finally, if a person has WEAKNESS in muscles (not just pain necessarily) but if I detect a drop foot, a weakness in the thigh or calf muscles such that a person is having difficulty arising or sitting into a chair, getting in or out of a car, getting up or down on a toilet or sofa, etc. then, I will also invoke the use of an EMG/NCV study which is an electrical study of the patient's muscles and nerves. Surgery becomes more of an option in my mind and by extension in my patients when weakness is present and can be directly correlated or linked back to the results of neurological examination and radiography results.
So, that's how I will approach a patient such as yourself in order to first ascertain what they've got going on to be sure that we would be treating an entity that should be treated. Remember things such as surgeries, injections, or any other INVASIVE procedures that people may offer always come at a price. One is financial, the second and more important is the risk of anesthesia, the risk in recovery/rehabilitation, and the 3rd is the risk or recurrence. I am NOT a huge fan of EPIDURAL BACK INJECTIONS in patients even though as you say, "I have had these injections in the past." For most individuals they represent very short term fixes for a long term problem and they do nothing for addressing the root of the problem.
On the other hand good aggressive physical and especially AQUATHERAPY along with appropriate medication support can be much more effective since the patient is trying to alter the underlying cause of the problem by doing things such as stretches and exercises to strengthen supporting muscles, potentially moving internal structures such as tendons and ligaments (tendon gliding maneuvers used by PT therapists) over places of entrapment or arthritic calcification. I also have seen people change the way they sleep and the mattresses and support systems they use for their bed and have significant success with the control of pain and other symptoms. I always tell my patients to sleep a bit more in an inclined position to take pressure off the lower spine using either a WEDGE TYPE of pillow or if the bed is adjustable to bring it up to about 30 degrees. They should also do what they can to sleep on their backs although keeping one in this position all night long is neither easy nor recommended since we naturally MUST turn throughout the night to avoid pressure injuries. Also, I've found that many patients get relief by placing a stiff pillow or wedge device under their bent knees. This again, takes as much traction off from the lower back as possible during the night.
Shots are merely the instillation of medication which has anesthetic effects into a place where the operator HOPES or THINKS the most significant GENERATOR of pain is located and then, the procedure has to be repeated in a number of weeks or months. I've had patients who have obtained relief on a longer term basis of several months but they are rare. Most patients I've treated over the years who get started on shots eventually find that they become ineffective after shorter and shorter periods of time until finally, they don't really seem to work at all. Also, the injection of some of these steroids and anesthetic agents have been shown to have DIRECT TOXIC effects to the subcutaneous tissues and even to things such as ligaments, tendons, and bone. Imagine that...getting injected with material that is supposed to relieve pain and discomfort that can actually cause or accelerate deteriorative processes of the very elements NEEDED to provide support and strength to the spinal column in order to help minimize muscle fatigue and joint or disc pain. That's not good news.
So while steroid injections and surgery are certainly tools in the box that can be offered and used for your symptoms they are not the things I reach for first as opposed to figuring out the underlying issues that need addressing and then, going through a complete program of therapy (I really do find AQUATHERAPY most helpful..especially WATER JOGGING in a pool....or nowadays PT clinics even have these underwater treadmills! Technology...people love that sort of stuff!). I think that all these modalities and approaches are worth trying first before getting surgerized or injected.
I'll send you another link for your edification and if you're not familiar with this website please take a look. It is the LIVING WITH ARTHRITIS page of the XXXXXXX ARTHRITIS FOUNDATION where they talk about all sorts of things having to do with the form of arthritis you most likely possess which is OSTEOARTHRITIS. Recommendations for exercises, diet, and then, alternative treatment strategies that can be used to deal with the symptoms of chronic pain and paresthesias. Take a gander and see what you think:
https://www.arthritis.org/living-with-arthritis/
I especially like their tabs on DIET and EXERCISE but actually you could spend a long time looking at all sorts of tips and mind you what they advocate is backed by plenty of experience and studies done in the field. There are some perspectives and suggestions I'm not entirely in synch with such as the section where they discuss INJECTIONS and the use of hyaluronic acid into joints for "months" of relief....I've not seen that type of outcome in all the years I've been dealing with chronic back pain patients and so I can't agree with their recommendations except to say that perhaps from some theoretical perspective such a treatment would be good for that length of time using that particular substance.
