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Old 02-19-2004, 04:46 PM   #1
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natureschild HB User
Sacroiliac joint/L5-S1 disk bulge

I've been reading the posts here for quite some time. They are very helpful. I wanted to see if anyone has my problem and hope to get some help. I slipped and fell over a year ago and have had pain since then. 2 MRI's (12/02 and 1/04) show a central disk protrusion at L5-S1 with annular tear and mild multilevel facet arthropathy. My orthopedic surgeon suggests a disc fusion because I have not had any relief from the physical therapy or steroid injections and it has been over a year. My physical therapist says I have all the symptoms of sacroiliac joint dysfunction. Anybody else out there have this? If so how are you getting relief. My hips hurt all the time, and I can't sit for more than 10 minutes without terrible leg pains.
Thanks!
Paula

 
Old 02-19-2004, 05:21 PM   #2
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SpondyMom HB User
Re: Sacroiliac joint/L5-S1 disk bulge

[QUOTE=natureschild]I've been reading the posts here for quite some time. They are very helpful. I wanted to see if anyone has my problem and hope to get some help. I slipped and fell over a year ago and have had pain since then. 2 MRI's (12/02 and 1/04) show a central disk protrusion at L5-S1 with annular tear and mild multilevel facet arthropathy. My orthopedic surgeon suggests a disc fusion because I have not had any relief from the physical therapy or steroid injections and it has been over a year. My physical therapist says I have all the symptoms of sacroiliac joint dysfunction. Anybody else out there have this? If so how are you getting relief. My hips hurt all the time, and I can't sit for more than 10 minutes without terrible leg pains.
Thanks!
Paula[/QUOTE]


Hi Paula. I had a herniated L5/s1. The first orthopedic surgeon wanted to first do a miscrodiscectomy then wanted to to a complete fusion a month later! I thought that was a bit drastic so I went to another orthopedic surgeon who wound up performing a hemilaminectomy -- where they basically cut off the portion of the disc pressing on your nerve and leave the rest of it in place. Of course it can always reherniate or degenerate down to nothing, in which case I'd need a fusion, but it seems a heck of a lot drastic.

I'd ask your doc why not a hemilaminectomy. The surgery was pretty easy and the recuperation wasn't too bad either. My back isn't perfect but a lot better than it was!

 
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Old 02-19-2004, 06:25 PM   #3
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natureschild HB User
Re: Sacroiliac joint/L5-S1 disk bulge

He told me because the protrusion was down the center, not on one side or the other, and removing part of it wouldn't make any change

 
Old 02-19-2004, 06:59 PM   #4
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txteacher HB User
Re: Sacroiliac joint/L5-S1 disk bulge

[QUOTE=natureschild]He told me because the protrusion was down the center, not on one side or the other, and removing part of it wouldn't make any change[/QUOTE]


I had an mri done in August that showed a bulging disc, too..at L5-S1. I also have spondo ..slipped vertebra at L5. Nov. 12 I had a lamenectomy to remove the disc and then an anterior spinal fusion with cages.

Prior to surgery I was walking with a cane (i'm 36)...terrible leg pain.
I went to back to teaching 3 weeks after surgery. I am doing great now. Virtually no back pain..unless I sit too much..and no leg pain unless I walk a very long distance.

Get another opinion from a reputable ortho doc. It may be worth it to have the surgery.

 
Old 02-19-2004, 09:39 PM   #5
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standingman HB User
Re: Sacroiliac joint/L5-S1 disk bulge

I appreciate what others have already said. At the same time, I think it may be critical to get clarity on whether you have two sources generating pain (the 5/1 disk and the SI joint) or only one. If it turned out the SI was responsible for most of your symptoms, surgery would be unnecessary--at least 5/1 fusion would be (there are also surgeries of the SI, although much less often done). I would get the best differential diagnostic work-up you can. I have some of the same issues--both demonstrable (on MRI) SI issues and disk problems (at a different level than yours). Right now, I will be doing what I can to treat the SI (via PT and possibly injections) to see how much relief that may provide. If I'm _really_ lucky, that may turn out to be the ballgame. I hope that may be true for you as well! (As my moniker implies, sitting also my biggest problem.)

Standingman

 
Old 02-20-2004, 05:16 AM   #6
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Amy R. HB User
Re: Sacroiliac joint/L5-S1 disk bulge

Hi Natureschild,
You and standingman remind me a lot of myself!
I, too, probably have more than one pain generator, and it is very important that you find this out for yourself. If you do have several things going on, and you just get a fusion, it will not sove all - or even most - of your problems.
Diagnostically, we sound a lot alike. I, too, have central protrusions (only at L3-4,4-5) that aren't pressing on nerves, and disc tears. I have many si symptoms as well.
Yesterday, I had my first si joint injection. It was very easy and somewhat fun. The painful area did not go completely numb (left dimple), which means it's not ALL of my problem, but it does feel a lot better! I can even sit! It helped my tailbone, too.
Next, we will probably test the facets and look more into the tears.
Please, inject the si, inject the facets, and see what that does. You can't get a fusion not knowing about these other things!! Remeber, you may have more that one pain generator! Good luck!

 
Old 02-25-2004, 07:57 AM   #7
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jmichaelp HB User
Re: Sacroiliac joint/L5-S1 disk bulge

Paula,
I have si joint dysfunction as well as a centrally protruding herniation of L5-S1 disk.

A fusion should be the last resort because any functionality provided by the L5-S1 in its current condition is better than no functionality (i.e. fusion no disk & no functionality). With a fusion, all of the pressure is borne by the next disk up which may lead to its demise...

