Brief Answer:
Your answers as follows...

Detailed Answer:
Hello again! I am sorry that things haven’t improved for you and are feeling the need for further procedures.

Regarding your question, I am not sure what you mean by affecting immune system, the steroid shots aim to reduce local inflammation not to affect immune defences. If you mean affecting immune system as a side effect I would say that the risk of that is close to nothing, its effect is local, doesn’t decrease immune responses. If you meant to say how long does the therapeutic anti inflammatory effect last, then the answer would vary, generally from 4 weeks to 3 months. Some patients may report longer lasting benefit but it’s hard to say whether it’s due to anti inflammatory effect, rather than that, it may be more likely that improvement would have gradually happened anyway (most patients improve with time even without any shots or surgical procedures).

As for how long to wait before doing surgery… if injection is not producing the desired effect I would give it about 4 weeks before undergoing surgery (though it’s not a clear cut time limit, depends on the urgency of the patient's condition, may be done earlier). If you improve from the injection hopefully surgery won’t be needed at all.

Whether the surgeon will ask for a new scan depends on when was your last scan, whether the symptoms have remained unvaried and whether they correspond to the scan findings. If the same symptoms, corresponding to the past imaging findings and to the EMG, the surgeon may not see it necessary to demand new imaging. If symptoms have changed in the past 6 months and you haven’t had new imaging they should ask for a repeat MRI scan (if not readily available, then CAT scan).

I hope the injection will produce the desired improvement.

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Brief Answer:
Your answers as follows...

Detailed Answer:
Hello again! I am sorry that things haven’t improved for you and are feeling the need for further procedures.

Regarding your question, I am not sure what you mean by affecting immune system, the steroid shots aim to reduce local inflammation not to affect immune defences. If you mean affecting immune system as a side effect I would say that the risk of that is close to nothing, its effect is local, doesn’t decrease immune responses. If you meant to say how long does the therapeutic anti inflammatory effect last, then the answer would vary, generally from 4 weeks to 3 months. Some patients may report longer lasting benefit but it’s hard to say whether it’s due to anti inflammatory effect, rather than that, it may be more likely that improvement would have gradually happened anyway (most patients improve with time even without any shots or surgical procedures).

As for how long to wait before doing surgery… if injection is not producing the desired effect I would give it about 4 weeks before undergoing surgery (though it’s not a clear cut time limit, depends on the urgency of the patient's condition, may be done earlier). If you improve from the injection hopefully surgery won’t be needed at all.

Whether the surgeon will ask for a new scan depends on when was your last scan, whether the symptoms have remained unvaried and whether they correspond to the scan findings. If the same symptoms, corresponding to the past imaging findings and to the EMG, the surgeon may not see it necessary to demand new imaging. If symptoms have changed in the past 6 months and you haven’t had new imaging they should ask for a repeat MRI scan (if not readily available, then CAT scan).

I hope the injection will produce the desired improvement.

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Brief Answer:
May be postponed more if it can wait

Detailed Answer:
If it can wait then it may be postponed a little further. When there has been a shot in the area of surgery it increases the risk of wound infection. According to a recent study, it is a very slight increase, 3% higher during the first month, after the first month we are talking about a difference of only about 1% in the 2nd and 3rd, and after 3 months it’s the same as if you hadn’t had the shot at all.

So ideally you could wait 3 months, but if in debilitating pain or risking neurological deficit the added risk is really small and surgery can certainly be done earlier.

As for the CAT scan issue…it is true that showing the bones is one thing CAT scan is even better than MRI, MRI is better for all the rest (disc, ligaments, tendons, muscles, etc).

Surgeons in our center do not routinely order CAT scan when an MRI has been done, but protocols may vary between centers, I see nothing wrong in your surgeon wanting to have one, the provided explanation he has given to you makes sense, so nothing wrong in being thorough and wanting assess the procedure as well as possible through all imaging modalities.

Regards

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Brief Answer:
May be postponed more if it can wait

Detailed Answer:
If it can wait then it may be postponed a little further. When there has been a shot in the area of surgery it increases the risk of wound infection. According to a recent study, it is a very slight increase, 3% higher during the first month, after the first month we are talking about a difference of only about 1% in the 2nd and 3rd, and after 3 months it’s the same as if you hadn’t had the shot at all.

So ideally you could wait 3 months, but if in debilitating pain or risking neurological deficit the added risk is really small and surgery can certainly be done earlier.

As for the CAT scan issue…it is true that showing the bones is one thing CAT scan is even better than MRI, MRI is better for all the rest (disc, ligaments, tendons, muscles, etc).

Surgeons in our center do not routinely order CAT scan when an MRI has been done, but protocols may vary between centers, I see nothing wrong in your surgeon wanting to have one, the provided explanation he has given to you makes sense, so nothing wrong in being thorough and wanting assess the procedure as well as possible through all imaging modalities.

Regards

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