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Thread: Spine problem , CES ? Help please Dr. Young or SCI-Nurse - as worried

  1. #1

    Spine problem , CES ? Help please Dr. Young or SCI-Nurse - as worried

    Hello Dr. Young or SCI-Nurse and everyone I am new to this forum

    PLease may I have some advice situation which worries me alot

    Approx 3 years ago I apparently slipped, damaged or whatever to the L5 disc the pain was acute but gradually it went away with physio chriopractice treatments. I retuned to normal activity and started walking 10 miles at weekends with no problems.

    Every now and then I still get the bad sharpe pain in the lower spine but it lasts just a day or so. ( I even had a year long pain free episode )

    However, since the slipped disc I suffered impairment of
    erectile function / reduced sense in penis at the same time I damaged my back. I never mentioned this to the doctor as I was embarrased. The situation is not total, just impaired and I have had to work around the problem with some success.

    Two weeks ago I was diagnosed with sciatica in left leg with knee jerk weakness on testing ( there is no pain in the central L5 area ). The leg is painful to walk on. This is the first time i have had Sciatica ( i did not have it when i slipped the disc 3 years ago ) and without sounding dramatic, pain is not the right word to use, it is utter hell. The pain / stength is improving over the last week.

    No other symptoms, bladder, bowel seem okay, though when I originally damaged the spine, uriniry urge increased for about 2 weeks, which i told my doctor. I do not have saddle numbness or bladder problems though bowel sphincter seems less strong ( I did have an sphincotomy op 10 years ago to repair a fissure. I do not have incontinence but I find it sometimes difficult to keep gas in.

    I am really concernd that this may progress to some form of debility by way of CES. I dangerously read on the Internet about Caudia Equina but the only red flag I have is 3 years of erectile dysfunction and reduced sense in penis.

    I have seen two doctors about my concerns and they dont associate this with my current sciatica. They are adament that it is urgent if serious bowel bladder, saddle symptoms occur.

    Is this typical in a spine related problem like disc injury, I am 50 years old male but phisically fit.

    Please if you can comment I would be thankful

    tonyinhampshire

  2. #2
    Quote Originally Posted by tonyinhampshire View Post
    Hello Dr. Young or SCI-Nurse and everyone I am new to this forum

    PLease may I have some advice situation which worries me alot

    Approx 3 years ago I apparently slipped, damaged or whatever to the L5 disc the pain was acute but gradually it went away with physio chriopractice treatments. I retuned to normal activity and started walking 10 miles at weekends with no problems.

    Every now and then I still get the bad sharpe pain in the lower spine but it lasts just a day or so. ( I even had a year long pain free episode )

    However, since the slipped disc I suffered impairment of
    erectile function / reduced sense in penis at the same time I damaged my back. I never mentioned this to the doctor as I was embarrased. The situation is not total, just impaired and I have had to work around the problem with some success.

    Two weeks ago I was diagnosed with sciatica in left leg with knee jerk weakness on testing ( there is no pain in the central L5 area ). The leg is painful to walk on. This is the first time i have had Sciatica ( i did not have it when i slipped the disc 3 years ago ) and without sounding dramatic, pain is not the right word to use, it is utter hell. The pain / stength is improving over the last week.

    No other symptoms, bladder, bowel seem okay, though when I originally damaged the spine, uriniry urge increased for about 2 weeks, which i told my doctor. I do not have saddle numbness or bladder problems though bowel sphincter seems less strong ( I did have an sphincotomy op 10 years ago to repair a fissure. I do not have incontinence but I find it sometimes difficult to keep gas in.

    I am really concernd that this may progress to some form of debility by way of CES. I dangerously read on the Internet about Caudia Equina but the only red flag I have is 3 years of erectile dysfunction and reduced sense in penis.

    I have seen two doctors about my concerns and they dont associate this with my current sciatica. They are adament that it is urgent if serious bowel bladder, saddle symptoms occur.

    Is this typical in a spine related problem like disc injury, I am 50 years old male but phisically fit.