A physical therapist/Chiropractor/Doctor can easily tell if your si joint is out through a couple of quick tests (e.g. lifting one leg while standing). I can tell when mines is out because of the pain of course, but my pelvis feels twisted as well.

If you have si joint problems, I would recommend a COMPETENT Chiropractor. When this joint pops out of place, your pelvis is dislocated hence the pain in your hip area and lower back (the ligaments/tendons are stretched which causes the pain). The procedure to put the joint back in place is simple & GENTLE - you lie on your side with arms crossed, the lower leg pulled up and the upper leg extended. The Chiropractor pushes down on your hip, and repeats for the other side. It's that EASY, don't let any Chiropractor twist you up like a pretzle!

Mike

 
Old 02-25-2004, 05:52 PM   #8
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JewelsD HB User
Re: Sacroiliac joint/L5-S1 disk bulge

Hi! I'm new to this board, and I'm trying to find people with problems/pain like mine.

I have a "mild" disc bulge at L4/L5 and SI dysfunction. I was in a MVA in Sept 2002. I've been going to phyiscal therapy regularly and I've had epidural steriod injections in my facets (early 2003), disc (Nov,Dec 2003), and in my SI joint (Dec 02, Jan 04). After the first ESI in the L4/L5 disc (Nov '03), I was actually pain free for a couple of days. That was the first time since the accident that I had NO pain. The ESIs are also somewhat diagnostic...I think proving the main source of my pain to be disc related. I think most of my pain is with my sciatic nerve in my butt. I experience most pain while sitting (I have a desk job). Last week I had the worst leg pain/tingling since the accident. (Keep in mind my injury was 17 months ago). So I feel like I'm obviously not going to heal on my own.

In the last week I have begun to consider an endoscopic microdiscectomy. They say this is the least invasive procedure of back surgeries - it's outpatient and you leave with a bandaid where they entered your back. Has anyone had this particular procedure and if so, what were your results??

Thanks.

 
Old 02-25-2004, 06:02 PM   #9
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JewelsD HB User
Re: Sacroiliac joint/L5-S1 disk bulge

Paula, is there a physical therapist in your area that does manual adjustments? My therapist is able to adjust my SI when it rotates out of place. But, I agree - you need to find your pain generator. My SI dysfunction is a "result" of my bulging disc, not the actual "cause" of my pain. Good luck!



[QUOTE=natureschild]I've been reading the posts here for quite some time. They are very helpful. I wanted to see if anyone has my problem and hope to get some help. I slipped and fell over a year ago and have had pain since then. 2 MRI's (12/02 and 1/04) show a central disk protrusion at L5-S1 with annular tear and mild multilevel facet arthropathy. My orthopedic surgeon suggests a disc fusion because I have not had any relief from the physical therapy or steroid injections and it has been over a year. My physical therapist says I have all the symptoms of sacroiliac joint dysfunction. Anybody else out there have this? If so how are you getting relief. My hips hurt all the time, and I can't sit for more than 10 minutes without terrible leg pains.
Thanks!
Paula[/QUOTE]

 
Old 02-29-2004, 07:04 PM   #10
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injured betty HB User
Re: Sacroiliac joint/L5-S1 disk bulge

[QUOTE=natureschild]I've been reading the posts here for quite some time. They are very helpful. I wanted to see if anyone has my problem and hope to get some help. I slipped and fell over a year ago and have had pain since then. 2 MRI's (12/02 and 1/04) show a central disk protrusion at L5-S1 with annular tear and mild multilevel facet arthropathy. My orthopedic surgeon suggests a disc fusion because I have not had any relief from the physical therapy or steroid injections and it has been over a year. My physical therapist says I have all the symptoms of sacroiliac joint dysfunction. Anybody else out there have this? If so how are you getting relief. My hips hurt all the time, and I can't sit for more than 10 minutes without terrible leg pains.
Thanks!
Paula[/QUOTE]

Injections for over a year equals chronic pain syndrome. Orthopedic surgeons are looking at surgury which means $. Go to a site on Prolotherapy and read up on it.

 
Old 02-29-2004, 07:08 PM   #11
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injured betty HB User
Re: Sacroiliac joint/L5-S1 disk bulge

[QUOTE=JewelsD]Paula, is there a physical therapist in your area that does manual adjustments? My therapist is able to adjust my SI when it rotates out of place. But, I agree - you need to find your pain generator. My SI dysfunction is a "result" of my bulging disc, not the actual "cause" of my pain. Good luck![/QUOTE]

Manaul adjustments are great but if you have to have them done more than a few times it may be more than just being out of place. When I researched SI dysfunction the bulge was not causing it, the ligaments being lax were. When the ligaments become lax they can't hold your pelvis in place and it twists. If it continues to twist, due to lax ligaments, that bulge will herniate, eventually. If your ligaments are in good shape there is no reason for your pelvis to twist. Also, there is an exercise to move it back by yourself, thus saving you $$$$.

 
Old 02-29-2004, 08:40 PM   #12
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Cindy Stoller HB User
Re: Sacroiliac joint/L5-S1 disk bulge

My first question would be: how severe is the herniation at L5-S1? Is it impinging (touching) the nerve root?
The majority of the pain could be coming from the annular tear. There is a new procedure for fixing tears called an IDET procedure. It basically superheats the disc, melting it, then as it solidifies, the tear is gone, and hopefully so is the pain.
My second question is: what are your symptoms like? Just back pain? Does the hip pain extend beyond the hip, like down the legs to your toes? The hip pain really isnt unexpected, due to your back pain - you walk "different" to compensate for the pain, hence your throw-off your hips too. What injections have you tried? What meds?
Let me know, and good luck.

Last edited by Cindy Stoller; 02-29-2004 at 08:42 PM.

 
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