Severe foraminal stenosis - advice pls.

[muddywaters]

Hi, this is ans. Glad to be at this excellent site (thanks!).

I have severe foraminal stenosis at one level (unreal pain/responsive to epidural) and have extensive DDD with some auto-fusion going on (will get some consults next week to determine the degree, etc.).

One UCLA doc told me that I'm inoperable (oh, forgot, facets = pain drivers and S-I joint pain/responsive to epidural) due to extensive DDD. He said many people do OK with severe stenosis.

I think "Oh really?". My sense is that when this and other formens are completely "stenoses"/blocked, that I will eventually not be responsive to epidurals and could have permanent numbness in the affected/dermatome regions.

Also, is there a risk that with osteophyte growth unimpeded that they could *sever* the nerve?

This has been weighing on my mind as I'd probably have to get a two level fusion which from my understanding doesn't help non-stop/drill bit back pain and w/extensive DDD is a set-up for adjacent level deterioration - if fused.

Oh, finally, is there any merit at this point to get MRI Neurography e.g with Dr. Aaron Filler in LA?

Thanks for your time.

ans

[Justin]

Hi Ans,

Wow...I'm sorry for everything you have going on. Hopefully with your consultations next week, you can ask your surgeons about addressing the foraminal stenosis & osteophytes.

MRI Neurography with Dr. Aaron Filler in Los Angeles might be worthwhile in your situation.

Good luck and keep us posted after your consults...I wish I had more to add.

[muddywaters]

Thanks Justin! I think having > 3 mm of retrostilothesis might make fusion a must if they can get in there.

I love this site but of course haven't figured out how to reply to a kind PM!

Remain well. ~ m

[Katie]

If you scroll down to the bottom of the PM, you will see 'reply' or 'reply with quote'. ( I think those are the words!) I usually use the second one as I save many of the messages and it allows me to save one instead of two...coming and going ;-) I know...that's clear as mud

[MDE]

What they can do would be a 2 level fusion with a foraminotomy Foraminotomy - Wikipedia, the free encyclopedia

They would partially restore disc height (Good surgeons will typically use the phrase "as the body will let me" or some other indicator telling you that they aren't going to over-distract your spine) and remove the bone around the peripheral nerve to decompress the nerve. They will also typically completely remove the facets and Laminas. Then the pedicle screws, rods, and depending on your size/activity level, cross connectors.

So far as I know, there have not been any clinical studies conclusively showing that the severity of degeneration at one level being a risk factor for adjacent level disc disease (I could be behind on this topic) Obviously smoking is a big one, as is post menopause for women.

There are also some of the best neuro surgeons in the world in LA and if you would like a few names to look into, PM me.

As an FYI, the original reason that "Dynamic Rods" were created was to "top off" fusion constructs. The idea being that they would slow, or stop degeneration at the superior adjacent level. The problem is that this theory has not been proven effective, nor have any of the dynamic rods been approved for this use by the FDA. (There are some on the market, approved as "an adjunct to fusion")