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Thread: Leg & Foot Pain - Lumbar Epidural Injections to treat this before & after surgery

  1. #1
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    Leg & Foot Pain - Lumbar Epidural Injections to treat this before & after surgery

    Hi everyone-

    I just wanted to see if anyone out there has had a doctor who has suggested getting lumbar epidural injections in the lower lumbar section of the spine instead of getting a fusion to the L5 or to the sacrum. I am scheduled for spinal fusion surgery in June to correct my scoliosis. My curves are currently 55 (thoracic) and 58 (lumbar) degrees. My doctor, who is one of the top scoliosis doctors, recommends fusion from T4-L3. At my first appointment with him last week, I told him how I have been having SEVERE foot pain for the past 3 years where other doctors have told me it is coming from my back. The past 3 months the nerve pain has now moved into my leg. It is mostly from my behind my knee, goes down my calf, into my ankle and through the side of my foot and into my pinky toe. I did alot of research on the location of pain and motor deficits in association with nerve root involvements, and at the disc level L5-S1, the location of pain is at the lateral aspect of the foot which goes into the pinky toe, which is exactly the pain that I have. Every morning I have to walk around my room for like a 1/2 hour with my toes curled in order to have the tingling, burning and stabbing sensation to go away for awhile. My MRI shows that I have "Moderate disc degeneration with shallow eccentric disc herniation to left at L5-S1, also with far lateral disc buldging at the L5-S1." It also shows "moderate disc degeneration with loss of disc signal and disc height and shallow eccentric disc herniation to left at L4-L5." This scoliosis doctor told me he doesn't believe the foot pain is related to my back, and that he recommends just fusing to my L3 since I am only 31 years old and also for other mobility reasons. He recommended treating my leg and foot pain with lumbar epidural injections before and after the surgery. I am alittle disappointed because I thought by having the scoliosis surgery, the nerve pain down my leg and into my foot would go away, and now that isn't going to be touched. I have read where other people on this forum have their fusions done to the sacrum which alleviates leg pain. My question is, Do lumbar epidural injections work for foot and leg pain? Can I get them every year for the rest of my life? The pain in my foot sometimes is so unbearable that I have to limp around at times. He also mentioned when I am older, like in my 50's, I may need another surgery to address the further degeneration in my L4, L5, S1 discs. I'm was thinking that he would have recommend doing my fusion all the way down to the sacrum because of my pain and the bulging and herniated discs, but he doesn't see any evidence to do this, even though he sees the results on the MRI report and hears about my pain. He suggested I also get a EMG and NCV test. I already did those 3 months ago, and they came out normal.

    I was also wondering if after the surgery the nerve pain will diminish simply because of my curves being reduced by 60%. The doctor already did my bending x-rays and he said he would be able to reduce both of my curves to 20-25 degrees. I'm wondering if by having the curves reduced by 60% this would align the spine more, putting less pressure on the bulging and herniated discs at L4, L5, and S1, and then the nerve pain could possibly diminish or disappear. Does anyone have any thoughts on this?

    Any thoughts would be appreciated as I have been worrying about this for the past week! I really thought surgery would take the nerve pain away in my foot and leg. I emailed the dr. about all of this after my appointment but he replied that lumbar epidural injections were my best bet. Maybe he is right (after all, he is one of the top surgeons and is highly spoken of) and I should just try to get one and see if it works. I never had one before. I was also wondering how long they last.

    Thanks!

  2. #2
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    May 2009
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    Hi Jen
    i have not had surgery...yet...

    i have a 40 degree thoracic curve that is treated with botox injections...it freezes the muscles so that they cannot spasm or bunch up or do any of the other stuff that causes me alot of pain...i get 3-4 botox sessions a year..several injections at each session are required...

    i have had many injections for the 61 degree (currently) lumbar curve...i have rotation...i also have spinal stenosis, degenerative disc disease & severe arthritis in my spine (lyme disease made it all worse)...i've had epidurals..more than once...they didnt help me (but everyone is different)...facet block & nerve ablation helped somewhat...sacroiliac injections worked best for me...but that is my personal experience...different people need different treatments..depending on where the worst pain is located..& i am not saying that everyone can be helped with these injections...just reporting my own experiences with them...

