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Old 04-26-2005, 08:46 AM   #1
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aestrella411 HB User
It's been awhile and I need advise!!!

Because it has been so long since I've been on here, I wanted to put my MRI results and then explain briefly what my problem is:

MRI Results

The L1-L5 vertebral bodies are visualized in anatomic alignment without evidence of fracture or dislocation. The vertebral body heights and signal characteristics appear within normal limits. There is disk desiccation at the L4-5 level where there is an annular tear and small posterior disk protrusion. There is no significant spinal canal stenosis or neural foraminal narrowing at this or any of the other visualized levels.

The conus medullaris terminates at L1-2 level, which is within the normal limits.

Incidental note is made of a cystic structure in the left lateral pelvis which is likely the ovary.

Note that there is a transitional vertebra at the lumbosacral junction. It has an enlarged transverse process that appears to have an articulation with the underlying sacrum on the right.

Impression:

Degenerative disk disease at the L4-5 level with a small posterior disk protrusion and annular tear but not significant spinal canal stenosis or neural foraminal narrowing.

X-Ray Results

An AP and lateral view were obtained of the lumbar spine. There are five lumbar vertebrae. No compression or deformities are seen. The L5 vertebral segment has undergone partial sacralization. The transverse process of L5 on the right has hypertrophied and articulates with the superior aspect of the sacrum. The L5-S1 disk space is mildly narrowed. It is likely rudimentary. The rest of the discs have normal height. The pedicles and spinous processes appear to be intact. The sacroiliac joints are normal in appearance.

Impression:

1. Partial sacralization of the L5 segment.
2. The L5-S1 disk space is mildly narrowed and is believed to be rudimentary.
3. No fractures.

I have been undergoing pain for three years now (and I'm only 21 now) and didn't have a real memory of my "injury" because there was not anything significant that I could remember that would warrant such pain. I have been in the hospital for about two years and initially was taking motrin, naproxin and flexeril. That all too soon stopped working so I tried physical therapy for four months. That made my symptoms much worse. So, they put me on narcotics (which I'm still on them for what seems like too many months to be on Vicodin) and referred me to the pain management clinic. There, I received one ESI and that didn't do a thing for me so they didn't do another one. Meanwhile my physiatrist put me on oxycodone and methadone (separately of course) but those are drugs I will not be on ever again. The symptoms of the pills alone was too great.

After that, this year, I had a successful medial branch block. This gave the doctor the chance to perform a procedure called radiofrequency lesioning on me. I did this on April 15. I was pleased at how well the procedure went, there were no complications. The doctor told me that I was the best patient he ever had because it was real easy for him to get the needles in the right spots for him to lesion the nerves that feed to my facet joints thus cutting the pain receptor that tells my brain there's pain. I was sore immediately after but didn't seem to notice the underlying pain, the pain I've been dealing with for three years. The next day I actually felt pretty good. Then, out of the blue, I woke up on Sunday and my pain was back. I know the difference between muscular pain and my discogenic pain and it was clear to me that something just wasn't right. Ultimately, the procedure didn't work. I don't know why. That's why I'm writing. I mean, if I had a successful medial branch block, then how could the procedure not work? I think I may know why. If you have the medial branch block, they're injecting numbing stuff EVERYWHERE. So naturally it would get rid of my pain because it's even covering those nerves that the lesioning wouldn't be able to do. I mean, my legs were completely numb from the branch block because the numbing stuff went over my sciatic nerve. But with the radiofrequency nerve lesioning, they can't lesion the sciatic nerve because that would cause paralysis. So...that part makes sense to me I guess. I just feel so lost right now. The procedure DID narrow the scope of the pain however I think now it's making me focus on the root of the pain, my disc. I only have one bad disc but it's literally killing me. Ever since the procedure, my sciatica has been getting worse. It use to be on the left side but now it's primarily on my right leg. On bad days both legs hurt but nonetheless, everyday, I'm still dealing with the same level of pain. It gets worse EVERY DAY. On average from 1-10, my pain level is still a 6. That's what its average was and still is.

What do I do now? I'd like to get another MRI because the above one was a year ago and I think, well I hope, that maybe another MRI could show an updated extent of the damage. I wish they could give me a new disc entirely (it's my lumbar spine) but, it hasn't been done enough in California that I would even consider getting the ADR. I wish I could get that. If Cali were at the stage that Germany is right now then I'd totally be in line to get the ADR done. My husband suggests a micro-d. I'd go for it if that's what the doctor's told me. Thing is, I just don't know what to do. Am I just going to wait for it to get worse before my doctors do anything about it. May 3 is my followup appointment for the procedure and I am so angry that I don't have good news for them.

