Question
hello Dr.Leatheman..I had a total left hip replacement over 5 yrs ago.But as the years past,severe lower back pain with left buttocks pain and tingling pain along my left rear buttocks to numbness in my left toes. The actual prosthetic seems in place and I was receiving excellent care at the Boston VA facility. I moved to Florida and they do everything different(slow) Although a recant x-Ray showed no significant changes to the hip replacement, my (Sciatica ?) and back pain is getting worse. They(St Petersburg VA)would not give the same medication I was getting in Boston.(Less effective) Maybe I should go to a private DR. because I do have Medicaid..Any suggestion. You think my being a 100% Disabled Vietnam Veteran(PTSD) that I would be getting better care. One of the reports from boston says=Mild to moderate central stenosis? another states Moderate to severe Foraminal Stenosis?  Please,Please help..thank you jams M

Answer
Dear James,

I do not think that the hip replacement has anything to do with the pain you are feeling.  I understand this surgery very well and have actually seen the procedure performed a few times in the operating room.

With what you have described, I suspect that the cause of the problem is the central canal stenosis and the foraminal stenosis.  Central stenosis is a term that is used to covey a lack of space inside the spinal cord.  This is often caused by scar tissue, disk bulging, or degenerative changes of the bone such as spurring.  As the canal gets smaller, the spinal cord has less room to move and becomes inflamed or irritated which can initiate significant pain in the back or into the legs.  Foraminal stenosis implies that the nerve roots that exit the spine are compressed and irritated.  The nerve roots exit though a hole created on the side the side of the vertebral connections called the neuroforamen.  If you have numbness in the toes, I would suspect that the L5/S1 nerve root is affected.

So now what?  Well since the foraminal stenosis is termed severe, I would suggest that you seek out the advise of a neurosurgeon to "clean it out".  Point blank:  tell them you want a neurosurgical consult! There are a few different procedures that can be performed to open up the holes and decompress the neuroforamen or central canal if needed.  The first I would ask about is called a Foraminotomy where they actually cut away bony tissue from the nerve...works great and is minimally invasive.  Second...if a disk bulge is the problem, then a diskectomy can be performed...fairly similar surgery ...different structure.  Third, a laminectomy can be performed where they actually cut away the back aspects of the vertebra (lamina and spinous process) which will allow more space for the cord and nerve roots to move.  This is much more invasive and will require a longer recovery period.  Lastly, I would not recommend spinal fusion surgery unless it is the absolute last resort...these are often ineffective and actually cause more issues down the road...The neurosurgeons I utilize for my patients only perform these surgeries as a last resort.

I would suggest that you look these procedures up on the internet first so that you understand them well before going back to the VA.  As a chiropractic physician I try to keep people out of surgery, however there is a time and a place for it.  I think chiropractic care may offer you some definite benefits to reduce your pain, but it will not eliminate it, and it will not fix this problem.  I have had to refer some patients for surgery, and in your case I think it would be one of the best options.  If they want to perform pain management injections, epidurals, radio frequency neurotomy, etc...  these will not solve the problem...they will not fix the stenosis.  Please research these online as well.

Good Luck James, I wish you the best.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net