And so once again, young lady....if I've provided good information for your purposes could you consider CLOSING THE QUERY and TAKING A MOMENT to provide POSITIVE words of feedback and even a 5 STAR rating if so deserving?
Please stay in touch in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 116 minutes of professional time in research, review, and synthesis of a response.
Would counsel getting more info on what's up BEFORE surgery or injections
Detailed Answer:
Good morning young lady. How are things in the Lone Star State today? I know....you're in a bit of pain, right?
Typically, something like lumbar stenosis is NOT something I would recommend you do surgery on right away without getting more information on what's going on. When it comes to spinal canal STENOSIS at any level (cervical, thoracic, lumbar) there is GOOD news and BAD news.... The Good news is that for most individuals once you've got narrowing of the canal it generally doesn't get worse. In other words, it doesn't progress. The bad news is that surgical decompression can be a bit tricky since results vary widely in terms of success rates for the procedure. For example, if a person suffers with numbness, tingling, and pain in the lower extremities because of the lumbar canal stenosis then, often times success after decompression using a laminectomy can treat the symptoms with consistent results when done by an experienced surgeon. Healing and rehabilitation in different individuals can be another problem (obesity, diabetes, cigarette smoker, other comorbid medical conditions). But the surgery itself for pain management IN THE LEGS can have good outcomes most of the time.
It is not considered a procedure of choice, however, when it comes to dealing with the more commonly complained of problem of pain in the BACK and especially if that back pain is triggered or worsened by activity using the back. In another words, people who complain of back pain that radiates or paresthesias that come on after they've been doing a lot of lifting, bending, stooping, or squatting do not seem to have nearly as much success when they get something like LUMBAR CANAL STENOSIS decompressed using available procedures. It's not fully been clarified why it has so much better a track record in relieving pain and discomfort in patients who have mainly or only symptoms in the legs and below as opposed to low back pain which is either chronic or activity dependent. So that's one thing that needs to be taken into consideration.
Also, as a neurologist my approach to people with such symptoms that you describe is to get MORE INFORMATION before jumping into any surgical procedure. I want to be sure that the OBVIOUS problem that we are told exists on a scan (canal stenosis, nerve root compression, facet arthropathy or spurring, etc.) can really be LINKED to a person's symptoms. Believe it or not, just because a person has a bulging disk...or even a HERNIATED disk in the back doesn't always mean that they are suffering from symptoms. There was a study done that I recall reading where they had just done screening MRI's of people's backs who had NO COMPLAINTS of any pain, numbness, tingling, imbalance, falls, etc....nothing...just people who were completely symptom free of back or leg symptoms. They imaged their backs and found a full 40% of them had some type of pathology that was caused by arthritic degeneration, overuse of the back, excessive curvature of the spine, bulging disks, and even herniated disks. Yet they were symptom free.
So again, what you SEE or what you are TOLD by a radiologist often times is only partially relevant....or perhaps in the study I mention above....TOTALLY irrelevant to the symptoms a person brings to the table. And that is why I will put patients through at least MRI's of the back (or neck) along with either plain X-rays or CT scans which can help increase the sensitivity and validity of reads. You don't need gadolinium contrast for such studies. That way we get a very good read radiographically of what's going on. Then, we put those results together with the very thorough neurological exam that has already been performed on the patients so that clinically I am satisfied that if they're complaining of pain, numbness, tingling, or any other odd/bothersome symptom that it is present ANATOMICALLY where it should be found to be consistent with wherever the radiographic anomaly lies. Make sense?
