Q. I am on pacemaker with back pain and weakness in left leg. Will nerve root injecion help?

Answered by
Dr. Renjit George Marcus
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 08, 2020

Hello doctor,

I am a 66-year-old male. I am on a pacemaker for the past 18 years (non-MRI-compatible, dual-chamber with full dependence on a pacemaker). I weigh about 78-80 kg. I have back pain for several years, but I have severe back pain for the past month, and my left leg muscles went flaccid. I have a slight weakness in the right leg too.

I consulted a neurologist and an orthopedic surgeon. The pain was reduced in the back by medications (steroids, painkillers, etc.), but the pain near the buttocks pertains, and left leg weakness continues in the selected muscles while a few have started recovering. I am continuing painkillers and some other neuro medicines like Cirrosam, Felicita, Nervemax, and Trigabantin 300. I had to go for a CT myelography to examine the issue after a month. I am attaching the report for reference.

Will epidural or nerve root injections be of any help in reducing pain? Do these injections help heal or reduce compression? Or are used only for pain management? Can this be treated without surgery (traction, physiotherapy, or alternative treatments)? Given age and pacemaker, is it advisable to go for surgery? Are surgeries successful in the level with severe impact (L2/L3)?



Welcome to icliniq.com.

I am sorry to hear about what you are going through from the details of your symptoms and your reports (attachment removed to protect patient identity).

In my opinion, the best option would be to undergo a microscopic discectomy or an endoscopic decompression of the spine at L2 L3. The nerves to your left thigh and knee are blocked due to the disc bulge.

Epidural and nerve root injection only reduces the inflammation around the nerve root and does not remove the block. It is just like a high dose of anti-inflammatory at the site of obstruction. So the relief is mostly going to be temporary.

All the symptoms you described can also come due to a knee problem like a meniscal or ACL (anterior cruciate ligament) injury. I suggest you make sure your knee is fine before doing anything else. A nerve root injection, which is a simple procedure, will give you a better idea of how much improvement you will have after surgery. So it can be used in deciding if you need surgery rather than treatment as such.

Microscopic surgeries are relatively safe, and though you have a pacemaker, it should not be a serious problem. Decompression will give good results. With this weakness, physiotherapy is unlikely to give any lasting improvement. Since the muscles are atrophied, it means that the compression had been there for a long time, and a lot of damage has already happened to the nerve. Surgery will decompress the nerve, but the recovery of damaged will take time and need not be complete. But the pain will be relieved. You will need physiotherapy after surgery.

So my final opinion in a nutshell. Go for a nerve root injection. See how you feel. If you are feeling much better and relieved, go for surgery and get well soon. If there is not much improvement with nerve root injection, the results of the surgery is not going to be great.

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