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Old 10-26-2012, 04:07 AM   #1
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Help please - opinions needed

I'm new here, although I've been reading for awhile.

I am 21 years old, a student nurse ( although that is unfortunately on hold ), moderately active and I need help!

I have suffered from lower back pain for about 4 years, thought never severely. I tried physio and pain meds, but there was never much of a change.
About 6/7 weeks ago I woke up in agonizing pain. Went to the Dr who prescribed me oxycodone and sent me for a CT scan.
In summary, the CT scan said -
-Retrolisthiasis of L5 on S1
-Left paracentral disc protrusion with mild calcification
-Mild indentation on the thecal sac
-Marked compression of the left side S1 nerve root.

Ever since this episode I have been unable to do most of my normal activities. I am housebound, and struggle to shower and dress myself.
My left leg hurts all the time, burning down the back of my thigh and calf, on the side of my knee, and numbness and tingling on the outer side of my left foot.

I am getting an MRI in 5 days, and then seeing a neurosurgeon a week later.
I am going nuts trying to figure out what he will recommend - steroid injections, physio, surgery?

The level of pain in my back and leg are debilitating, I need to go back to my studies, and I'm getting so depressed being stuck in the house all the time in severe pain.

Thankyou in advance!

 
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Old 10-26-2012, 08:29 AM   #2
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Re: Help please - opinions needed

First of all Welcome to the board. Sorry you are having such trouble.

I have been on disabililty for 10 years after going thru 7 spine surgeries to my neck and lumbar areas. I have Harrington rods in probably half of my spine at this point and I am still suffering.

I used to handle Bodily Injury claims in the insurance business so I was used to reading MRI and CT scans.

First I was always taught, and this is only an opinion, but MRI's are supposed to give better details then CT scans. Again right or wrong that seemed to be the opinion.

It would appear that you have some disc issues in that you stated there was a protrusion. It is not uncommon for an adult to have spine issues. Most people do once they reach adulthood. But what concerns me is the nerve that is noted at S1. So you disc issues that are affecting your nerves as well.

Think of your spine as bony material. But at each level there is this soft material which is the disc. As we get older it will shrink in size and protrude. It is like a grape that has lost some of the water within it and thus the disc shrinks and will start to protrude. It seems that it is causing nerve problems.

What concerns me is that your quality of life being affected in that you can not do things your normal daily activities.

I think for now get the MRI done and see if it can give you more details. When you get the MRI report if you want post the results of the actual report so that we know the wording as per the radiologist.

Has the oxycodone been helpful in relieving the pain? Oxycodone is an opiate/narcotic and can be powerful.

Before surgery is considered see what the surgeon says as to whether physical therapy can be helpful in getting you back to normal. Spine surgery is not to be taken lightly. Get 2 or 3 opinions if needed to see if they agree on the issue of surgery.

Please let us know what the MRI says. Good luck

 
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Old 10-26-2012, 09:09 AM   #3
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Re: Help please - opinions needed

Quote:
Originally Posted by pebblebeach3 View Post
First of all Welcome to the board. Sorry you are having such trouble.

I have been on disabililty for 10 years after going thru 7 spine surgeries to my neck and lumbar areas. I have Harrington rods in probably half of my spine at this point and I am still suffering.

I used to handle Bodily Injury claims in the insurance business so I was used to reading MRI and CT scans.

First I was always taught, and this is only an opinion, but MRI's are supposed to give better details then CT scans. Again right or wrong that seemed to be the opinion.

It would appear that you have some disc issues in that you stated there was a protrusion. It is not uncommon for an adult to have spine issues. Most people do once they reach adulthood. But what concerns me is the nerve that is noted at S1. So you disc issues that are affecting your nerves as well.

Think of your spine as bony material. But at each level there is this soft material which is the disc. As we get older it will shrink in size and protrude. It is like a grape that has lost some of the water within it and thus the disc shrinks and will start to protrude. It seems that it is causing nerve problems.

What concerns me is that your quality of life being affected in that you can not do things your normal daily activities.

I think for now get the MRI done and see if it can give you more details. When you get the MRI report if you want post the results of the actual report so that we know the wording as per the radiologist.

Has the oxycodone been helpful in relieving the pain? Oxycodone is an opiate/narcotic and can be powerful.

Before surgery is considered see what the surgeon says as to whether physical therapy can be helpful in getting you back to normal. Spine surgery is not to be taken lightly. Get 2 or 3 opinions if needed to see if they agree on the issue of surgery.

