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I Have Sciatica In My Right Leg. I Had An
Question: I have sciatica in my right leg. I had an MRI which said the following about L4 L5:
"Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
I had 3 epidural injections in the last 9 months. I will have one more soon and then may go for minimally invasive laminotomy. My questions are in your opinion:
1) I will take epidural at L4 L5. I previously had half on left and half on right. Should I take the entire injection on right since my pain is in right leg?
2) Will it need shaving down facet joints? what percent of the facet joint may have to be shaved down?
3)Shaving down facet joint may cause spinal instability. Generally what percent shaving causes spinal instability? More than 20 percent or 40 percent or 50 percent ?
4)Reading my MRI, is there any chance sciatica can heal with time? I had PT and injections over 15 months.
5)Anything else besides surgery that can help me?
Thanks for your response.
"Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
I had 3 epidural injections in the last 9 months. I will have one more soon and then may go for minimally invasive laminotomy. My questions are in your opinion:
1) I will take epidural at L4 L5. I previously had half on left and half on right. Should I take the entire injection on right since my pain is in right leg?
2) Will it need shaving down facet joints? what percent of the facet joint may have to be shaved down?
3)Shaving down facet joint may cause spinal instability. Generally what percent shaving causes spinal instability? More than 20 percent or 40 percent or 50 percent ?
4)Reading my MRI, is there any chance sciatica can heal with time? I had PT and injections over 15 months.
5)Anything else besides surgery that can help me?
Thanks for your response.
I have sciatica in my right leg. I had an MRI which said the following about L4 L5:
"Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
I had 3 epidural injections in the last 9 months. I will have one more soon and then may go for minimally invasive laminotomy. My questions are in your opinion:
1) I will take epidural at L4 L5. I previously had half on left and half on right. Should I take the entire injection on right since my pain is in right leg?
2) Will it need shaving down facet joints? what percent of the facet joint may have to be shaved down?
3)Shaving down facet joint may cause spinal instability. Generally what percent shaving causes spinal instability? More than 20 percent or 40 percent or 50 percent ?
4)Reading my MRI, is there any chance sciatica can heal with time? I had PT and injections over 15 months.
5)Anything else besides surgery that can help me?
Thanks for your response.
"Severe central stenosis with pinpoint narrowing the thecal sac and obliteration of CSF signal around the cauda equina. Series 6 image 16. This due to protrusion as well as severe facet arthrosis and ligamentum flavum hypertrophy. There is severe narrowing the L5 axillar sleeve in the lateral recess as well as severe bilateral L4 foraminal stenosis and nerve root impingement. Cystic changes extend along the posterior margin of the severely degenerated left facet joint".
I had 3 epidural injections in the last 9 months. I will have one more soon and then may go for minimally invasive laminotomy. My questions are in your opinion:
1) I will take epidural at L4 L5. I previously had half on left and half on right. Should I take the entire injection on right since my pain is in right leg?
2) Will it need shaving down facet joints? what percent of the facet joint may have to be shaved down?
3)Shaving down facet joint may cause spinal instability. Generally what percent shaving causes spinal instability? More than 20 percent or 40 percent or 50 percent ?
4)Reading my MRI, is there any chance sciatica can heal with time? I had PT and injections over 15 months.
5)Anything else besides surgery that can help me?
Thanks for your response.
Brief Answer:
Surgery is indicated. The facet joint should be preserved.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Since the pain is on the right, the injection can be done entirely on the right.
If the facet joint is damaged during the surgery ( even minimally ) it is possible to result in instability.
The surgery in your case should aim to preserve the facet joint. It is possible to remove partially the lamina, the ligamentum flavum and a part of the disc, this way sufficient decompression may be achieved without causing instability.
Since the symptoms lasted for so long and there was no significant improvement with conservative measures, in my opinion, surgery seems the best option.
Hope you found the answer helpful.
Let me know if I can assist you further.
Surgery is indicated. The facet joint should be preserved.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Since the pain is on the right, the injection can be done entirely on the right.
If the facet joint is damaged during the surgery ( even minimally ) it is possible to result in instability.
The surgery in your case should aim to preserve the facet joint. It is possible to remove partially the lamina, the ligamentum flavum and a part of the disc, this way sufficient decompression may be achieved without causing instability.
