Brief Answer:
Major Surgeries-VERY High Risks-Not Recommended

Detailed Answer:
Good afternoon sir. My name is Dr. Dariush Saghafi. I am a neurologist from the XXXXXXX OH region of the country.

My understanding is that you are poorly able to use your last and that has gotten progressively worse over the last 2 months without the presence of much pain but that your balance is not good.

You want to know how significant of a surgery would be required for these problems and what the recovery time would be for this as well as the risks the procedure carries.

I've read your MRI report thoroughly and have numbers of patients who have similar types of reports with many changes that are seen in the lumbar spine as you do. They, as you, have what are referred to as "Multilevel athropathies" and on top of that have several nerve roots at different levels which are being are pinched off or "crowded" by the amount of arthritis that is in the spinal column.

So if we were to just classify the problems that you have into general categories we could come up with the following list:

1. Compressed/Irritated Nerves Roots (L2, L3, L4, L5)
2. Arthritic Changes- Moderate to Severe (L2, L3, L4, L5)
3. Spinal canal Narrowing- Moderate to Severe (L3, L4, L5)
4. Disc bulge- L4/L5

I am rather surprised but not necessarily shocked that all of these arthritic and abnormal findings of the lumbar spine are not causing you much pain. Patient usually suffer from a tremendous amount of pain when these many nerve and nerve roots are affected. Please note that the LUMBAR SPINE, almost in its entire trajectory have MAJOR PROBLEMS that could potentially be addressed and even ultimately "FIXED."

Here's the problem I envision for you. For precisely the reason that there is SO MUCH damage (in the way of degenerative arthritic disease) and such severe spinal canal NARROWING with nerve roots either PINCHED or crowded along with likely damage and scarring not seen on the MRI, any surgery would have a LOW LIKELIHOOD of succeeding and if anything I believe the risk that things would get worse postoperatively are pretty high. I really don't see any neurosurgeon with integrity being interested in putting you through this EXTENSIVE procedure which would likely have to be staged or done in parts for the risks that will be present both during as well as well after the surgery and could result in complications that may leave you worse off than you started.

Remember, any kind of surgery in the body will inherently cause its own scarring of nerves, bone, muscle, and other tissues. Therefore, with that much burning away, as well as cutting and sewing that would have to be done; plates and screws that would have to be fastened and donor bone that would have to be use, you may literally end up with pain and discomfort from just the SCAR TISSUE that will remain chronically for the rest of your life.

And so, the surgery and its unavoidable consequences of scar tissue which develops afterward will be so extensive and difficult to stop from invading even good areas that you may end up with pains of a rather bothersome and even intolerant type where once you didn't have very much pain. You may end up with severe numbness and tingling or electrical feelings when once you had very little or none. And your balance which you say is affected and not good now could become worse.

In short, your MRI results do not contain the type of results that back surgery is likely to help and in fact, surgical manipulation (even if by LASER TECHNOLOGY) should not be undertaken. Any individual surgeon or Group Practice which markets themselves as "Advanced Laser" or "Precise Robotic Technology" or any such thing are just trying to appeal to you from an angle which is a false one of hope and full of danger and risk. Not only that they will charge you very dearly and many places will not even deal with insurances and wish to be paid IN FULL ahead of time just to schedule. These are the places and people to avoid.

If you wish to solicit a 2nd opinion (which I always tell my patients is an outstanding way to get more quality information) then, I suggest you seek out a neurosurgeon at the closest Academic Teaching Institution where the faculty and professors do not necessarily concern themselves as much with numbers of patients or the bottom line as private practices and other enterprises often do.

I know you say you've been through physical therapy without success. Have you been through AQUATHERAPY or AQUATIC THERAPY? And if so, have you been through WATER JOGGING which is an excellent support type of exercise for this multilevel pathology that you have. Also, traction is another possible adjunctive form of intervention that could possibly work but I would do it in conjunction with the aquatherapy and not separately.

I wish you all the best.

If this answer has been helpful then, I'd appreciate some written feedback with a STAR RATING and if you do not have any further questions or comments to return to me would you terribly mind CLOSING THE QUERY on your side. That will signal the network that we have closed the thread so that they may properly credit the case and file it for future reference.

This query took 105 minutes of physician direct time to review, research, with final draft documentation for envoy

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