Finally, if a person has WEAKNESS in muscles (not just pain necessarily) but if I detect a drop foot, a weakness in the thigh or calf muscles such that a person is having difficulty arising or sitting into a chair, getting in or out of a car, getting up or down on a toilet or sofa, etc. then, I will also invoke the use of an EMG/NCV study which is an electrical study of the patient's muscles and nerves. Surgery becomes more of an option in my mind and by extension in my patients when weakness is present and can be directly correlated or linked back to the results of neurological examination and radiography results.
So, that's how I will approach a patient such as yourself in order to first ascertain what they've got going on to be sure that we would be treating an entity that should be treated. Remember things such as surgeries, injections, or any other INVASIVE procedures that people may offer always come at a price. One is financial, the second and more important is the risk of anesthesia, the risk in recovery/rehabilitation, and the 3rd is the risk or recurrence. I am NOT a huge fan of EPIDURAL BACK INJECTIONS in patients even though as you say, "I have had these injections in the past." For most individuals they represent very short term fixes for a long term problem and they do nothing for addressing the root of the problem.
On the other hand good aggressive physical and especially AQUATHERAPY along with appropriate medication support can be much more effective since the patient is trying to alter the underlying cause of the problem by doing things such as stretches and exercises to strengthen supporting muscles, potentially moving internal structures such as tendons and ligaments (tendon gliding maneuvers used by PT therapists) over places of entrapment or arthritic calcification. I also have seen people change the way they sleep and the mattresses and support systems they use for their bed and have significant success with the control of pain and other symptoms. I always tell my patients to sleep a bit more in an inclined position to take pressure off the lower spine using either a WEDGE TYPE of pillow or if the bed is adjustable to bring it up to about 30 degrees. They should also do what they can to sleep on their backs although keeping one in this position all night long is neither easy nor recommended since we naturally MUST turn throughout the night to avoid pressure injuries. Also, I've found that many patients get relief by placing a stiff pillow or wedge device under their bent knees. This again, takes as much traction off from the lower back as possible during the night.
Shots are merely the instillation of medication which has anesthetic effects into a place where the operator HOPES or THINKS the most significant GENERATOR of pain is located and then, the procedure has to be repeated in a number of weeks or months. I've had patients who have obtained relief on a longer term basis of several months but they are rare. Most patients I've treated over the years who get started on shots eventually find that they become ineffective after shorter and shorter periods of time until finally, they don't really seem to work at all. Also, the injection of some of these steroids and anesthetic agents have been shown to have DIRECT TOXIC effects to the subcutaneous tissues and even to things such as ligaments, tendons, and bone. Imagine that...getting injected with material that is supposed to relieve pain and discomfort that can actually cause or accelerate deteriorative processes of the very elements NEEDED to provide support and strength to the spinal column in order to help minimize muscle fatigue and joint or disc pain. That's not good news.
So while steroid injections and surgery are certainly tools in the box that can be offered and used for your symptoms they are not the things I reach for first as opposed to figuring out the underlying issues that need addressing and then, going through a complete program of therapy (I really do find AQUATHERAPY most helpful..especially WATER JOGGING in a pool....or nowadays PT clinics even have these underwater treadmills! Technology...people love that sort of stuff!). I think that all these modalities and approaches are worth trying first before getting surgerized or injected.
I'll send you another link for your edification and if you're not familiar with this website please take a look. It is the LIVING WITH ARTHRITIS page of the XXXXXXX ARTHRITIS FOUNDATION where they talk about all sorts of things having to do with the form of arthritis you most likely possess which is OSTEOARTHRITIS. Recommendations for exercises, diet, and then, alternative treatment strategies that can be used to deal with the symptoms of chronic pain and paresthesias. Take a gander and see what you think:
https://www.arthritis.org/living-with-arthritis/
I especially like their tabs on DIET and EXERCISE but actually you could spend a long time looking at all sorts of tips and mind you what they advocate is backed by plenty of experience and studies done in the field. There are some perspectives and suggestions I'm not entirely in synch with such as the section where they discuss INJECTIONS and the use of hyaluronic acid into joints for "months" of relief....I've not seen that type of outcome in all the years I've been dealing with chronic back pain patients and so I can't agree with their recommendations except to say that perhaps from some theoretical perspective such a treatment would be good for that length of time using that particular substance.