Any thoughts on this is greatly appreciated...

 
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Old 04-26-2005, 09:07 AM   #2
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victorsch HB User
Re: It's been awhile and I need advise!!!

Aestrella,

Boy, that is a tough one...

Looking at the results without actually viewing the films, it doesn't sound like a lot is going on structurally to cause the pain. The most notable thing that I see is just the transitional segment, which they call "sacralization," which just means that your L5 bone has more of the characteristics of your sacrum rather than the characteristics of your other lumbar vertebrae.

Too bad the block didn't work, but I think you hit it right on the head that you probably experienced relief because of the anesthetic. Holy cow...

Anyways, I would share with your doctors that you are frustrated and that you want something done. If you refuse to leave until they give you something to go on, or recommend something, they will likely help you out.

Wish I could tell you more, but perhaps others on the boards will be helpful as well.

-V

 
Old 04-26-2005, 09:08 AM   #3
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Nervous Nellie HB User
Re: It's been awhile and I need advise!!!

What kind of doctor are you seeing, an orthopedic surgeon or a neurosurgeon? What are your pain symptoms? What does your doctor say he/she thinks is causing the pain?

Nellie

 
Old 04-26-2005, 09:16 AM   #4
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et318 HB User
Re: It's been awhile and I need advise!!!

Just like Nellie indicated can you give more information on the exact location of your back pain and where it radiates too. Is it burning, stabbing, sharp or dull? Does it get worse when you sit for long periods of time?

My concern is that annular tear at L4-5. This means the disc is likely incompetent and you may have a chemical irritation of the adjacent nerve roots. When there is an annular tear it can allow the fluid contained in the nucleus of the disc to leak. When contained in the disk this fluid is fine, but if it leaks into the posterior epidural space it can cause significant irritation to the nerve roots and tissues. The pain is often described as an intense burning pain down the legs and a severe lower back ache sometimes sharp.

Most often they will do a discogram to see the extent of damage to the disc. Depending on the results they may have some non-surgical options to treat the disc.

 
Old 04-26-2005, 09:20 AM   #5
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aestrella411 HB User
Re: It's been awhile and I need advise!!!

Thank you victorsch. If there was some way I could send you the pictures so you could see my MRI and x-ray results I would because I do have those records on the computer. At my request, the hospital gave it to me on a CD so I've got it here at my work and also at home.

Nellie, I'm just seeing a physiatrist and a PM doc. Lately I've been dealing more with the PM doc and the physiatrist just gives me meds now. The type of pain that I have is a sharp dull pain at the center of my back. The pain literally radiates from my back through my hips. From there, my back and side right thighs are very painful to the point where I've been limping lately while I walk. I have pain constantly every single day and I'm so fortunate that I can sleep again. When my husband was away in the army I would wake up every night in terrible pain. Though the pain is there now, I think him being there is very comforting to me so I can get through the nighth. The problem with my pain is that it's too constant and gets worse when I do anything for a long period of time. It's dibilitating, it truly is. Since I had that successful medial branch block, the doctors all thought that my facet joints were the cause of my pain. I don't get it though because if you look atmy MRI, that l4/l5 disk is black. all my other disks are white. It's just bad. I dunno....I feel so tired of this. I'm tired of complaining about this to people (with the exception of my husband) who don't even understand this kind of pain. My co-workers sort of write me off because well, they just dont' knwo what it's like and I completely understand that. I just don't know.

I think with my recent common sciatic flareups that the disc material is beginning to impinge more on teh nerve. I believe that and I Just don't know what to do about it. I will not go through IDET or fusion, those are two procedures of which I will never do. It's just so overwhelming. It's so nice to get some responses about this because I sure do need the support right now...

 
Old 04-26-2005, 09:35 AM   #6
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et318 HB User
Re: It's been awhile and I need advise!!!

Aestrella,

Again, I am sorry that you are experiencing so much pain. I am also sorry to hear that you are so against IDET. Given the fact that your disease is so focused to one level that is a very good indicator. A discogram can reveal the extent of damage and guide treatment.

Bad IDET outcomes are usually due to surgeons attempting to treat too many levels. Multi-level IDET has been very hit or miss. Single level IDET in a patient with limited disc disease has had great success. I would think a good pm doc who is skilled in interventional pain techniques could work wonders with a case like yours.

 
Old 04-26-2005, 09:43 AM   #7
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victorsch HB User
Re: It's been awhile and I need advise!!!

Aestrella,

I am glad that we have been able to help. et318 is right about the irritation to the nerve roots.

Make sure whatever decision you make that you are well educated and are informed of all the risks that are involved.

