PDA

View Full Version : Some questions regarding CES??


teonguyen
02-19-2009, 12:31 AM
Hi everybody!

I have had the herniated disc for 4 months. I guess i got the herniated disc due to workout, I usually do squat and calf raises which put lot of pressure on the spine. Initially, the pain started at the back , and then it radiated down to the buttock , thigh , calf, and ankle on my left leg. For the first two months of injury, I had excruciating pain that i could barely walk (pain is 8 out 10). I refused to see the doctor because i thought i was simply having some sorts of muscular pains, tendons. Eventually, i no longer suffered from its awful pain; I went to see the doctor. They send me for an MRI, and the result states:

L1-2 through L3-4 demonstrates no evidence of disc bulge or protrusion. Central canal and neural foramina are patent.

L4-5 shows a minimal disc bulge flattening the thecal sac anteriorly. Central canal and foramina are patent.

L5-S1 is significant for presence of large disc extrusion which is eccentric to the left measuring 1cm in AP dimension. This is associated with an annular tear about its posterolateral margin to the left. A small component of disc extends slightly caudal to the interspace. This extends into the left lateral recess contacting and deflecting the left S1 nerve root. The right S1 is crowded however not deflected. The central canal remains patent. There is mild narrowing of the left neural foramina.

IMPRESSION: Large L5-S1 disc protrusion effacing the left S1 nerve root within a lateral recess

After doctor looked at my result , he said "this is very bad" , then he started asking me some questions regarding any problem with my bowel and bladder, and saddle numbness, I basically did not have any problem with that . The only problem i had was extremely excruciating pain. Then , he prescribed "Prednisone" for 2 weeks term, he said if " I don’t see any improvement after 2weeks of taking this medicine , he will transfer me to the specialist of pain management for the Cortisone injection . A day after taking prednisone, I began to have constipation and diarrhea, but constipation is most of the time. I was not sure, could the prednisone cause constipation? (I m scared of having cauda equina) I ran to the office, and tried to see him. Unfortunately, he was out for vacation and not come back after two weeks. I came back 2 weeks later when i finished the Prednisone. I asked him "do I have cauda equina?" because I am having the difficult bowel movement .He said "he does not think my constipation and diarrhea related to my back”. He also did some physical examinations; he tested my ankle reflexes and anal sphincter (he said they were fine).He gave me some the Lyrica. But i actually still worry about CES, i think about it all the time. I would not worry that much if I don’t have constipation and diarrhea. I have searched so many information online that herniated disc can cause "Cauda equina Syndrome" .The most common cause is large disc herniation and central compression on the cauda equina nerve roots, and its symptoms associate with bladder / bowel disturbances(retention and/or incontinence), saddle anesthesia, perianal numbness, foot drop..etc... .My disc protrusion is large (1cm).However, i know I don't have problem with my bladder; I am able to urine when I need. There is no numbness around my anus, but I feel uncomfortable due to hard and dry stool that make my anal skin becomes sensitive....there is no saddle anesthesia. I do have some tingling on the left calf down to feet when I have awkward posture (lean my back against the wall and put the right feet on the wall, the left leg will tingle). I can walk on my toe and heel...

The pain is getting better, i can describe the current pain is about 1 out of 10. I think i can run now; however, there is just only 1 problem that really frightens me is the "irregular bowel movement". I have suffered alternating between constipation and diarrhea for more than 1 month (right after the day I took prednisone).

My MRI shows no evidence of central compression on the nerve root...My question is "Does the disc likely to move and compress on the cauda equina nerve root? (I m sorry if this question sounds idiot...I 'm too depressed about CES)--- my MRI has been done two months ago; i asked Dr for another set of MRI, but he said it is not necessary.

Nana4&cntn
03-13-2009, 08:26 PM
Hi and welcome to BT,

I am so sorry you are in pain and afraid you have CES. Since your Doc has checked you over and is sure you don't have CES. From what I have read usuallt you would have bowel and bladder problems if you had CES.

I would suggest trying Miralax for your constipation. Make sure you drink plenty of fluids and a healthy diet.

I know you said your pain levels are down and you could run. Please don't run until you talk to your doc. The lumbar region takes considerable punishment from physical activity. Since your mri already shows an annular tear, you sure don't want to make it worse and press on the S1 nerve root worse that it already is.

I have the same type of injury and have had surgery 3 times, w/o success. Please follow your doctors orders to the tee.

Please feel free to join us in Spinal Disorders, just continue to scroll down and you will find some of the most knowledgable people with back problems and a couple with CES, who know a lot more than I do.

Take care and all my best,
Kathy

sandi1016
03-25-2009, 11:31 PM
Hi and Welcome. As it sounds like your doctor is a bit misinformed about what CES is and what it isn't.....it does not have to be BOTH bladder and bowel changes to be CES, it has to be one or the other, or BOTH but not BOTH exclusively.
Many of the people that I know that do have CES have bladder problems or bowel problems but not both, and then there are those, like me, who do have both issues to contend with. In large part, what determines whether you have bladder or bowel issues or both is where exactly the nerve roots are compressed. Unfortunately for you, the S1 nerve root is connected to the bowels, so it is very possible that it is CES, and it may be that the fragment of the herniation was touching or compressing the nerve root, and that is what caused the bowel problems. The good news is that the anal wink test that he did, shows the nerve function is preserved, which means that it is not a "complete" spinal injury....what that means is that nerve function is preserved at that level, but it does not mean that it did not cause damage.....is that clear as mud?
I think that you really need to go see your doctor again and discuss his misconceptions about CES....maybe even direct him to some resources so that he can see that for himself...
If you have any more questions, feel free to ask.....I'm sorry that you have found yourself here.....
Sandi