Please let us know what the MRI says. Good luck
Thanks for your reply
The oxycodone helps, a few days ago my regular dr prescribed lyrica for the pain in my leg. In conjunction, they work pretty well, sometimes so well thy I have to be really careful not to overdo it even if I can't feel the pain.

I'm happy to post the MRI report here and see what you think.
Thanks for your help, and sorry to hear about the trouble you have

 
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Old 10-26-2012, 09:24 AM   #4
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Re: Help please - opinions needed

I was on oxycodone but had trouble with it. It affected my breathing for some reason. But I am now on hydrocodone. Sometimes it helps sometimes it doesnt.

I think you will find people here with tons of knowledge and different experiences.

I learned the hard way but when it comes to medical treatment get the best doctor that you can to treat you.

I dont know what your insurance plan is but I always check to see who is on the list and find out where they went to school, where they did their residency/internship how many years in practice. And what their speciality is. Are they published and do research? that type of information is what I look for.

but what is on paper isnt the only criteria for who is the best. It comes down to also as to how they communicate with you. Do they answer your questions? Do you have confidence in them when you have an office visit? Is it easy getting an appointment as well. How is the office staff when you have to deal with them. A lot of factors in choosing the right doctor.

As to the MRI yes the actual results would help us and we can see if we can relate or supply any insight.

I just posted my MRI of cervical spine to get feedback to see if they or any agrees with me on how I intrepret the results and if any one has similar issues.

Good luck and keep us posted.

 
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Old 10-26-2012, 10:45 AM   #5
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Re: Help please - opinions needed

When i was 26 y/o i had an accident, someone fellon meresults wereL4-L5 & L5-S1 severe disc & nerve root probs. Had lumbar lams. By nrurosurgeon. Now they have SOME neurosurgeons that do minimally invasive surgeries. Make SURE that is who you see. At a major hospital. Call thevneoro icu and ask a nurse or 2 to give you who they think is top notch 3 min inv neuros or ask PT. Back then, my neurosurgeon, lets say NS now, admitted me & did 2 weeks of PT first and then surgery. Thank you,snapdragon. Let me know if you need anything that i could do from here, an ear?

 
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Old 10-30-2012, 07:17 PM   #6
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Re: Help please - opinions needed

As promised - my MRI report

Findings -
Sagittal alignment of the lumbar spine is intact.

Vertebral body heights and bony signal intact.

Posterocenteral discopathy noted at L5/S1, degenerate disc signal. Remaining disc signals are intact, allowing for Schmorls nodes at all levels T12 - L3.
The conus is identified without significant changes to the conus.

L2/L3/L4/L5 - disc, thecal sac, foramina are intact.

L5/S1 - Mild left paracentral disc protrusion impinges on the S1 nerve root to the left. Canal diameter is 11.7mm.
Annulus bulge touches the exiting L5 nerve root on the left.




There are two differences between this and my CT scan (13 days prior).
1. I had retrolithiasis on the CT
2. My canal diameter was measured at 12.2mm

So, I know that this probably looks like its not causing me much pain, but I promise that it is.

Also, I've been changed from Lyrica to Neurontin today

Thanks

 
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Old 10-31-2012, 06:14 AM   #7
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Re: Help please - opinions needed

How much Neurontin were you put on?

As with any medication it works for some people and not for others. I was on Neurontin 2X's. the first time I was on 3600 mg per day and it did NOT help me. In fact I was bouncing off the wall in that I blacked out once. I was having a conversation with someone and didn't even remember it.

Then I was put on it a 2nd time I think it was 900 mg and did NOT help the pain.

Hope it works for you

 
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Old 10-31-2012, 06:28 AM   #8
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Re: Help please - opinions needed

Quote:
Originally Posted by pebblebeach3 View Post
How much Neurontin were you put on?

As with any medication it works for some people and not for others. I was on Neurontin 2X's. the first time I was on 3600 mg per day and it did NOT help me. In fact I was bouncing off the wall in that I blacked out once. I was having a conversation with someone and didn't even remember it.

Then I was put on it a 2nd time I think it was 900 mg and did NOT help the pain.

Hope it works for you
Hi
I was put on 300 mg tid, so 900 mg a day. I've only taken two doses, and although the pain in my left leg is a little better, I'm getting some side effects.
The best way to describe it is that I get stoned...wandering around doing randomthings, forgetting things, gibbering a mile a minute until I eventually fell asleep.

Tomorrow I'll try only taking one in the morning. We switched to Neurintin because with all the bills for drs and scans coming in, I can't really afford to stay on Lyrica. We've spent $1000 this week alon (MRI, 2x dr visits and prescriptions).

