Lumbar nerve impingement

[Javelin18]

I responded to another post about index numbers on scans. This generated a question about symptoms from the nerve impingement that showed up on my recent MRI. I decided to answer in a new post.

My MRI showed a new lesion pressing on the root of the nerve where it leaves my third lumbar vertebra. Here’s the answer to what symptoms I saw from the impingement

At first there was direct pain and weakness in my right hip, and upper thigh. I didn’t have the ability to lift my right leg. After dexamethasone and oxycodone, the intense pain went away.

My body seemed to compensate by tightening muscles on the left side of the lumbar. This shifted pain and weakness to my left leg, with bad pain where the outer quadricep attaches to my outer knee.

At this point, I’m working on pain management until I get a SBRT treatment on Thursday. I’m able to manage it with oxycodone, and icing my lumbar.

[noirhole]

Good luck. Radiation helped me get over pain and numbness caused by a tumor in L2 & L3.

Tip- the Radiation table is hard as a rock and very painful for the 5 minutes treatment took. I would take an oxy about 30 minutes before treatment and that helped me get through the treatments.

[Javelin18 in reply to noirhole]

Glad it turned out well for you. Unfortunately, this will be my third session on the ViewRay. I had SBRT to my prostate, and treatment of another lesion on a thoracic vertebra.

Thanks for the advice on taking pain management drugs. It’s an hour drive from my house to UCLA, so I’ll be timing my use to span the trip.

By the way, I like your screen name. I sometimes feel like getting cancer was like standing on a sinkhole that opened up. I’m trying to stop falling, and climb out.

[Javelin18]

Thanks, that sounds like an informative post. I’m loosely ligamented (double jointed), so I don’t have a lot of stability in any joints. I know that strengthening muscles to compensate is required, but hard to do that with injuries.

[Tall_Allen]

Your RO may want to bring in a neurological consult.

[Javelin18 in reply to Tall_Allen]

Thanks, I'm being treated by Dr Kishan at UCLA. The team includes a Neurosurgeon and Physicist to plan treatment.

[Tall_Allen in reply to Javelin18]

Amar Kishan is the best!

[tango65]

I hope you are consulting with orthopedic surgery since the symptoms you describe indicate motor branches of the nerves are being compressed. Radiofrequency may deal with the pain, but it will not correct the problems related to your ability to lift your leg. The orthopedic surgeons will know if there is a need to relieve the compression of the motor branches before the problem becomes chronic.

[Javelin18 in reply to tango65]

Yes, a Neurosurgeon is involved in selecting the treatment plan.

[Hidden]

Ouch and more ouch . Dam im sorry that is a lot of pain . I hope that Srbt knocks it away for you . I’m pulling for it to work . Hang tuff! 🙏🤙🏽

[HopingForTheBest1]

Depending on where you live there may be a physical therapy location that offers cancer rehab services, which focuses on pain and fatigue side effects. It is called the Revital program and is available in 13 states. You can go to revitalcancerrehab.com for locations. I use it myself. It is covered by insurance. I find it very effective.

[Javelin18 in reply to HopingForTheBest1]

Thanks, I'll dig into it

[Javelin18 in reply to Javelin18]

I'm about an hour north of Los Angeles

[podsart]

I’m dealing with severe pain from L3 to L5, with a concentration at L3/L4, where L3 is shifted out of alignment with L4. Of course, there is arthritis and bad disc conditions. This offset itself causes nerve impingement both where the nerve branches exit the vertebrae and in the spinal column as well.

First I went down the physical therapy path that’s usually tried, as an initial step. Unfortunately, that failed,

I’ve been following Nalakrats’ path together with a backup surgical plan by doing all the pre steps , including consulting multiple top neurosurgeons. I finally found great pain specialist that does that radio frequency ablation process that Nalakrats discussed. A few weeks ago, she started with Facet injections and last Friday I got an epidural, just before we got hit with a foot of snow. I’ll see if the epidural does anything. I will have a follow up consult with her in 2 weeks. If this epidural fails, we’ll have a more detailed conversation re RFA for me.

I hope the epidural at least gives me enough pain relief to get to hospital and take the flexon/extension x ray which tells you how stable this L3/L4 offset is [called spondylolisthesis].

Good luck

[gyancey in reply to podsart]

podsart I am dealing with the exact same issue. It is very confounding. I was told by a spine surgeon that if flexion/extension x rays show the spondylolithesis is unstable then an epidural might not be as effective as it otherwise would. I am hoping an epidural will work but I'm starting to feel that surgery is inevitible. The low back MRI showed what might be a lesion in a lumbar pedicle so there's that to deal with as well. Fun never stops. I'd love to hear how your treatment course progresses.

