CT guided celestone chronodose injection

[MareeHH]

Good Evening Folks

Hubby has developed a very dibilitating case of sciatica and recently had an MRI at Bangkok Hospital. The results showed significant nerve root compression on both the left and right side at L4-L5 with stenosis from L2-3 to L5-S1. The condition of his spine is as a result of a number of njuries sustained during heavy lifting over the years. 

He has been prescribed anti-inflamitory and pain management medication, which to date has been unsuccessful. Additionally he has tried physiotherapy and dry needling.  

As he has had no success thus far, Hubby contacted our doctor in Australia with the results and he recommended trying a CT guided celestone chronodose injection rather than fly home for treatment. Has anyone had any experience with this type of procedure here? How successful was it and what was the approximate cost (the old pre-existing issue regarding insurance). Fortunately we have preserved our,private health insurance in Australia. 

 

We want to minimise the risks and if we cannot find an experienced radiologist to do ithis procedure we will fly home. 

Thanks in advance for any advise and info.

Cheers Maree

[Sheryl]

Celestone chronodose is a brand name for a steroid. This particular brand is not available in Thailand but others are  and epidural injection can be obtained from spinal specialists. It is done fluorscopically.

 

HOWEVER you need to know that:

 

1 - from what you describe, your husband probably  needs surgery assuming he is does not  have other major medical issues that would make it inadvisable

 

2- pain relief from steroid injections is not as good in cases of lumbar stenosis as it is in back pain form other causes (for obvious reasons - the pain is due to bone pressing on nerve and the injection does nothing to relieve that)

 

3- any pain relief that is obtained, will only be temporary

 

4- if there is nerve root impingement there is a real risk of permanent nerve damage. Any damage that occurs before hand will not be reversible once he gets surgery as he likely will in the end. Many people end up with permanent limps and other disabilities as a result of putting surgery off for too long.

 

In short, he should probably go back to Australia and have surgery there to correct the problem.

 

If you want adiditonal opinions I recommend:

 

Dr. Wicharn  at BNH hospital  https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

 

Dr. Chaiwat Kraiwattanapong at Vejthani Hospital   https://www.vejthani.com/web-english/pop_en.php?id=377

 

When you see them, bring the MRI with you (actual film not just the report). Things to specifically ask about are:

 

- whether surgery is indicated and risk of delaying it

 

-pros and cons of epidural steroid injection in his specific case (likelihood of achieving temporary pain relief; whether doing this instead of surgery sooner will risk nerve damage

[MareeHH]

Sheryl. Thank you so much for your valuable information and advice. It makes a great deal of sense to me. 

I also agree that returning to Australia for surgery is a good option. 

 

Cheers Maree. 

[MareeHH]

Well it’s been quite a while since I posted this topic and thought I would give an update on how things turned out.  

 

On arriving back in Australia my husband had an emergency appointment with a spinal specialist. The specialist undertook an examination and very quickly found that although my hubby did indeed appear to have some concern around his sciatic nerve, the biggest issue was lack of blood flow to his leg. Apparently he had NO femoral pulse, and the only blood reaching his leg was from small veins. 

 

He was then then rushed over to the vascular surgeon who on examining said he needed to get him into surgery to save his leg, as he had a total blockage and had already developed a tiny sore on his little toe which indicated that time was of the essence. 

 

The surgery was somewhat intricate as hubby is prone to adhesions and therefore the surgeon wanted to stay away from his heart and stomach so had to take blood supply from the other leg via a fem fem crossover.   Hubby has healed well apart from some residual nerve damage in his foot.  

 

Ultimately a good outcome, and we have now been back in Thailand for a few months. 

 

A special thanks to Sheryl, I really appreciated you insight and knowledge. You are a treasure. 

[Sheryl]

Thank you for the feedback, I am glad it worked out for your husband.

 

Thank goodness you flew back to Australia rather than getting steroid injection here - it might have cost him his leg.

 

This case is a good example of the facts that:

 

(1) the presence of abnormal spinal findings on MRI or CT does not necessarily mean that pain being experienced is due to them. Post-mortem studies of people with no back symptoms at all have found a very high rate of things like stenosis and disk herniations, for example. In this specific case the OP's husband's pain was actually due to peripheral arterial disease and compromised blood circulation, and not his spinal issues, though he has a number of abormalities in his spine.

 

A main reason why spinal surgeries sometimes fail in terms of pain relief is that the pain was not actually due to the problem the surgery corrected. There is no substitute for a careful physical examination by a good specialist. Nerve conduction studies can also help pinpoint the source of pain and are a good idea for anyone considering spinal surgery.

 

(2) the risks of long distance consultations. Initial rec from their home doctor, made in all good faith, would if followed have been dangerously off base, because the problem was not what it was assumed to be at all, but something entirely different which he (the doctor back in Aus) had no way of knowing. Again, there is no substitute for a hands on examination.

 

It is rather worrying that Bangkok Hospital doctors did not catch the fact that he lacked femoral pulses!  I assume he was examined there before having the MRI? If so this may be an example of specialist tunnel vision i.e. looking only at the spine and not thinking to look at other possible causes.