And so once again, young lady....if I've provided good information for your purposes could you consider CLOSING THE QUERY and TAKING A MOMENT to provide POSITIVE words of feedback and even a 5 STAR rating if so deserving?
Please stay in touch in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 116 minutes of professional time in research, review, and synthesis of a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Would counsel getting more info on what's up BEFORE surgery or injections
Detailed Answer:
Good morning young lady. How are things in the Lone Star State today? I know....you're in a bit of pain, right?
Typically, something like lumbar stenosis is NOT something I would recommend you do surgery on right away without getting more information on what's going on. When it comes to spinal canal STENOSIS at any level (cervical, thoracic, lumbar) there is GOOD news and BAD news.... The Good news is that for most individuals once you've got narrowing of the canal it generally doesn't get worse. In other words, it doesn't progress. The bad news is that surgical decompression can be a bit tricky since results vary widely in terms of success rates for the procedure. For example, if a person suffers with numbness, tingling, and pain in the lower extremities because of the lumbar canal stenosis then, often times success after decompression using a laminectomy can treat the symptoms with consistent results when done by an experienced surgeon. Healing and rehabilitation in different individuals can be another problem (obesity, diabetes, cigarette smoker, other comorbid medical conditions). But the surgery itself for pain management IN THE LEGS can have good outcomes most of the time.
It is not considered a procedure of choice, however, when it comes to dealing with the more commonly complained of problem of pain in the BACK and especially if that back pain is triggered or worsened by activity using the back. In another words, people who complain of back pain that radiates or paresthesias that come on after they've been doing a lot of lifting, bending, stooping, or squatting do not seem to have nearly as much success when they get something like LUMBAR CANAL STENOSIS decompressed using available procedures. It's not fully been clarified why it has so much better a track record in relieving pain and discomfort in patients who have mainly or only symptoms in the legs and below as opposed to low back pain which is either chronic or activity dependent. So that's one thing that needs to be taken into consideration.
Also, as a neurologist my approach to people with such symptoms that you describe is to get MORE INFORMATION before jumping into any surgical procedure. I want to be sure that the OBVIOUS problem that we are told exists on a scan (canal stenosis, nerve root compression, facet arthropathy or spurring, etc.) can really be LINKED to a person's symptoms. Believe it or not, just because a person has a bulging disk...or even a HERNIATED disk in the back doesn't always mean that they are suffering from symptoms. There was a study done that I recall reading where they had just done screening MRI's of people's backs who had NO COMPLAINTS of any pain, numbness, tingling, imbalance, falls, etc....nothing...just people who were completely symptom free of back or leg symptoms. They imaged their backs and found a full 40% of them had some type of pathology that was caused by arthritic degeneration, overuse of the back, excessive curvature of the spine, bulging disks, and even herniated disks. Yet they were symptom free.
So again, what you SEE or what you are TOLD by a radiologist often times is only partially relevant....or perhaps in the study I mention above....TOTALLY irrelevant to the symptoms a person brings to the table. And that is why I will put patients through at least MRI's of the back (or neck) along with either plain X-rays or CT scans which can help increase the sensitivity and validity of reads. You don't need gadolinium contrast for such studies. That way we get a very good read radiographically of what's going on. Then, we put those results together with the very thorough neurological exam that has already been performed on the patients so that clinically I am satisfied that if they're complaining of pain, numbness, tingling, or any other odd/bothersome symptom that it is present ANATOMICALLY where it should be found to be consistent with wherever the radiographic anomaly lies. Make sense?
Finally, if a person has WEAKNESS in muscles (not just pain necessarily) but if I detect a drop foot, a weakness in the thigh or calf muscles such that a person is having difficulty arising or sitting into a chair, getting in or out of a car, getting up or down on a toilet or sofa, etc. then, I will also invoke the use of an EMG/NCV study which is an electrical study of the patient's muscles and nerves. Surgery becomes more of an option in my mind and by extension in my patients when weakness is present and can be directly correlated or linked back to the results of neurological examination and radiography results.
