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Not able to walk properly. Have herniations in cervical, bowel movement problem. May I need surgery?

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General & Family Physician
Practicing since : 2001
Answered : 11916 Questions
Hi, I have an MRI report that says:

L4-5 level: Posterior disc space narrowing is seen. Central disc herniation with annular tear impinges upon the thecal sac and nerve roots. There is facet joint hypertrophy with inflammation and moderate canal narrowing.

L5-S1 level: Posterior disc space narrowing is present. Left paracentral disc herniation with annular tear impinges upon the anterior thecal sac and left nerve roots.

Now I was wondering how serious this may be? I have trouble walking, currently am not able to move my right or left foot from the ankle down/also no toe movement on either foot (I have been diagnosed with drop foot as well), I also have a right paralized hand....and over the past few months my fingers on my left hand has been acting up as well. I have horrible pain from my neck down to my lower back. I also have issues with bladder and bowel movements. I have herniations in my cervical and thoracis spine areas as well. All this from a fall injury 2 years ago, and my symptoms continue to get worse. I am in between treatment right now because I was hurt on the job and I am dealing with workers compensation and my employer not wanting to take responsibility for my it has been a struggle.... I am waiting to see a back specialist, but in the meantime I was wondering if you would be able to give me a little bit of an insight as to how serious this mri report may be...and if I may need surgery?
Posted Thu, 11 Oct 2012 in Bones, Muscles and Joints
Answered by Dr. Michelle Gibson James 4 hours later
Hi, thanks for using healthcare magic,I am sorry about your injury

There is a vertebral disc between each vertebra, it acts as a shock absorber, it is composed of two parts, the outer part called the annulos fibosis (your report mentioned a tear in the annular ring) and the inner aspect , that is normally fully surronded by the annulus, called the nucleus pulposus.
Because the lower back has more motion than the thorax and carries all the weight of the torso, it is more commonly injured.
The lower disc L4-L5 and L5 to S1 take the most strain and are more likely to herniate.

Your report states that there is narrowing of the space between L4 and L5 which is usually due to degeneration of the disc.It also states that in the left aspect of the spine (as it relates to L4 and L5) there is a tear in the annulus that I mentioned earlier with herniation of the central disc (nucleus).This is compressing on your nerves and would be contributing to your symptoms.
In terms of the facet hypertrophy mentioned-Facets are where the vertebra interact with each other and move.Hypertrophy means that these 'joint area' become enlarged.The damage that you got in your discs could have possibly resulted in problems with the facets.Potential facet hypertrophy can result in narrowing of the spinal canal.
Treatment of facet joint hypertrophy can be conservative (pain medication, steroid injections, physio) or surgical.Degenerative disease is one of the most common indications for surgery.

In terms of L5 to S1- again there is narrowing of the space and herniation noted towards the left.
The indications for surgery with persons with lumbar disc disease are:(1) persons with a condition called cauda equina syndrome which is a pattern of neurological , muscular and urogenital symptoms due to compression of certain nerves in the lumbar sacral area.The symptoms would be lower back pain,sciatica, bladder and bowel symptoms,loss of sensation in the buttocks and perineum,muscle weakness.It is a serious condition, you mentioned that you have bladder and bowel dysfunction, your doctor should evaluate you for this.Treatment is aimed at the cause of the condition.
(2)if the neurological deficit is observed to be worsening-if your symptoms and difficulites are progressing
(3)sciatic pain for a 6 to 12 weeks
Sciatica-this is leg pain that is related to one or more of the nerves coming out from the lumbarsacral spine

In general I believe that you may be a candidate for surgery as you state that your symptoms are significant and progressing however your that is an area that your neurosurgeon and yourself will discuss.
I hope this helps and I wish you the best,feel free to ask any other questions

