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Suggest treatment for lumbar spinal stenosis

Answered by
Dr.
Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5895 Questions

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Posted on Mon, 11 Sep 2017 in Brain and Spine
Question: My sister has Lumbar disk disease and lumbar spinal stenosis. She has just come through viral cardiomyopathy (coxsackie and echo virus) and CHF. Her ejection fraction has gone from 15 percent to 50-55 percent. She survived an ischemic stroke wth nothing more than some aphasia. She is much better with speech therapy. She recieved PTA at an Emergency Stroke Center. We are grateful and thankful.
Now every disk in her lumbar spine is herniated (any where from 5 mm to 7mm) and pressing on the nerves of her spinal cord. She is taking 5-325 of Percocet, but the pain persist to the point of tears. She doesn't like the medicine because of how it makes her head feel. The. Emergency room and other doctors have told me that they believe the pain is making her blood pressure go up from time to time. So it is not her heart or a TIA or a Stroke. Yet, dealing with the pain without Meds is not working. She does not like taking Meds, and has to take more now than she has ever had to take before. Her mind is off with the Percocet, I don't like this either. She has come through so much I can't see her taken down by this problem and pain. It is affecting her quality of life to the point that she is not gardening, cooking or shopping like she was doing before this event. She also has a diagnosis of Multiple Sclerosis since 2009, without much trouble and migraine headaches,which is why she has te percocet but they don't hurt her all the time. I cannot believe in this date in time that ther is nothing that can be done except a medication, that does not work, and meditation. Do you have any thoughts or helpful advice on this Critical situation?

doctor
Answered by Dr. Sudhir Kumar 23 minutes later
Brief Answer:
Epidural injection or surgery may help.

Detailed Answer:
Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and I would try my best to help you.

I have noted your sister's clinical details. It is unfortunate that she has suffered from a variety of illness in the recent past. However, I am glad that she has fought them well and overcome many of them.

Regarding disc bulges and nerve compression, the following treatments are generally advised:

1. Medications such as pregabalin or gabapentin capsules, along with physiotherapy.

2. Those who do not respond to the above medicines, epidural injection (injection in the lower back region near the compressed nerve) is advised.

3. Finally, about 10% people do not respond to the above two treatment modalities. In those, surgery is an option.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 2 hours later
I have set her for an epidural injection for tomorrow morning at 8:00 am. What I have read about gabapentin and it seem contraindicated for her heart. I don't know. She has been in physical therapy for four weeks. She starts with warm water therapy with a one on one therapist on Tuesday.
If we're talking surgery? What are we talking about? Every disk is herniated in her lumbar spine. Does the injection go into each area in her lumbar spine? Is there away to get you a copy of the MRI?
doctor
Answered by Dr. Sudhir Kumar 11 hours later
Brief Answer:
You can upload the MRI report here.

Detailed Answer:
Thank you for getting back with more information.

Gabapentin is usually safe for patients with heart disease.
Physiotherapy can be continued.
The levels for surgery would be decided on the basis of symptoms. Even though MRI shows disc herniation at all levels, the symptoms are often caused by one or two discs (surgery would focus on those).
Similarly, the injection would be focused on the "culprit" discs, which are responsible for the patient's symptoms (this can be found out on the basis of her symptoms, findings of neurological examination and correlating them with MRI spine findings).
MRI scan report can be attached here.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Prasad
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