So, that's how I will approach a patient such as yourself in order to first ascertain what they've got going on to be sure that we would be treating an entity that should be treated. Remember things such as surgeries, injections, or any other INVASIVE procedures that people may offer always come at a price. One is financial, the second and more important is the risk of anesthesia, the risk in recovery/rehabilitation, and the 3rd is the risk or recurrence. I am NOT a huge fan of EPIDURAL BACK INJECTIONS in patients even though as you say, "I have had these injections in the past." For most individuals they represent very short term fixes for a long term problem and they do nothing for addressing the root of the problem.
On the other hand good aggressive physical and especially AQUATHERAPY along with appropriate medication support can be much more effective since the patient is trying to alter the underlying cause of the problem by doing things such as stretches and exercises to strengthen supporting muscles, potentially moving internal structures such as tendons and ligaments (tendon gliding maneuvers used by PT therapists) over places of entrapment or arthritic calcification. I also have seen people change the way they sleep and the mattresses and support systems they use for their bed and have significant success with the control of pain and other symptoms. I always tell my patients to sleep a bit more in an inclined position to take pressure off the lower spine using either a WEDGE TYPE of pillow or if the bed is adjustable to bring it up to about 30 degrees. They should also do what they can to sleep on their backs although keeping one in this position all night long is neither easy nor recommended since we naturally MUST turn throughout the night to avoid pressure injuries. Also, I've found that many patients get relief by placing a stiff pillow or wedge device under their bent knees. This again, takes as much traction off from the lower back as possible during the night.
Shots are merely the instillation of medication which has anesthetic effects into a place where the operator HOPES or THINKS the most significant GENERATOR of pain is located and then, the procedure has to be repeated in a number of weeks or months. I've had patients who have obtained relief on a longer term basis of several months but they are rare. Most patients I've treated over the years who get started on shots eventually find that they become ineffective after shorter and shorter periods of time until finally, they don't really seem to work at all. Also, the injection of some of these steroids and anesthetic agents have been shown to have DIRECT TOXIC effects to the subcutaneous tissues and even to things such as ligaments, tendons, and bone. Imagine that...getting injected with material that is supposed to relieve pain and discomfort that can actually cause or accelerate deteriorative processes of the very elements NEEDED to provide support and strength to the spinal column in order to help minimize muscle fatigue and joint or disc pain. That's not good news.
So while steroid injections and surgery are certainly tools in the box that can be offered and used for your symptoms they are not the things I reach for first as opposed to figuring out the underlying issues that need addressing and then, going through a complete program of therapy (I really do find AQUATHERAPY most helpful..especially WATER JOGGING in a pool....or nowadays PT clinics even have these underwater treadmills! Technology...people love that sort of stuff!). I think that all these modalities and approaches are worth trying first before getting surgerized or injected.
I'll send you another link for your edification and if you're not familiar with this website please take a look. It is the LIVING WITH ARTHRITIS page of the XXXXXXX ARTHRITIS FOUNDATION where they talk about all sorts of things having to do with the form of arthritis you most likely possess which is OSTEOARTHRITIS. Recommendations for exercises, diet, and then, alternative treatment strategies that can be used to deal with the symptoms of chronic pain and paresthesias. Take a gander and see what you think:
https://www.arthritis.org/living-with-arthritis/
I especially like their tabs on DIET and EXERCISE but actually you could spend a long time looking at all sorts of tips and mind you what they advocate is backed by plenty of experience and studies done in the field. There are some perspectives and suggestions I'm not entirely in synch with such as the section where they discuss INJECTIONS and the use of hyaluronic acid into joints for "months" of relief....I've not seen that type of outcome in all the years I've been dealing with chronic back pain patients and so I can't agree with their recommendations except to say that perhaps from some theoretical perspective such a treatment would be good for that length of time using that particular substance.
And so once again, young lady....if I've provided good information for your purposes could you consider CLOSING THE QUERY and TAKING A MOMENT to provide POSITIVE words of feedback and even a 5 STAR rating if so deserving?