Good luck!

-V

 
Old 04-26-2005, 09:46 AM   #8
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aestrella411 HB User
Re: It's been awhile and I need advise!!!

Aside from my personal opinion about IDET, I did see a very quacky neurosurgeon and he did agree with me (I read it in his doctor's notes) that he didn't recommend IDET because of what he knows about it. That was a story for ya right there when I had that appointment with teh neuro dude. I had gone through the grievance process because my physiatrist wouldn't let me see a neuro and so finally the board made him refer me to one and I think he just referred me to ANYONE and didn't at all care for his experience. The neuro didn't even look at my file, didn't have a computer in the office, and explained to me that the reason why I felt different levels of poking (because he did a test where he poked me with a pin on my legs and asked if i felt anything different) was not because of my sciatica but because he's so old his hands can't poke with teh same pressure like they use to. Oh I cried the whole way home. I wanted to believe that whatever the neuro said I would truly believe but not this guy.

Sorry to ramble like that, thinking of IDET just reminded me of that story...have you had IDET? Has it worked?

 
Old 04-26-2005, 09:56 AM   #9
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aestrella411 HB User
Re: It's been awhile and I need advise!!!

Am I being unreasonable about all of this? I truly tried with all of my procedures to have the best mindset as I could. I've been very positive about everything but nothing is working. Has anyone out here ever been or gone through what I've gone through and/or what I"m going through right now??? As not alone as I know I am with this back pain, I feel I am alone in my situation...

 
Old 04-26-2005, 09:59 AM   #10
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aestrella411 HB User
Re: It's been awhile and I need advise!!!

OH, another thing I wanted to ask, is, other than IDET, what are my options??? I mean, I know what I sort of want, but, in reality, what can I really do or what can really be done to help me? I don't believe it will be 100% new but, if I can have level 1 or 2 pain that would be absolutely wonderful....

 
Old 04-27-2005, 11:52 AM   #11
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Nervous Nellie HB User
Re: It's been awhile and I need advise!!!

Aestrella,

My understanding of the IDET procedure (Intradiscal Electrothermal Therapy) is that it treats pain coming from the disc itself, not the disc's pressure on any nerves surrounding it.

I would imagine that any pain coming from the disc would be well-localized and wouldn't radiate down the leg, but again, referred pain can do lots of things.

I think in terms of what you should do, you first have to know what you're dealing with, exactly. Is your pain being caused by the disc itself, or by the pressure that it's exerting on the adjacent nerve roots?

That is the question I would be asking the doctors in your case.

If it is nerve pressure, discs to tend to heal and dry out somewhat with age, but because you are so young, you have a lot of disc material to be re-absorbed. I would definitely be asking my doctor what exactly he/she thinks is the true cause of my pain and what the options are.

Keep asking questions. Keep researching and don't give up. You WILL get better someday. I can say this from experience and if I only knew then what I know now! LOL

Nellie

P.S. Edited to add that you really need to see an orthopedic surgeon or a neurosurgeon in order to obtain the real answer to this question, I think.

Last edited by Nervous Nellie; 04-27-2005 at 11:55 AM.

 
Old 04-27-2005, 12:30 PM   #12
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et318 HB User
Re: It's been awhile and I need advise!!!

Nellie and Aestrella,

The idea that internal disc disruption or disc problems not contacting the nerve roots cannot cause pain is erroneous. The intervertebral discs contain a nuclear fluid that when contained in the disc is rather benign. As a matter of fact when we talk about MRI's showing dark/dessicated discs we are talking about that fluid.

When this nuclear fluid escapes the nucleus and leaks through annular tears in the disc this is problematic. The nuclear fluid is a significant irritant to spinal nerve roots and soft tissue structures. When a good PM doc is treating a radiculopathy (spinal nerve root irritation) he should be trying to decipher whether this is a chemical (nuclear fluid) and/or physical (impingement) irritation.

In Aestrella's case, she shows evidence of an annular tear. These tears can often be predictors of internal disc disruption and possible chemical irritation of spinal nerves. Procedures like IDET and Nucleoplasty when performed appropriately tend to repair these tears and can result in alleviation/reduction of pain symptoms.

Hope that helps.

 
Old 04-27-2005, 12:43 PM   #13
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Nervous Nellie HB User
Re: It's been awhile and I need advise!!!

That's good to know ET318!

I wasn't thinking of the chemical irritation of leaking disc fluid to the nerve roots/soft tissues. If IDET can stop that, then perhaps it's worth a try?

Again, I agree that Aestrella's doctor should be making that call and determing which situation applies in this case. Then she can make a more informed decision.

Nellie

 
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