    Please if you can comment I would be thankful

    tonyinhampshire
    Excellent description and much better understanding of the situation than most people (and even doctors). I want to emphasize several points that you made.

    First, L5 disc (if it is herniating into the canal) is pressing on spinal roots in the cauda equina and not the spinal cord. The spinal cord ends just below L1. The so-called saddle-shaped loss of sensation is a result of conus injury and you are far from the conus of the spinal cord, located in the L1 segment. The disc at L5 could potentially press on spinal roots L5 through S5. All the other nerve roots would have exited the spinal canal above the foramina for L5. The dorsal penile nerve (which innervates the tip of the penis) comes from the S2 spinal root. So, an L5 disc could easily damage the S2 spinal root and may account for the loss of penile sensation and erectile dysfunction.

    Second, many neurosurgeons are reluctant to operate on the spinal cord when there are no other neurological symptoms of sensory or motor loss. This is because, unless the surgery is done within 3 months of pain onset, it may not eliminate the pain even when the disc is removed. In my opinion, if there is evidence of disc herniation and it is definitely impinging on a spinal root and there is evidence that the pain is localized to the root (L5 would be the dermatomes around the foot and would cause sciatica), the disc should be removed. Depending on the herniation, a surgeon can do a microdiscetomy through a relatively small opening. The surgery is not dangerous for the spinal cord and you should just get it done.

    Third, spontaneous reduction of back pain can occur as a result of exercise and physical therapy. This does not mean that the herniated disc has unherniated itself. It is just that the rest of the tissues have accommodated to the presence of the disc and your body has gotten use to the disc and molded itself around whatever the disc is pressing against. Once you have reached the age of 40-50 years old, most herniated discs are a result of disc degeneration. Because the disc is continuing to press on the structure, it means that the structure has less room to accomodate any further herniation and the likelihood of more herniation, pain, and neurological loss is high. You also sound like you have an active life-style and do not want your back pain to cramp that life style.

    Just based on your description, without looking at any of the images, I think that you need to have the herniation removed. At the present the best and least risky approach is to do a microdiscetomy. If you have a very large herniation, more exposure may be necessary. Since it is in the lumbar region, there is probably no reason to minimally invasive methods where you cannot see as well and may not be able to remove as much disc. In any case, the results of surgery depending on the experience of the doctor and how well they do each of the procedures. Obviously, the doctor knows his or her own skills and what his best results are. In short, you need a discetomy.

    Wise.

  3. #3

    Unhappy Thank you Dr Wise

    Thank you Dr Wise

    I cannot thank you enougth for your reply and understanding of the situation.

    The sad fact is I have yet to have an MRI. The UK NHS is slow and beurocratic. My MD has already told me that unless I have the symptoms mentioned ref to bowel / bladder ,etc , a referal to a Neurologist is not urgent. Therefore in my case, I have to wait the standard six weeks from the onset of sciatica to then get placed on a waiting list to see a specialist.

    The more I read about CES the more I feel that it is more common than the ' very rare ' event.

    May I ask would you consider my case an emergency or can a more conservative approach be used ( which is my MD's approach ), at least for the time being. I read about people being rendered disabled within hours of onset, but my situation has been almost 3 years !

    Thank you again for your time and understanding

    tonyinhampshire

  4. #4
    Senior Member skippy13's Avatar
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    Time to start being the squeaky wheel to get the grease. I went for fifteen years with nerve outlet issues and now have permanent damage that is unrecoverable. I am a walking quad because the weakness generated by the problems caused me to fall and really injure my neck. I would hate for you to end up with myelopathy like I did.

    Get loud and in their faces. Three years is long enough to suffer and it is clear that the conservative treatment is doing you no good. I get so mad at docs that seem unwilling to do their jobs to our detriment.
    Anything worth doing, is worth doing to excess

  5. #5

    Thankyou Skippy

    Thankyou Skippy for your advice, this is the path I am determined to take in order to avoid potential problems and get to the heart of the problem. I can then say to myself that I tried every avenue to get this sorted. Are you in the UK and did you have similar issues like me that Drs brushed to one side ?

    best wishes

    tonyinhampshire

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