Please stay in touch in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 116 minutes of professional time in research, review, and synthesis of a response.
Would counsel getting more info on what's up BEFORE surgery or injections
Detailed Answer:
Good morning young lady. How are things in the Lone Star State today? I know....you're in a bit of pain, right?
Typically, something like lumbar stenosis is NOT something I would recommend you do surgery on right away without getting more information on what's going on. When it comes to spinal canal STENOSIS at any level (cervical, thoracic, lumbar) there is GOOD news and BAD news.... The Good news is that for most individuals once you've got narrowing of the canal it generally doesn't get worse. In other words, it doesn't progress. The bad news is that surgical decompression can be a bit tricky since results vary widely in terms of success rates for the procedure. For example, if a person suffers with numbness, tingling, and pain in the lower extremities because of the lumbar canal stenosis then, often times success after decompression using a laminectomy can treat the symptoms with consistent results when done by an experienced surgeon. Healing and rehabilitation in different individuals can be another problem (obesity, diabetes, cigarette smoker, other comorbid medical conditions). But the surgery itself for pain management IN THE LEGS can have good outcomes most of the time.
It is not considered a procedure of choice, however, when it comes to dealing with the more commonly complained of problem of pain in the BACK and especially if that back pain is triggered or worsened by activity using the back. In another words, people who complain of back pain that radiates or paresthesias that come on after they've been doing a lot of lifting, bending, stooping, or squatting do not seem to have nearly as much success when they get something like LUMBAR CANAL STENOSIS decompressed using available procedures. It's not fully been clarified why it has so much better a track record in relieving pain and discomfort in patients who have mainly or only symptoms in the legs and below as opposed to low back pain which is either chronic or activity dependent. So that's one thing that needs to be taken into consideration.
Also, as a neurologist my approach to people with such symptoms that you describe is to get MORE INFORMATION before jumping into any surgical procedure. I want to be sure that the OBVIOUS problem that we are told exists on a scan (canal stenosis, nerve root compression, facet arthropathy or spurring, etc.) can really be LINKED to a person's symptoms. Believe it or not, just because a person has a bulging disk...or even a HERNIATED disk in the back doesn't always mean that they are suffering from symptoms. There was a study done that I recall reading where they had just done screening MRI's of people's backs who had NO COMPLAINTS of any pain, numbness, tingling, imbalance, falls, etc....nothing...just people who were completely symptom free of back or leg symptoms. They imaged their backs and found a full 40% of them had some type of pathology that was caused by arthritic degeneration, overuse of the back, excessive curvature of the spine, bulging disks, and even herniated disks. Yet they were symptom free.
So again, what you SEE or what you are TOLD by a radiologist often times is only partially relevant....or perhaps in the study I mention above....TOTALLY irrelevant to the symptoms a person brings to the table. And that is why I will put patients through at least MRI's of the back (or neck) along with either plain X-rays or CT scans which can help increase the sensitivity and validity of reads. You don't need gadolinium contrast for such studies. That way we get a very good read radiographically of what's going on. Then, we put those results together with the very thorough neurological exam that has already been performed on the patients so that clinically I am satisfied that if they're complaining of pain, numbness, tingling, or any other odd/bothersome symptom that it is present ANATOMICALLY where it should be found to be consistent with wherever the radiographic anomaly lies. Make sense?
Finally, if a person has WEAKNESS in muscles (not just pain necessarily) but if I detect a drop foot, a weakness in the thigh or calf muscles such that a person is having difficulty arising or sitting into a chair, getting in or out of a car, getting up or down on a toilet or sofa, etc. then, I will also invoke the use of an EMG/NCV study which is an electrical study of the patient's muscles and nerves. Surgery becomes more of an option in my mind and by extension in my patients when weakness is present and can be directly correlated or linked back to the results of neurological examination and radiography results.
