Moderate Stenosis Conservative Care

 

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Surgery is not always the answer. Indeed, experienced surgeons will almost always start with conservative treatment to avoid surgery. Non-Surgical patients should ALWAYS get the opportunity to tell their story, and should receive a proper workup and healthy recommendations. Observation and frequent follow-up can improve compliance with conservative treatments. In Dr. McLaughlin's practice, less than 10% of patients initially seen are considered to be surgical candidates. Patient Notes is for medical professionals and patients alike. In this video series Dr. McLaughlin demonstrates and explains key parts of patient care. He's a highly acclaimed Neurosurgeon, an athlete (previous NCAA I wrestler), a coach, an author, and a motivational speaker.

Transcript

Hello Samuel, how are you? It’s good to meet you. I heard you were a police officer. Thank you for your service. Could you tell me about your symptoms?

I understand you have a problem with your right leg and have had two knee replacements done. I don’t want to be biased about what somebody else told you. I want to come to my own conclusion. So, if you can tell me your symptoms, I can give you an independent opinion of what I think is going on.

You mentioned you experience a lot of pain, particularly in your back. Do you also have pain in your neck?

So, we have pain in your lower back on the right side and pain in your neck going down your left arm. That’s something I can work with. You mentioned that you have to keep adjusting your position when sleeping at night to get comfortable. Have you had any surgery on your neck or your back? Any steroid injections?

I understand the only shot you’ve had has been on your knee. Do you take any medications for your neck or your back like Motrin, Advil, muscle relaxants, or painkillers?

I need to focus on your spine because that’s the only thing I can help you with. You mentioned it’s difficult for you to move, sleep, sit down, stand up. If you’re perfectly straight, you’re okay.

How long have you been using this walker? You started using it about two months ago and before then, you were on a cane. But your balance got so bad that you would walk into a wall. Are you using this walker because of your back and neck or because of your knee and ankles?

Is your neck the worst or is your back the worst?

You mentioned that everything you do basically depends on your back. We need to check your reflexes. Do you have diabetes? Diabetes can affect the reflexes, it diminishes them.

Looking at your spine film, I see some degenerative disc disease at L5 S1 and L4 L5 and there is some bulging into the spinal canal. This channel right here is your spinal canal. You’ve got some narrowing there at L5 S1 and L4 L5. It’s not severe, but it’s moderate.

The good news is, I think we’re going to be able to manage this without a surgical procedure. This is your spinal canal looking up the barrel. We’re looking at the caliber of your spinal canal. That’s at L1, that’s at L2, it looks nice and open. You see all the nerves in here, that looks normal. At L3 L4 it gets a little bit crowded, you’ve got a little arthritis in the joint there but it’s still open.

At L5 and S1, your spinal canal is open. It’s got some arthritis in it and I really think that we should start with some physical therapy on your back. Just some simple exercises with a trained professional to try and really get your back in shape. That’s going to start with also getting your abdomen in shape too. You need to get your abdominal muscles in shape and your back muscles in shape and that’s going to help your back pain.

As you age, every day is a pain. It’s not like when you’re in your 30s or 40s and can get away with stuff. When you get older, you’ve got to take care of your body.

So, I think the first step is to get some X-rays of your neck. We don’t have any pictures of your neck yet. I’ll order some X-rays and give you a prescription for physical therapy for your low back. Let’s see you back in a month or so and see how things are going.

I think we can get you better without surgery. I hope so, because I really don’t want to do surgery. In the right person with the right problem, surgery is highly effective. But in your case, I don’t think that’s going to be necessary.

Do you have any more questions? Most of what we discussed in this conversation has answered a lot of what you needed to know. You’ve been going through this for about seven to eight months now.

Well, it’s not my first rodeo. It was a pleasure meeting you. Thank you.