Question
Hello Dr.A very Good Morning,
         My mother now aged 75 years underwent lumbar laminectomy for lumbar canal stenosis with HNP L3 - L4 inthe year 1983.Post surgical symptoms recurred in the year 1992 like numbness of both the lower limbs and low backache.MRI REPORT IN 1992 revealed DEGENERATIVE LUMBAR SPINAL AND DISC DISORDER. Dr. opined that no symptoms of Neuropathy to co relate clinically and surgery not warranted at this stage.In 1997 GTT report positive and symptoms of  lower limb pain  from hip region, diminished sensation of soles and gait, incontinence of urine  aggravated.Also suffering from Hypertension and known Diabetic.Diabetic neuropathy? could not be co related clinically. Latest MRI scan on 8.6.2012 .IMPRESSION Bilateral flaval ligament hypertrophy at D9-D10 and D1-D11 levels with mild thecal sac compression at D10-D11 LEVEL. and Nerve Conduction Tests revealed normal thereby Dr. ruled out Diabetic Neuropathy. Advised to consult neuro surgeon after 2 weeks. Please give your opinion about the case is any surgical intervention will be warranted and what will be the chances of recovery at this age

         sincerely yours
         P.N.Vageeswaran
         INDIA

Answer
Dear Mr. Vageeswaran,

Please be aware that much of what I am going to tell you is simply opinion and of little worth for many reasons.  First of all, I am a chiropractor and not a spinal surgeon. Second, I do not know your mother, nor have I examined her, and even though you have written a detailed question, nothing substitutes for a good physical examination and the ability to read reports and see diagnostic images.

That being said, consider the following:

If there is significant central canal stenosis, and if indeed the stenosis is causing her symptomatology, then perhaps the only thing that can be done is surgery to decompress the spinal cord/cauda equina in the dorsal spine region.  I would ask for the doctors to make sure that the L3-L4 level is not contributing to your mother's troubles. The last thing that you want is to have your mother undergo surgery at one level while a completely different level is the cause of neurological compression.  

The negative nerve conduction test... may take the suspicion away from peripheral neuropathy, but I would hesitate to say that it eliminates that possibility.  Urinary incontinence can also be caused by many things. You might consider taking her to a urologist prior to surgery, if you have not done so.

As far as how your mother would do with surgical intervention... this is dependent very much on the vitality of your mother.  She is 75 years old, but I have known elderly individuals that are very healthy generally.  I have also known of much younger individuals that would not have a good prognosis with surgery due to their deteriorated health.  I am sure that the surgeon, before conducting his/her procedure, would have your mother undergo lab and cardiology tests in order to insure a positive outcome prior to performing the surgery.

I know that you are worried for your mother and desire the absolute best of care for her.  I hope that you are able to get the answers that you desire, and that you are able to help your mother to make the best decision for her.  Surgery is never an easy answer.  Don't hesitate to ask questions to your physicians in India.  Some that come to mind are as follows:

1) What are the odds of a positive outcome, with a reduction/elimination of symptoms?
2) What would happen if we choose NOT to undergo surgery?
3) Would an epidural injection help my mother?  How about physical therapy treatment?
4) What are the risks of surgery?  What steps are you going to take to minimize the risks?

It sounds like, to me, that you have thought of many of these questions already.

Good luck.  I hope that you are able to get the help that you are seeking for your dear mother.

Keith Biggs, DC
http://www.eastmesachiropractor.com