So, that's how I will approach a patient such as yourself in order to first ascertain what they've got going on to be sure that we would be treating an entity that should be treated. Remember things such as surgeries, injections, or any other INVASIVE procedures that people may offer always come at a price. One is financial, the second and more important is the risk of anesthesia, the risk in recovery/rehabilitation, and the 3rd is the risk or recurrence. I am NOT a huge fan of EPIDURAL BACK INJECTIONS in patients even though as you say, "I have had these injections in the past." For most individuals they represent very short term fixes for a long term problem and they do nothing for addressing the root of the problem.
On the other hand good aggressive physical and especially AQUATHERAPY along with appropriate medication support can be much more effective since the patient is trying to alter the underlying cause of the problem by doing things such as stretches and exercises to strengthen supporting muscles, potentially moving internal structures such as tendons and ligaments (tendon gliding maneuvers used by PT therapists) over places of entrapment or arthritic calcification. I also have seen people change the way they sleep and the mattresses and support systems they use for their bed and have significant success with the control of pain and other symptoms. I always tell my patients to sleep a bit more in an inclined position to take pressure off the lower spine using either a WEDGE TYPE of pillow or if the bed is adjustable to bring it up to about 30 degrees. They should also do what they can to sleep on their backs although keeping one in this position all night long is neither easy nor recommended since we naturally MUST turn throughout the night to avoid pressure injuries. Also, I've found that many patients get relief by placing a stiff pillow or wedge device under their bent knees. This again, takes as much traction off from the lower back as possible during the night.
Shots are merely the instillation of medication which has anesthetic effects into a place where the operator HOPES or THINKS the most significant GENERATOR of pain is located and then, the procedure has to be repeated in a number of weeks or months. I've had patients who have obtained relief on a longer term basis of several months but they are rare. Most patients I've treated over the years who get started on shots eventually find that they become ineffective after shorter and shorter periods of time until finally, they don't really seem to work at all. Also, the injection of some of these steroids and anesthetic agents have been shown to have DIRECT TOXIC effects to the subcutaneous tissues and even to things such as ligaments, tendons, and bone. Imagine that...getting injected with material that is supposed to relieve pain and discomfort that can actually cause or accelerate deteriorative processes of the very elements NEEDED to provide support and strength to the spinal column in order to help minimize muscle fatigue and joint or disc pain. That's not good news.
So while steroid injections and surgery are certainly tools in the box that can be offered and used for your symptoms they are not the things I reach for first as opposed to figuring out the underlying issues that need addressing and then, going through a complete program of therapy (I really do find AQUATHERAPY most helpful..especially WATER JOGGING in a pool....or nowadays PT clinics even have these underwater treadmills! Technology...people love that sort of stuff!). I think that all these modalities and approaches are worth trying first before getting surgerized or injected.
I'll send you another link for your edification and if you're not familiar with this website please take a look. It is the LIVING WITH ARTHRITIS page of the XXXXXXX ARTHRITIS FOUNDATION where they talk about all sorts of things having to do with the form of arthritis you most likely possess which is OSTEOARTHRITIS. Recommendations for exercises, diet, and then, alternative treatment strategies that can be used to deal with the symptoms of chronic pain and paresthesias. Take a gander and see what you think:
https://www.arthritis.org/living-with-arthritis/
I especially like their tabs on DIET and EXERCISE but actually you could spend a long time looking at all sorts of tips and mind you what they advocate is backed by plenty of experience and studies done in the field. There are some perspectives and suggestions I'm not entirely in synch with such as the section where they discuss INJECTIONS and the use of hyaluronic acid into joints for "months" of relief....I've not seen that type of outcome in all the years I've been dealing with chronic back pain patients and so I can't agree with their recommendations except to say that perhaps from some theoretical perspective such a treatment would be good for that length of time using that particular substance.
And so once again, young lady....if I've provided good information for your purposes could you consider CLOSING THE QUERY and TAKING A MOMENT to provide POSITIVE words of feedback and even a 5 STAR rating if so deserving?
Please stay in touch in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.
This query has utilized a total of 116 minutes of professional time in research, review, and synthesis of a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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