I cant see me being able to work, but I don;t think I'll have much of a choice soon, even if it worsens my injury

Oh well, we will soldier on

What do you think of my MRI?
I was quite surprised at how minimal the remarks were, considering the severity of symptoms.

I hope you're well

 
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Old 10-31-2012, 01:19 PM   #9
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Re: Help please - opinions needed

Why were you changed from the Lyrica to neurontin? Lyrica has fewer side effets for most people as you need less of it. It is the newer formulation of neurontin (Gabapentin).

Did you have the MRI done at the same facility and was the CT available to the radiologist for review?

The retrolisthesis did not just go away on its own. It may be that it didn't show up on the MRI. Have you had a flexion/extension x-ray? That is usually the test that is best at showing a spondylolisthesis.

Were you an athlete in your teens?

The fact that you have two nerves that are coming in contact with the bulging disc is reason enough for the pain you are feeling. I disc bulge does not have to be large to be painful...and an annular tear can result in lots of pain, or none at all...it just depends on whether the nerves are impacted, or not.

There are nerve endings in the outer rim of the disc, so an annular tear can cause irritation.

Schmorl's nodes are an indication of spinal degeneration of the "wear and tear" variety and are most often found in people older than you. They generally are not considered a pain generator, but I would wonder why the doctor thinks you have them, and at so many levels.

So, how were things left? What is the plan of treatment?

 
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Old 10-31-2012, 06:26 PM   #10
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Re: Help please - opinions needed

Quote:
Originally Posted by teteri66 View Post
Why were you changed from the Lyrica to neurontin? Lyrica has fewer side effets for most people as you need less of it. It is the newer formulation of neurontin (Gabapentin).

Did you have the MRI done at the same facility and was the CT available to the radiologist for review?

The retrolisthesis did not just go away on its own. It may be that it didn't show up on the MRI. Have you had a flexion/extension x-ray? That is usually the test that is best at showing a spondylolisthesis.

Were you an athlete in your teens?

The fact that you have two nerves that are coming in contact with the bulging disc is reason enough for the pain you are feeling. I disc bulge does not have to be large to be painful...and an annular tear can result in lots of pain, or none at all...it just depends on whether the nerves are impacted, or not.

There are nerve endings in the outer rim of the disc, so an annular tear can cause irritation.

Schmorl's nodes are an indication of spinal degeneration of the "wear and tear" variety and are most often found in people older than you. They generally are not considered a pain generator, but I would wonder why the doctor thinks you have them, and at so many levels.

So, how were things left? What is the plan of treatment?
I'm trialing Neurontin mostly because of the difference in price. It seems to be going well.

The MRI was done at the same facility, and reviewed by the same radiologisit, which is why I was confused.
I haven't had an x-ray, only the CT and MRI. I wasn't an athlete, moderately active, but nothing serious.

I dont have a plan yet, I'm seeing the neurosurgeon on the 5/11, so not long now thank god

Thanks for replying

 
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Old 11-02-2012, 02:07 PM   #11
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Re: Help please - opinions needed

Dear snapdragon, I hope that you will get minimally invasive spine only neurosurgeon!! I was so much like you, @ 26 working, its impossible to say. Something in my gut told me not to have surgery. After surgery, neurosurgeon, top in tx medical center, he found my discs had exploded into pieces @ L4-L5 & @ L5-S1. So, he did dural grafting in 32 places where I was leaking CSF. 2 days after surgery I start leaking CSF again. This led to 2nd surgery, more dural grafts. Then punched out disc @ L5-S1 again 7 years later.3rd surgery- i leaked CSF again. 4th surgery, fascial plastic closure to dura. I have been in pain chronic for 30 years. Please, please,please try everything before letting someone open your meninges!!! I have a chronic condition called adhesive arachnoiditis that causes great pain forever, caused by medical invasive testing, epidural steroids that accidentally go intradural, & surgeries. I think back on the pain i had before surgery, it was zero compared to now! You arent leaking CSF, IF you have surgery do minimally invasive. Time is what you dont have because i understand about nursing school, how you have to start over, or change class that you will graduate with. But, a large percentage of herniated discs self heal(76%?). My own childs did @ 1 year. Nothing that you have to
give up is worth what i have now. Time, PT, exercises, a steroid injection epidurally or facets. Please I believe you that you cant function but a wise dr said an intact CNS is the most perfect, fragile environment in the body. It is your greatest asset. Try everything else first. I say this because I care about you & your life, your whole life. Not just right now life. I hope you understand that I say this to support you. Take your parents with you to neurosurgeon. Write down all your questions. Make one of them" Do people ever get better from this without surgery

Last edited by gmak; 11-02-2012 at 02:10 PM.

