Patient replied :
There is some new bone formation in
the left paracentral to foraminal region along the tract of the interbody
fusion device at L3-L4 which may narrow the left lateral recess. Correlate for
any clinical evidence of left L4 radiculopathy. I am really worried about this in the report. I don't understand how this could be normal. Is this the reason I have the pain in my leg? The pain radiates from the low left spine, left glute, outside edge to backside of quad muscle, and sharp pain in the shin. The doctor told him it was nerve regeneration pain prior to seeing the CT scan results, but then called and said everything looks fine on the CT scan. The report seems like it tells a different story. Also, the surgery was a TLIF with BMP and a PEEK inter body cage. Am I able to recover without surgery? How long is a reasonable time to wait to feel better? Thanks so much for your help. I have a copy of my cat scan disk if you tell me what to take a photo of I can post a photo so you can see it. Thank you so much for your time and help.
Patient replied :
Dear Dr Goutham Cugati, Neurosurgeon:
Thank you for your detailed response. It definitely helped calm some fears we were having. Would you suggest having the steroid infiltration be done now or wait a couple of months? What type of infiltration is it exactly? Also, it has been just over 5 months post op now, what should he be doing as far as physical therapy and what restrictions would you still recommend. He was told he can lift 25 lbs, no excessive or repetitive twisting or bending. He even said he could use the riding mower (our yard is bumpy). The physical therapists were concerned about the increasing pain and weren't sure what to still do or not to do. He was doing lower trunk rotations, straight leg lifts, side leg lifts, side bridges, regular bridges, bridges with leg marches, marches on a ball and leg lifts on a ball, wall squats, dumbbell rows, step exercises, stationary sitting bike, and standing pull ups and push ups. He was also doing piriformis stretch, knee to chest stretch, bending with arms extended rolling a ball out and back to the left, center, and right while sitting on a bench, and a hamstring stretch. His insurance stopped covering physical therapy so now he's left on his own. Do you feel any of these are aggravating his symptoms or are ok to do? Are there any other you'd recommend? He doesn't hurt while doing them but seems like he feels worse a couple of hours later after doing them. He has also started taking Gabapentin (Neurotin) 1800 mg per day (600mg morning, noon, and night). It helps some but not much. Should it be increased or do you not feel that it would not be of much help. His insurance doesn't pay for Lyrica. Thank you for all your help, it is greatly appreciated. He has a lot of confidence in this neurosurgeon, but they are very busy and don't have the time to spare to answer any of these questions or concerns.
Hello,
Regarding steroid infiltration, if the pain is intolerable its better to get it done now.
It's called a transforaminal steroid injection which will be given under fluoroscopic guidance. This is what I usually practice in India. I am not sure about the practice in your country. As I have seen, it is given by pain therapist in the western countries only after being referred by your treating neurosurgeon.
It's better to avoid twisting n bend excessively. Mowing on a bumpy yard is better avoided.
The exercises mentioned by you can by done. But if they are hurting you much, then, do it for shorter duration.
Gabantip 1800/day is already a high dose. I don't suggest any further increase in the dose.