Since the symptoms lasted for so long and there was no significant improvement with conservative measures, in my opinion, surgery seems the best option.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Surgery is indicated. The facet joint should be preserved.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Since the pain is on the right, the injection can be done entirely on the right.
If the facet joint is damaged during the surgery ( even minimally ) it is possible to result in instability.
The surgery in your case should aim to preserve the facet joint. It is possible to remove partially the lamina, the ligamentum flavum and a part of the disc, this way sufficient decompression may be achieved without causing instability.
Since the symptoms lasted for so long and there was no significant improvement with conservative measures, in my opinion, surgery seems the best option.
Hope you found the answer helpful.
Let me know if I can assist you further.
Surgery is indicated. The facet joint should be preserved.
Detailed Answer:
Hello and welcome to "Ask a Doctor " service.
I have read your query and here is my advice.
Since the pain is on the right, the injection can be done entirely on the right.
If the facet joint is damaged during the surgery ( even minimally ) it is possible to result in instability.
The surgery in your case should aim to preserve the facet joint. It is possible to remove partially the lamina, the ligamentum flavum and a part of the disc, this way sufficient decompression may be achieved without causing instability.
Since the symptoms lasted for so long and there was no significant improvement with conservative measures, in my opinion, surgery seems the best option.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you Dr Spaho for your quick response.
My potential surgeon told me that he will have to cut lamina by about 5 mm. He will also have to Shave the facet joint by about 4 mm. The total facet joint is about 28 mm so he will shave only about 15 percent. According to him, if the facet joint is shaved by more than 30 percent, that can cause instability. Pls advise your thoughts on this.
Also what are normally the chances of damaging the facet joint if it has to be shaved about 15 to 20 percent during surgery.
Thank you.
My potential surgeon told me that he will have to cut lamina by about 5 mm. He will also have to Shave the facet joint by about 4 mm. The total facet joint is about 28 mm so he will shave only about 15 percent. According to him, if the facet joint is shaved by more than 30 percent, that can cause instability. Pls advise your thoughts on this.
Also what are normally the chances of damaging the facet joint if it has to be shaved about 15 to 20 percent during surgery.
Thank you.
Thank you Dr Spaho for your quick response.
My potential surgeon told me that he will have to cut lamina by about 5 mm. He will also have to Shave the facet joint by about 4 mm. The total facet joint is about 28 mm so he will shave only about 15 percent. According to him, if the facet joint is shaved by more than 30 percent, that can cause instability. Pls advise your thoughts on this.
Also what are normally the chances of damaging the facet joint if it has to be shaved about 15 to 20 percent during surgery.
Thank you.
My potential surgeon told me that he will have to cut lamina by about 5 mm. He will also have to Shave the facet joint by about 4 mm. The total facet joint is about 28 mm so he will shave only about 15 percent. According to him, if the facet joint is shaved by more than 30 percent, that can cause instability. Pls advise your thoughts on this.
Also what are normally the chances of damaging the facet joint if it has to be shaved about 15 to 20 percent during surgery.
Thank you.
Another question please. My doctor uses 1 ml dexamethasone equal to 10 mg for the epidural injection. Do you think this is the right dosage and the right steroid. Thanks.
Another question please. My doctor uses 1 ml dexamethasone equal to 10 mg for the epidural injection. Do you think this is the right dosage and the right steroid. Thanks.
Brief Answer:
The aim of the surgery should be to preserve the facet joint.
Detailed Answer:
Welcome back.
In my opinion, the facet joint should be preserved as much as possible.
Some bone removed without destroying the facet anatomy is acceptable, but often difficult during surgery.
Percentages are difficult to be foreseen.
Dexamethasone is one of the possible corticosteroids that may be used for spinal injections in addition with an anesthetic.
Hope this helps.
Take care.
The aim of the surgery should be to preserve the facet joint.
Detailed Answer:
Welcome back.
In my opinion, the facet joint should be preserved as much as possible.
Some bone removed without destroying the facet anatomy is acceptable, but often difficult during surgery.
Percentages are difficult to be foreseen.
Dexamethasone is one of the possible corticosteroids that may be used for spinal injections in addition with an anesthetic.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
The aim of the surgery should be to preserve the facet joint.
Detailed Answer:
Welcome back.
