Successtory -

Hi again, just me. I wanted to ask you a question and see what you think.
My nucleo on 10/20/03 did help recede the herniation, but it was not the cure I hoped for because I have a small radial annular tear at L5-S1. So pain still exists either due to chemical irritation and/or nerve fibers in the outer annulus. Cortisone and nerve blocks help contune to fight it temporarily, but I know that if the annular tear was closed it could help. I have found no procedure which does this except for supposedly IDET which I have read too many negative outcomes and long painful post-op pain and recouperations.
I won't do fusion, and ADR is a possibility down the road.

But hence my question. There is a procedure called SED (selective endoscopic discectomy) from Dr Yeung out in Phoenix. His technique uses a microdiscetomy with an endoscope and an adjunctive procedure called thermal annuloplasty. It is supposedly less invasive and post operatively pai nful than IDET. But it claims to heal a annular tear. Just wondering what you think? And what you know of anything that seals annular tears, even small ones?

Seems like all discectomy and micro-discectomies, even traditional ones remove herniated material from the nerve root, but I still feel that as long as the tear is there, it will just come back and leak out once again. Thoughts?

Hope your well,
Ken

I'm not successtory (obviously). I'm going in Wed to talk to my dr's re. my annular tears. I know my neuro's not as impressed w/ IDET as he used to be. They've done 6 - 3 better, 2 same, 1 worse. Did you consider Enbrel? I haven't talked anyone in to prescribing it. But, today I read of the herb DHEA inhibiting TNF-A factor (the burning chemical that leaks from the tears) just as Enbrel does! We'll see, I started today. 30 days worth for $7. I'll tell you if it helps any!!

Hi Ken,

I'll do some investigation on the SED, but I concur with your thoughts that the only thing that will "heal" a tear is either the IDET or the nucleoplasty. My doctor used to specialize in the IDET....he prefers to perform only the nucleo on tears now. The temperature is infinitely less than with the IDET, thus less damage and recovery time.

You are also right about the pain not going away due to the tear(s). It won't until they are (it is) fixed. Cold therapy is one of the best ways to control the leakage (liquids get slower when cold) and thus help with your pain. It is too bad they didn't do the IDET when you had your nucleo. They used the same holes with the nucleo for my IDET--less trama and stuff. Do you have a good doc available? What about another nucleo....maybe the radio frequency nucleo is something for you. At least with a nucleoplasty....one CAN have another, whereas most of the other operations a repeat performance would weaken the disk too much. I hope this answers your question, if not...keep trying. hehe Good luck!:)

Amy R -

I have heard that many things can seal a tear (enbrel, DHEA, glucosamine/chondroition/dmso intradiscally, etc....). It is all anectdodal. Until I see some real clinical studies, it is just pot shots from docs who want to make a few more $$$$. Sounds pessimistic I know, but no more docs guessing what "could or might" work.

Successtory -

Nucleo is for contained herniations only. There are no guarentees about annular tears. I have spoke with the med director at Arthrocare, my doc, your doc out in California, and some other nucleo docs. It's only purpose is to decompress any material touching a nerve root. I have a bad feeling about IDET from everything I have read, read on these posts, talked to docs, etc...
I take glucosamin/chondroitin in large (normal) doses thinkin that might help, so far no luck. If I can't find anything, or if SED is not an option, I may end up with another discogram to see exactly how large the tear is. If very small, I'll just have to survive with shots until ADR is more a possiblity.
See what ya think about SED!

Ken

Hi Ken,
I feel the same way. I wasn't always so pessimistic. I take glucosamine/chondr/msm, too. A year later, the tears are still there. I never knew they could inject them in the discs, like you said! When you say survive w/ shots, are you talking about epi's?

Ken--I don't have much substantive to add. There are some who suggest that tears heal "naturally" in something like 18 months, but I don't know how solid is the data for such claims. Certainly, you are doing the work to find out. Have you contacted Dr. Yeung directly?

Standingman

Amy & Standingman -

The shots I was talking about are both epidurals (remember, only 3 per year), or a nerve block in between those times, you know.....

I have not contacted Dr Yeung yet. I am still doing as much research as I can find. My problem is either disc touching nerve root, chemical irritation of nucleus material, or annular nerve fibers. I am talkining to one of the best neuro's around my area tommorrow to see his thoughts, then I would still get two more opinions. Found one of the best neuro's in NY, then there is either Penn Spine or the Rothman Institute in Philly. I have done OK with strong P/T, but still would like a more permanant solution. Maybe it is just a matter of learning to live with better pain management.
I certainly do know more about ADR than I ever did. Looks very promising but of course nothing is a guarentee right. Still fighting to never have a major surgery and hopefully I won't ever need to. Whatever keeps me going!
Hope your both OK.

Ken

Glucosamine raises cholesterol. Watch your cholesterol.
fly

I guess I keep showing up as the Enbrel Scrooge, but I don't mean to be. If one has had apparent success with it, terrific. But there are simply no studies (beyond anecdotal) that show usefulness more broadly, and even the anecdotal study--although it appeared in a journal--was written by a guy who has patented the use of Enbrel for back pain and has an acknowledged financial interest in its being thus used. When I wrote to him in order to get fuller numbers about the proportion of successes and failures among those back pain patients he's treated, I heard nothing back. Nada. Given my own profession, I am used to being in touch with authors of journal articles; do so all the time. This is the first time in my experience that one has refrained from responding at all to this sort of query. Make of that what you will.

Enbrel is a drug with a black box warning--the most serious warning the FDA requires for possible adverse reactions (short of withdrawing a drug from use). It may well be worth it to some patients to try it, just as many RA patients use it regularly and with good results. It's important to know the potential risks/benefits though, and, for back pain patients, we essentially have no useful info at this point on which to predict potential benefits.

Standingman

Oh, I know. I wouldn't trust that man as far as I could throw him, and I coudln't throw him very far with this back!