Above answer was peer-reviewed by
Follow-up: Not able to walk properly. Have herniations in cervical, bowel movement problem. May I need surgery? 1 hour later
Thank you for your reply. I don't have some of my previous MRI reports handy to tell you exactly what they say, but I have had MRI's of my cervical, thoracic, and lumbar on several occasions over the past 2 years, and each time it seems as though they are getting worse. There are herniations throughout my spine, in those areas as well, and also I do know the reports mentioned degenerative disc disease on a good portion of my spine as well, especially in the cervical and thoracic, on previous mri's of my lumbar spine it did mention it as well. Now I don't think any of the reports have mentioned anything about cauda equina syndrome, but I do have all of the symptoms you mentioned except the loss of sensation in the buttocks and perineum, which I don't believe I have experienced yet. I always get sciatic pain going down both of my legs, as well as the "pins and needles" pain in both feet, plus I also get the "pins needles" and pain going down my arms and also down my times I will even have sharp electrical shock type pains and my spine at times is very sensitive to touch when rubbing down my back, As far as the bladder and bowel disfunctions, at times I have had no control, where I will either urinate or have a bowel movement without even knowing it, and at other times, I will not be able to go at all even though I feel like I need to. Over the past 2 yrs my pain and symptoms have increasingly gotten worse. I also get pains that mimic "heart attack" symptoms, and I have been to the emergency room on many occasions for this because I don't want to take the chance of the pain being an actual heart attack, but as always, they say my heart is fine, and that the pains are most likely from the spine problems. I also have experienced sudden severe photosensitivity, and also times where my eyelids would not open at all on their own and when I had to manually open them with my hand, they would just close back up, I've also experienced facial numbness, and also bouts of "alzheimer like" symptoms, where I become confused as to where I am at, and I have become very forgetful, at times I have a hard time staying on task, etc. I also have experienced sudden vertigo at times. And since the day of my injury my thumb and pointer finger on my right hand has not moved and also has had loss of sensation. an orthopedic hand surgeon performed exploratory surgery of my right hand to see what was wrong, and said there was just bruising, but no damage, two weeks after surgery, I had a horrible tearing sensation/pain in the palm of my hand, and then I lost movement in all 5 fingers of my right hand, within weeks after my injury, I also experienced great pain in my neck/shoulder area, I had rapid muscle loss in my hand and arm (especially in the forarm area, great muscle weakness as to the point of not being able to lift my arm up off the table if it was resting there) I also had limited range of motion in the elbow, shoulder area, and wrist. one MRI report even showed a torn tendon in the wrist, but again, I was told by the workers comp doctor that this had nothing to do with the fact that I couldn't move my wrist up/down/ or side to side but when I did the research, the same torn tendon could cause that type of problem. Overall, the basic jist of things, the workers comp doctors recognized my symptoms when trying to say I had MS, but they wouldn't consider any other a neck/back injury causing those symptoms. and by the way, MS and all other autoimmune diseases, etc have all been ruled out. Now I also want to explain how I was injured. I fell through a chasis of a tractor trailer truck, landing hard in a sitting down position, with my right arm extended outward to try to catch myself, and at the time of trying to catch myself, my arm was XXXXXXX upwards into my neck, and I also punctured the palm of my hand with a bungee cord hook that ripped through the palm of my hand. With all of the symptoms and MRI/EMG reports that I have had done, that all suggest spine/nerve problems, and given the nature of how I became injured, the workers comp doctors, ignored the possibility that I injured my neck and back from falling with such abrubt force and landing in a sitting position. To this day, I am still fighting to get proper treatment, it has been a battle because my regular insurance doesn't want to cover anything that is from the work injury, but yet my employer doesn't want to take responsibility, so that is why treatment has been delayed. I am in the process of going to see my laywer's back specialist though, and I am suppost to be getting more MRI's done of my cervical and thoracic to recheck for any worsening since I have now had problems with fingers on my left hand not completely responding normally, and overall weakness of my grip...and to this day, my right hand has been completely paralized, it is in a closed up fist type position. I also have had pains going down my left arm as well. So again, my symptoms overall have been progressively getting worse over the past 2 years, as my left side is now also becoming affected. I have a very hard time with walking with both my feet having drop foot, and overall my pain has increased and is constant. I also want to mention that my right arm and hand gets discolored at times where it will turn bluish/purple, and extremely cold, also with this hand, shortly after the injury, it went through a period of extreme skin peeling and extreme wrinkling of the skin when wet within a minute or so of being in water, and now the skin is very shiney and thinish. I also want to make a note that at one point I was doing physical therapy with my hand, and the therapist used electrotherapy, to try to stimulate the muscles for my hand to move, and the muscles in my forearm would not even respond to the electrical shocks, even when set at a high number. also, and I know I am jumping around here, but I also do not have any reflexes on either of my feet. There has just been so much going wrong with my body, whereas before I got hurt at work, I was perfectly healthy, I did not have any of these problems at all.
Answered by Dr. Michelle Gibson James 11 hours later

I am really sorry about the physical trauma you would have suffered at work and the subsequent emotional trauma and frustration that you must be experiencing trying to obtain appropriate treatment.

I hope all of the red tape is resolved and everything is put in place for you to see the doctors and receive the treatment that is owed to you

wishing you the best
Above answer was peer-reviewed by
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