Good luck!

[podsart in reply to gyancey]

Sorry you are also going through this. It is very challenging to figure out the best path. I just got my epidural Friday, so it’s too soon to see how long any benefit will last. The flex ion/extension x-ray will help the surgeon determine whether fusion is needed, but apparently, not the only determinant. I feel some improvement today; tomorrow, who knows. Just to get some pain relief is welcome.

My friend who just had spine surgery’s wife said the epidural is a “bandaid”. From a structural perspective that is true. Most say avoid surgery if you can, but a concern is , as time go on, will something happen that makes me not eligible for surgery.

In the mean time I’m just moving along the pre surgery path in parallel with non surgical. In 2 weeks, I will find out if I am a good candidate for that radio frequency ablation.

I too, have that sensation that surgery is inevitable, but who knows.

One step at a time …

[Metaldraft]

I’m rooting for you no matter what….. you have great ability to want to understand the steps to try to achieve that curative solution.

[Kittenlover50]

Bill didn’t have the issue due to a leison, but they feel from his radiation treatments. A year after, began falling, ( stairs tge scariest) leg would just give out, couldn’t lift it, etc. Fell in docs office at Mayo. Off to neurologist next day. Testing had revealed that the mylion sheath around the nerve had completely worn away, similiar to MS issues. Lumbar plexopathy. He felt from radiation, they did not.. anyway had 17 infusions ( 5 in 5 days, then weekly for 17 weeks) of the prednisone like whatever. He didn’t didn’t have a lot of pain though. Doc started him on gabapentin, ( didn’t want to) and Bill was off it in a week.. didn’t like it. He had positive results from the infusions. Best wishes on your road. Kind of been there.

[Javelin18 in reply to Kittenlover50]

Thank you. I'm so glad he had poutine results in the end I feel so inspired by the stories of perseverance.

[MateoBeach in reply to Kittenlover50]

Thought I had radiation induced lumbosacral plexopathy after pelvic LN RT two years ago. Researched it: only identified effective treatment was pentoxiphylin (Trental) combined with high dose Vitamin E (must be both as shown in RCT), and must be continued for a very long time. Didn’t do anything for me. Finally had lumbar MRI with contrast and found severe left L2-3 root compression. Spine surgeon specializing in microscopic (minimal invasive) decompression resolved it nicely. Muscle loss from ADT reducing vertebral stability and support was a contributing factor. No cancer at that site BTW just severe degenerative disease.

[Kittenlover50 in reply to MateoBeach]

Evidentially our neurologist, at Mayo, felt his approach was better than your research, in Bills case, anyway. ( I don’t mean that sarcastically) Did your doc agree with your diagnosis and go along with your research before any type of diagnostics? Mayo did3 days of testing prior to diagnosis. Various MRI, cat scan, pet scan, blood work, lumbar puncture, testing for Lymes disease, MS, etc. prior to diagnosis and suggested treatment. . Treatment worked for Bill. In fact, husband was climbing an oil tank, at a beet plant in Fargo ND 6 mo later. That was 4 years ago. Still feels a twinge now and then though.

[MateoBeach in reply to Kittenlover50]

I was adding the info on managing radiation plexopathy, which is fairly rare with PC pelvic treatments but does happen, for the sake of others. Your guy had excellent evaluation and care so this does not apply to him.Yes I had two MRIs, one with contrast, PSMA-PET and consulted with two neurosurgeons plus a spine surgeon as well as my RO. Took the Trental and Vit E while awaiting my appointment for micro surgical decompression in case that was a component. Made no perceptible difference. First decompression failed and had a second one after two months last March. With careful progressive rehab I was able to do multi day backpacking in the mountains (Sierras and Sawtooths) by July without pain.

[j-o-h-n in reply to Kittenlover50]

Guess he beet it.......... (sorry couldn't resist)...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 01/31/2022 7:14 PM EST

[nonm in reply to MateoBeach]

accelerated aging.....they say👩‍🦽👨‍🦯🏃‍♂️

[j-o-h-n]

You forgot to mention your aggressive lady chasing............

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 01/31/2022 7:02 PM EST

[Parscore]

Thankyou that was very helpful.

[Hidden]

How were the spinal tumors first detected. I've begged for adequate imaging, as my spine pain has been worse and worse with every visit. Upper ( between the shoulder blades) and lower tail section. Entire pelvic area in constant pain.

[Javelin18 in reply to Hidden]

Whenever I have unexplained peripheral nerve pain , my MO orders an MRI. She pulled strings to get me scanned at the RR same day I showed up with extreme pain. Usually a 1 month wait for a scan with UCLA