Severe Left Thigh Pain: Should I Consider Surgery or Continue Rehab? - Neurosurgery

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When considering the management of severe left thigh pain, especially in the context of your medical history, it is crucial to weigh the options of surgical intervention versus continued rehabilitation. Given your age, diabetes, hypertension, and history of coronary artery bypass surgery, these factors significantly influence both the risks associated with surgery and the potential benefits of conservative management.

Firstly, the MRI findings indicating degeneration of the S1 and L5 vertebrae suggest that your pain may be related to spinal issues, potentially involving nerve compression or irritation. This can lead to symptoms radiating down the leg, including the severe pain you are experiencing. In cases like yours, where conservative measures such as physical therapy have shown some improvement, it is often advisable to continue with rehabilitation before opting for surgery.

Physical therapy can be particularly beneficial in managing pain and improving function. It often includes exercises aimed at strengthening the muscles around the affected area, improving flexibility, and enhancing overall mobility. Since you mentioned that the physical therapist was able to provide some relief and you could walk a few steps after their intervention, this indicates that conservative treatment may still be effective for you.
Surgery, while it may provide relief for some patients, carries inherent risks, especially for individuals with pre-existing conditions like diabetes and hypertension. Surgical risks can include infection, delayed healing, and complications related to anesthesia. Additionally, there is no guarantee that surgery will completely resolve your pain; some patients may continue to experience discomfort even after surgical intervention.

Given your situation, it would be prudent to continue with physical therapy and closely monitor your symptoms. If you find that your pain persists or worsens despite rehabilitation efforts, or if you experience new symptoms such as weakness or numbness, it may then be appropriate to revisit the option of surgery.
In terms of your specific questions regarding surgery:
1. Risks of Surgery: The risks associated with surgery in patients with diabetes and a history of heart disease can be significant. It is essential to discuss these risks with your surgeon, who can provide a detailed assessment based on your overall health status.

2. Likelihood of Recovery: While many patients do experience significant relief from surgical interventions, outcomes can vary. Factors such as the extent of degeneration, the specific surgical procedure, and individual healing responses all play a role in recovery.

3. Continued Rehabilitation: Continuing with physical therapy is a reasonable approach, especially since you have experienced some improvement. It is essential to maintain open communication with your healthcare providers about your progress and any changes in your symptoms.

4. Monitoring Symptoms: Keep a close eye on your symptoms. If you notice a decline in your ability to perform daily activities or if pain becomes unmanageable, it may be time to reconsider surgical options.

In conclusion, while surgery may be a viable option for some, your current improvement with physical therapy suggests that continuing this approach could be beneficial. Regular follow-ups with your healthcare providers will help ensure that you make informed decisions about your treatment as your condition evolves. Always prioritize a multidisciplinary approach, involving your primary care physician, physical therapist, and any specialists, to ensure comprehensive care tailored to your needs.