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Old 05-09-2009, 05:06 PM   #1
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blackberrybunny HB User
Question 2 annular tears at L4-L5 & L5-S1 w/leaking nucleus; now what? Anyone else?

Hi everybody. I'm new to these boards, and glad I found them, as I'm hoping someone else can share their story with me.

I am a 40 year old woman and recently, my L4-L5 and L5-S1 discs have incurred annular tears which resulted in the necleus pulposus to leak out. I was in severe pain and I had an MRI and then an LESI (which did NOT help). After I complained of no relief from the LESI, my pain management doctor sent me for another MRI to check for a problem. Nothing was found that was abnormal, so he had me undergo a Discogram. The discogram showed the 2 tears with the nucleus leaking out. He said no more epidurals or steroid injections--they will NOT help me, and I will need spinal fusion surgery now.

My question right now is about that nucleus leaking out. I don't know HOW MUCH of it is gone. I have my first appointment with my new spine surgeon in a little over a week, and hopefully he can answer my questions further. But I'd like to hear from others about their experiences with their nucleus leaking out. I do NOT have any traditional sciatica at all, never any leg pain. Just a severe pain right in the spine, at the vetebrae.

What happens when all of the nucleus leaks out? Does it replenish, or not? I am thinking it does not. Were you aware of the moment your disc ruputered and your nucleus started to leak out? I am pretty certain I am---for I was spelunking, cavern exploring! I was in severe pain and had to be rescued. When I had the discogram and felt the dye leakingo out of the bad discs, it felt just like the pain I suffered in the cave.

I guess if not all of the nucleus has leaked out, I am in danger of having more squish out at any point? Or any funny movement, rather? How long will it be before my discs collapse and the bones get all lopsided, or worse? OMG, it is freaking me out! And I'm not ever worrying about the fusion surgery YET!

If anyone has any stories, please do share!!

 
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Old 05-09-2009, 06:23 PM   #2
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brendaks1 HB Userbrendaks1 HB Userbrendaks1 HB User
Re: 2 annular tears at L4-L5 & L5-S1 w/leaking nucleus; now what? Anyone else?

Wow! I'm amazed that you were able to get a discogram so soon without any leg pain and a negative MRI. It took me forever to get a discogram (which did show my problem). You must have been in a lot of pain.

Like most people on this board, I suffer from sciatica in addition to lower back pain and have disc herniations in addition to tears.

I know I have heard of some surgeons that will not do back surgery on patients who have back pain and no sciatica, even if there are tears or herniations. It could be that your tears are so large that you are in horrific pain and a fusion will absolutely be necessary. I don't want to upset you by mentioning this, but I want you to be aware of it since you may run into a surgeon that is unwilling to do surgery. If this happens and your PM doctor thinks you need it and your pain is unbearable, then seek out another surgeon, perhaps at the recommendation of your PM doctor.

It is possible that if the tears are large enough, this could cause instability in your spine such as spondylolisthesis where one vertebrae slips over the next one. The cure for this is also a fusion.

You have probably already lost some of the disc height as you will be able to see when the surgeon takes X-rays at your appointment. This will be restored during your fusion. Also, the fusion will remove the center of the disc (only the outside walls are left), so you won't need to worry about it leaking more fluid in the future.

How long have you had this problem? If it hasn't been at least 3-6 months, you may want to ask the surgeon if more conservative treatment could possible get you back to a point where you could live without having surgery. Surgery can sometimes make your problem worse, so don't go in thinking that having surgery will be your cure all and bring you back to where you were before. If there is any possibility of getting better (even if it's not back to 100%) without surgery, give it a serious try first. The surgeon may tell you the discs are too far gone to attempt more conservative treatment, but it is worth inquiring about.

Keep in touch and let us know how your surgeon's appointment goes this week!

 
Old 05-10-2009, 03:12 AM   #3
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Re: 2 annular tears at L4-L5 & L5-S1 w/leaking nucleus; now what? Anyone else?

How long have you been in pain? I am asking as a fusion for annular tears and no sciatica, especially getting a FUSION is a large large step.

Alot of times your pain can subside over 12 weeks, usually no surgery and conservitive care for 12 weeks is standard, to see if the pain will subside, and the chemical reaction of the nucleus pulpus leaking subsides as well. Look up radiculitis and you will see what I mean.

As you are very active, cave diving and all LOL! I do semi understand the need to care for this NOW instead of waiting to see when and IF it will get worse, but a fusion is a LARGE surgery to undergo- I just had one on one level, you are talking about a two level!
It does not replenish, and can continue to get worse, sometimes the body will reabsorb the disc back into the disc space an an annular tear 'can' heal, but if you have an extruded disc instead of a bulge, it will not, I mean it can reabsorb some, but just as easily come back out of the disc space again and worse depending on when and how you do it.

Curious to see how long you're like this, and you don't have any leg pains just back pain?
If you are in such severe pain, over a period of time, yes surgery is your best bet, but if under the 12 weeks I would give it more time if you can handle it, what exactly did your MRI report say regarding the discs?????

Mine said 2 extruded discs impinging on the L5 nerve root, so I got a microdiscectomy the first time, one disc reherniated largely, and then I got a fusion on the disc that reherniated. I am 8 weeks post op now from it.

Best of luck and feel better!!

 
Old 05-18-2009, 07:32 AM   #4
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murr3 HB User
Re: 2 annular tears at L4-L5 & L5-S1 w/leaking nucleus; now what? Anyone else?

Dear blackberrybunny,

my mother is having a grade 4 annular tear in her L4/5 (seen on MRI as HIZ sign).

It is very difficult to threat this state. Intradiscal therapies do not work.

Our neurosurgeon will try to use Percutaneous Laser Disc-Decompression (PLDD) to get nucleus back in its original position.

Last option is fusion, but I am not sure will that help. I don't know so much about the spine, doctors for sure know much more then me, but it is so obvious that fusion will not help.

Why? Fusion is used to stabilize the area of 2 discs for example. But problem with annular tears is not "destabilization". Problem is chemical reaction of nucleus and other materials. So, it sound very obvious to me that fusion WON'T work.

I will try to get more doctor opinions about this.

Any advices are welcome!

 
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