    i dont have the nerve/foot pain you report...although i have had many foot surgeries for curled toes (i think the tendons & other stuff in the feet were too tight, but the surgeries didnt help much...problem kept reappearing!)i have really weird looking toes now i used to have a sciatica down my left leg(very long ago)...not any more..it was gone long before i ever had pain management injections, though...went away by itself...

    have you been given neurontin for nerve pain? i dont recall if you mentioned medications...i dont need that one, but i do take other pain meds...strong ones!!!

    i would suggest consulting with a pain management doctor..they are more knowledgeable in what is possible & what might help..or not help...

    best of luck
    jess

  3. #3
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    Hi Jen...

    If I thought my leg pain wasn't going to be potentially resolved by surgery, I probably wouldn't have the surgery. Although it wasn't constant, I did have frequent bouts of sciatica that went away when I had surgery. Since you have a lot of questions and doubts, I think it would be beneficial to make another office appointment to discuss things with your surgeon. Since you've had a recent change in the leg pain, I wonder if something has changed.

    I volunteer with Dr. Berven at UCSF, whom I trust implicitly. He rarely recommends surgery without having the patient try physical therapy and/or some type of injection.

    Regards,
    Linda

  4. #4
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    Sep 2009
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    Hi Jess-

    Thanks for your response!

    I have a few questions for you:

    1. I've been to a neurologist before who has prescribed me Topamax for the nerve pain. It has dulled the pain a little, but it's really not strong enough. I tried Lyrica before but that didn't work either. These meds are in the same class as neurontin. Is a pain management doctor different than a neurologist?

    2. What is nerve ablation and where did you go for that?

    3. Do the lumbar epidurals hurt? Where do I go for these, the pain management doctor or a local orthopedic?

    Thanks.

  5. #5
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    Sep 2009
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    Thanks for your response Linda.

    There are two main reasons I want to have the scoliosis surgery. One of them is to lessen my back pain, and the second was to alleviate the leg and foot pain (but now like I said in my post I don't think this is going to happen with the surgery). I'm still going to go forward with the surgery so that I can have my curves corrected which will hopefully help with my back pain. This summer my lower back went into a complete spasm which threw me into the ER. I've never felt so much pain in my life!!!! I even delivered 2 of my kids through a natural birth with no epidurals and that was no big deal compared to the back spasms I had this summer! I decided right then and there that I needed to have my scoliosis fixed sometime soon. My curves have increased 15 degrees in 4 years, so I feel like while I am in my early 30's this is the best time for me to do it, even if my leg pain isn't able to be taken away.

  6. #6
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    May 2009
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    Hi again, Jen
    guess you cant sleep either...or maybe you are in an earlier time zone, dont remember if you said where you live...anyway, i cant sleep too well, so i thought i'd write....

    nerve ablation is burning off nerves for pain relief......they grow back (darn) ....i go for all treatments i mentioned to pain management doctors...

    the neurologist question...my nyc pain doctor is both! he is neurologist & pain management doctor... smart guy...russian native (cute accent)....he does my botox injections in upper back, & has done my nerve ablation & facet block injections...the epidurals i had in CT where i live now...for some reason, that doctor doesnt believe in botox for back...dont know why, didnt want to argue with him, so i let the comment go...i know botox shots work for me from personal experience! he is an anesthesiologist, not a neurologist...but they are both excellent doctors...i had the sacroiliac injections in CT also with anesthesia guy....that worked best for me, but i think it depends on exactly where the worst of the pain is, & is coming from...he says "you've got to find the right spot"..says it with a grin...he makes jokes..i dont mind, it reduces the tension in the room a little...

    do the epidurals hurt? i've had them done twice...first time was years ago (at nyc hospital) & my curves werent as bad, nor was my pain as bad...it hurt less...just felt like a truck was pressing down on my back..second time everything about my back was worse...it hurt alot more...felt like he hit my kidneys (!!!)...he said no, he was no where near my kidneys..but that was my very subjective perception!! it didnt hurt so bad i wouldnt do it again if it helped...but it didnt! if you could go thru childbirth twice with nothing for pain, you could DEFINITELY handle an epidural, i think...