 
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Old 11-02-2012, 07:11 PM   #12
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Re: Help please - opinions needed

Quote:
Originally Posted by gmak View Post
Dear snapdragon, I hope that you will get minimally invasive spine only neurosurgeon!! I was so much like you, @ 26 working, its impossible to say. Something in my gut told me not to have surgery. After surgery, neurosurgeon, top in tx medical center, he found my discs had exploded into pieces @ L4-L5 & @ L5-S1. So, he did dural grafting in 32 places where I was leaking CSF. 2 days after surgery I start leaking CSF again. This led to 2nd surgery, more dural grafts. Then punched out disc @ L5-S1 again 7 years later.3rd surgery- i leaked CSF again. 4th surgery, fascial plastic closure to dura. I have been in pain chronic for 30 years. Please, please,please try everything before letting someone open your meninges!!! I have a chronic condition called adhesive arachnoiditis that causes great pain forever, caused by medical invasive testing, epidural steroids that accidentally go intradural, & surgeries. I think back on the pain i had before surgery, it was zero compared to now! You arent leaking CSF, IF you have surgery do minimally invasive. Time is what you dont have because i understand about nursing school, how you have to start over, or change class that you will graduate with. But, a large percentage of herniated discs self heal(76%?). My own childs did @ 1 year. Nothing that you have to
give up is worth what i have now. Time, PT, exercises, a steroid injection epidurally or facets. Please I believe you that you cant function but a wise dr said an intact CNS is the most perfect, fragile environment in the body. It is your greatest asset. Try everything else first. I say this because I care about you & your life, your whole life. Not just right now life. I hope you understand that I say this to support you. Take your parents with you to neurosurgeon. Write down all your questions. Make one of them" Do people ever get better from this without surgery
Wow that sounds so scary and painful I hope you're ok, well as ok as you can be.
I've already had to delay my graduation by 6 months because I was unable to complete the practical placement, so I have 6 months to trial physio/ESI, anything non-invasive.
The neurosurgeon that I'm seeing apparently doesn't reccommend surgery straight off the bat, which is great. I'm actually starting to feel a little better (as long as I remember not to over do it) with the Neurontin and oxycodone, but obviously I don't want to stay on them forever.
My partners coming with me We've been together 8 years and she always questions doctors.

Hope you're well

 
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Old 11-02-2012, 07:41 PM   #13
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Re: Help please - opinions needed

Quote:
Originally Posted by snapdragon123 View Post
Wow that sounds so scary and painful I hope you're ok, well as ok as you can be.
I've already had to delay my graduation by 6 months because I was unable to complete the practical placement, so I have 6 months to trial physio/ESI, anything non-invasive.
The neurosurgeon that I'm seeing apparently doesn't reccommend surgery straight off the bat, which is great. I'm actually starting to feel a little better (as long as I remember not to over do it) with the Neurontin and oxycodone, but obviously I don't want to stay on them forever.
My partners coming with me We've been together 8 years and she always questions doctors.

Hope you're well

Oh so great! So glad you have her! And glad neurosurgeon is not knife happy! Too say the least. No one told me for 30 yrs! I was 26, history above, then 2012 a neurosurgeon recommended by my old one that retired in 2005, gets MRI results & tells me that I have AA. I read over all my MRIs from all the years & it first showed in 1988! Got hurt 1982. Wow, i lost my dr of 12 yrs @ same time. Went to 3 NS (neurosurgeons) & 2 pain mgmt drs. While learning what AA was. Finally, i can say i am knowledable about ehat is really wrong with me. So, write those questions down, get well yourself first & then you can graduate & take care of others! I realize that you will have to take care of others in clinical, so, wait on that, too. You will reach all of these goals. In time. Consider pedi, nursery, or school nursing. Light lifting! Good luck to you. Sounds like your in great hands. Thank you, gmak

 
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Old 11-05-2012, 03:46 PM   #14
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Re: Help please - opinions needed

We saw the neurosurgeon yesterday, he did a full physical exam, and examined my MRI scans very closely.
I'm having a nerve root block this week sometime and if, in 3-4 weeks, my pain hasnt resolved, we'll go back to discuss options for surgey.
I was really happy with the neurosurgeon, he was nice and it was easy to ask questions. He also showed me the problematic areas on my MRI. He thinks that i will need a discectomy because part of the protrusion is calcified, and therefore I would have a lot of trouble getting it to reduce naturally.

Thanks

 
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Old 11-05-2012, 11:19 PM   #15
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Re: Help please - opinions needed

Quick question for those that have had a nerve root block, does the pain really intensify afterwards?

 
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