In my opinion, the facet joint should be preserved as much as possible.
Some bone removed without destroying the facet anatomy is acceptable, but often difficult during surgery.
Percentages are difficult to be foreseen.
Dexamethasone is one of the possible corticosteroids that may be used for spinal injections in addition with an anesthetic.
Hope this helps.
Take care.
The aim of the surgery should be to preserve the facet joint.
Detailed Answer:
Welcome back.
In my opinion, the facet joint should be preserved as much as possible.
Some bone removed without destroying the facet anatomy is acceptable, but often difficult during surgery.
Percentages are difficult to be foreseen.
Dexamethasone is one of the possible corticosteroids that may be used for spinal injections in addition with an anesthetic.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you Dr Spaho for your response.
I understand that if some pain is created due to Facet anatomy change, there is abelation therapy where they kill the nerves avoid pain signals. Please advise your thoughts on this and also what is the success rate of this therapy.
Thanks again.
I understand that if some pain is created due to Facet anatomy change, there is abelation therapy where they kill the nerves avoid pain signals. Please advise your thoughts on this and also what is the success rate of this therapy.
Thanks again.
Thank you Dr Spaho for your response.
I understand that if some pain is created due to Facet anatomy change, there is abelation therapy where they kill the nerves avoid pain signals. Please advise your thoughts on this and also what is the success rate of this therapy.
Thanks again.
I understand that if some pain is created due to Facet anatomy change, there is abelation therapy where they kill the nerves avoid pain signals. Please advise your thoughts on this and also what is the success rate of this therapy.
Thanks again.
Brief Answer:
Ablation is used mostly in degerative changes.
Detailed Answer:
Hello again.
Nerva ablation actually is a known minimally invasive procedure that is being used with benefits for pain.
However, it is mostly indicated to treat chronic pain caused by degerative changes of the spine, such arthritis, sacroilitis, etc.
Its target are small nerves that conduct pain.
Sciatica involves big nerves that can't be damaged by ablation because of the risk of paralysis.
Hope this helps.
Take care.
Ablation is used mostly in degerative changes.
Detailed Answer:
Hello again.
Nerva ablation actually is a known minimally invasive procedure that is being used with benefits for pain.
However, it is mostly indicated to treat chronic pain caused by degerative changes of the spine, such arthritis, sacroilitis, etc.
Its target are small nerves that conduct pain.
Sciatica involves big nerves that can't be damaged by ablation because of the risk of paralysis.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Ablation is used mostly in degerative changes.
Detailed Answer:
Hello again.
Nerva ablation actually is a known minimally invasive procedure that is being used with benefits for pain.
However, it is mostly indicated to treat chronic pain caused by degerative changes of the spine, such arthritis, sacroilitis, etc.
Its target are small nerves that conduct pain.
Sciatica involves big nerves that can't be damaged by ablation because of the risk of paralysis.
Hope this helps.
Take care.
Ablation is used mostly in degerative changes.
Detailed Answer:
Hello again.
Nerva ablation actually is a known minimally invasive procedure that is being used with benefits for pain.
However, it is mostly indicated to treat chronic pain caused by degerative changes of the spine, such arthritis, sacroilitis, etc.
Its target are small nerves that conduct pain.
Sciatica involves big nerves that can't be damaged by ablation because of the risk of paralysis.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Yes, ablation helps with that pain.
Detailed Answer:
Hello again.
You mean if you will experience some back pain after the surgery.
In such case, yes, ablation may help in that kind of pain and results in long term relief.
Hope I helped you.
Take care.
Yes, ablation helps with that pain.
Detailed Answer:
Hello again.
You mean if you will experience some back pain after the surgery.
In such case, yes, ablation may help in that kind of pain and results in long term relief.
Hope I helped you.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Yes, ablation helps with that pain.
Detailed Answer:
Hello again.
You mean if you will experience some back pain after the surgery.
In such case, yes, ablation may help in that kind of pain and results in long term relief.
Hope I helped you.
Take care.
Yes, ablation helps with that pain.
Detailed Answer:
Hello again.
You mean if you will experience some back pain after the surgery.
In such case, yes, ablation may help in that kind of pain and results in long term relief.
Hope I helped you.
Take care.
Above answer was peer-reviewed by :
Dr. Prasad
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