    any other questions i can help with, please feel free

    jess

  7. #7
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    Jun 2008
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    Before I had my first fusion (3 level) I had excruciating leg pain to the point of not being able to put my foot down. The surgery completely took that away. My limited understanding is that they can usually fix the leg pain but it is the back (pain) that is harder to treat. This fusion partially attempted to fix my curve but the reality was that it was the reason I had my most recent surgery. The first time I stood up after surgery, the leg pain was gone and has not returned since and it is 5 years later. I had all kinds of other pain and problems before my scoli surgery but leg pain wasn't part of it. I have also had 2 hip replacements and the most painful symptom of that was pain when I put leg to floor. Painful doesn't even tell the story. It took several years of leg pain before finally somebody figured out it wasn't my back it was my left hip. Had replacement surgery 10 years ago and voila no leg pain since then. I am sorry to run on like this. Have your hips been checked?
    avis
    1987 Lumbar Laminectomy (forget which levels)
    2005 A/P fusion, L2 - L5, 2/2005
    2009 2 Posterior fusions, T6 - Pelvis, 2/10 & 2/18,
    Dr. Frank Rand, NEBH

  8. #8
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    Mar 2008
    Location
    New Bern, NC
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    Quote Originally Posted by JenM View Post

    3. Do the lumbar epidurals hurt? Where do I go for these, the pain management doctor or a local orthopedic?

    Thanks.
    Hi Jen, In answer to your question #3, if you have the right Doctor, the epidurals shouldn't hurt very much. The first one I had was excruciating and I told the Pain Management nurse that I wasn't coming back for another epidural unless she made sure that she got a Doctor that wasn't so brutal. At first, she said they were all alike. I said I know that wasn't true since I worked at that hospital and have watched Doctors do various procedures, and some are good at what they do and some are not. She finally admitted to me that I was right and she would make sure that she got the best one for my next shot. What a difference. I hardly felt a thing. I should say that I had my shots at a community hospital where the anesthesiologists took turns doing the epidural shots. Did the shots work? Some did and some didn't.

    Have you thought about getting a second opinion from another scoliosis surgeon? If you are going to go through a difficult surgery and it isn't going to address your leg pain, I would think it would be wise to get another opinion.
    Diagnosed with severe lumbar scoliosis at age 65.
    Posterior Fusion L2-S1 on 12/4/2007. age 67
    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
    New England Baptist Hospital, Boston, MA
    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

  9. #9
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    Sep 2009
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    19
    Hi Jen,
    Getting a second opinion is probably an excellent idea. Knowing that you are not going to get relief from a major pain source makes having the surgery a difficult decision. You aren't guaranteed complete pain relief from the surgery at any time, but knowing you won't get relief - - -WOW, that's tough!
    Epidurals, I agree with everyone, sometimes they work, sometimes they don't. I did not get good results from my epidurals and I had selective nerve root blocks too, which I found to be painful, & they didn't work either.
    I am very grateful for my surgery. I still have random pain, but nothing like before, & I feel I'm still healing - surgery was in July.
    Take care & don't settle for less than you want. You get to live with your
    body & your pain, not the MD.
    HappyDeanna

  10. #10
    Join Date
    May 2009
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    3,745
    Dear Jen
    i cant imagine why any surgeon would suggest epidurals IN PLACE OF fusing to a lower level...i look at epidurals as a treatment to be used when needed, for pain, that sometimes helps, sometimes doesnt...i would never consider epidurals in place of surgery...i would only try it to get out from under pain until surgery, or as a temporary measure for someone not having surgery....

    you did not name your surgeon, except to say he is one of the best...why then would he recommend epidural treatment....if you need to be fused to a lower level, or even to sacrum, then why not do it now? why put you through 2 surgeries if it is a sure thing that a longer fusion will be needed....please consult with another one or two surgeons & question this..please! i reread what you wrote, & if epidural is indeed being suggested in place of longer fusion, i would not have alot of faith in that surgeon...maybe i am misreading what you wrote....maybe i am misunderstanding it...but please do not consider epidural treatment as a lasting solution to fusion problems....i do not believe it is something that anyone should rely on in any way for a long term treatment....

    best regards...hope you can find pain relief...
    jess

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