Hi all, new guy here after seeing the doc today to discuss MRI results. I think I need a second opinion because he said there's no way to fix this. Granted, however, that I don't really understand the meaning of the reports on my back. I'll post it below. Please help with the translation, so I can get a better grasp on what happens from here on out. I've only been referred to Physical Therapy and Pain Management, no referral to orthopedic or other spine specialists which is surprising to me.
Anyway, here's the info:
[B]SYMPTOMS:[/B] (33 y/o male, 400lbs)
Lower back pain - sometimes stabbing, but mostly general aching bilaterally and especially on the right side of the L4 area.
Radiating pain and numbness - down both legs sometimes, but mostly down right leg, following from L4 area into right buttocks, down rear of thigh to the side of the knee, accumulating in this area during prolonged driving or standing, sometimes continuing down side and rear of calf into foot. When stabbing pain is felt, I become weak/unsteady and have to grab onto something for support. When laying flat on back, during sleep for example, I will wake up with total numbness of my right outer thigh from lower hip to knee. Slight tingling numbness of left big toe when pressed upon.
Worsened by - driving +20 minutes, walking +10 minutes, standing +10 minutes, washing dishes, cooking. Laying flat on back on firm surface is the worst - almost could not get through the MRI due to extreme pain. Could not get up from MRI table on my own, people had to lift me up from table.
Haven't been able to work (driver) since August '10 due to back pain and unrelated lifelong recurring major depression which hits me hard every year. Dx of Depressive Disorder and currently in outpatient treatment.
[U]Findings[/U]: The bone marrow signal is normal throughout. There is no fracture, dislocation, or compression fracture. No paraspinal masses are seen. The conus medullaris is normal in appearance and location.
[U]L5-S1[/U]: There is disc dessication with endplate degenerative change. Moderate facet osteoarthritis is present. There is a 2 mm broad based midline disc protrusion with effacement of the anterior thecal sac and no abutment. There is no stenosis.
[U]L4-5[/U]: Disc dessication with endplate degenerative change is noted. There is a 5 mm broad based midline disc protrusion resulting in displacement and abutment of the descending L5 nerve roots bilaterally. An annular tear is present. Moderate central canal stenosis is noted. Moderate facet arthropathy is present.
[U]L3-4[/U]: There is disc dessication with endplate degenerative change. A 3-4 mm midline disc protrusion is present with an annular tear. Effacement of the anterior thecal is present with resultant minimal abutment of the descending L4 nerve roots bilaterally and mild to moderate central canal stenosis.
[U]L2-3, L1-2, T12-L1[/U]: There is no protrusion, abutment or stenosis.
1. 5 mm broad based midline disc protrusion at L4-5 with resultant displacement and abutment of the descending L5 nerve roots bilaterally. There is also an annular tear at this level with moderate central canal stenosis.
2. 3-4 mm midline disc protrusion at L3-4 with minimal abutment of the descending L4 nerve roots bilaterally. There is also an annular tear at this level and mild to moderal central canal stenosis.
1. What's the outlook of this long-term? Can surgery fix any of it?
2. Since I haven't been able to work, is this (coupled with the depressive disorder) a disabling condition for SS Disability? Does it ever get better, with or without surgery?
3. Can surgery be done on someone of my size? I would do gastric bypass surgery if it was medically necessary. I am pre-diabetes, with some liver abnormality (early damage).
4. Should I get a different PCP doc? He didn't explain much about this MRI report, and said it can't be fixed.
Thanks for the translation and help.. Feeling a bit lost on this, not understanding the anatomy and what it all means. I've done some Googling but still don't have a good picture of what all this means.
Hi, and welcome to the board, tho I am sorry you had to turn to an outside source to get the help you should have gotten from your doctor.
Most GP's are not great at reading spinal MRI's so I urge you to see a spine specialist. There are 2 kinds...Orthopedic and Neurosurgeon...and they have a fellowship in spine training. They are the best at reading the results of your test and in knowing what steps need to be taken. I personally prefer the orthopedic spine specialist simply because I have found them more compassionate, but that's just my experience. Others absolutely love their neurosurgeons, so it's a matter of personal preference.
I have to disagree with your GP. I do think you can be helped. You have the following issues as best as I can interpret them:
T12-L1 thru L2-3 are normal.
At L3-4 thru L5-S1, the discs are drying out (dessication).
At L3-4, you have a disc protrusion of moderate size and there is a tear in the lining of the disc. (annular tear) Sometimes that disc material will hit a nerve and irritate it causing pain as it is caustic. Any narrowing of a nerve exit or entrance is called stenosis and you have this both at the spinal cord and on both sides of the disc...this causing that burning, traveling pain you speak of.
The same holds true for the L4-5 area.
At L5-S1 you have another bulging disc but it is not causing any stenosis. However, you do have osteoarthritis as well.
Please keep in mind that I am not the greatest at interpreting anything but the most obvious. I will leave the rest to someone else tho I don't think anything else is prominent at this time.
These things are fixable...tho it may require surgery. I would urge you to get at least 2 opinions, one from an ortho spine specialist and the other from the neuro spine specialist. If they disagree, then a 3rd opinion should be gotten. Only you can decide if you want to do surgery....there might be some more conservative treatment, but keep in mind that those are just bandaids and do not "fix" the problems. In all honesty, surgery doesn't always turn out to be totally successful but when nerves are compressed as yours are, there comes a time when they are permanently damaged meaning that you will always have pain and/or numbness/and or weakness. Altho surgery should be the last option, there are times when it is the only good option available, but again, getting several opinions is important so that you are sure you are making the best possible decision.
You can do a search for a dermatome map; that might help you determine which area is causing the most pain for you. You can also look up all the terms individually to get a clearer understanding of what is happening.
Perhaps another poster will see this and give their opinions as well. I have no training....only personal experience which is long-standing unfortunately. I have had 7 lumbar surgeries, all of them successful at fixing the problem at the time. I am just one of those lucky people whose backs just keep deteriorating. Keep in mind, too, that the folks who have had surgery with no further problems are not on this board posting...they are out living their lives and not on here telling us about it. Most of these kinds of boards are joined by people who have problems like yours and mine so you won't read a lot of encouraging things here. Please don't let that frighten you or keep you from doing what is needed to improve your life and hopefully, either lessen or stop your pain.
Please keep posting and let us know how you are doing and what you learn from the spine specialists.
Best of luck to you.
Lumbar surgery x 7 over the last 30 years.
cervical fusion...2 levels
medtronic pain pump implanted
Last surgery Oct, 2010, 3 levels
The Following User Says Thank You to maltluver For This Useful Post:
[QUOTE=maltluver;4699765]Hi, and welcome to the board, tho I am sorry you had to turn to an outside source to get the help you should have gotten from your doctor.
Please keep posting and let us know how you are doing and what you learn from the spine specialists.
Best of luck to you.
Thanks so much for trying to better my understanding. I will go with my gut instinct about seeking other opinions and try to see a spine specialist. Lots of red tape with my coverage, they love to deny referrals and referrals are required for any specialists, so I may end up have to get another PCP doc first who will agree to argue for a specialist referral.
Thanks again! I look forward to any other offers of help here and will keep updates posted here with what I find out.
hey sorry to here of your problems ..my spine specialist pulled me from work and im out on diability for a bunch of thing herniations and annular tear is one of them..physical therapy is the firt step. then they gave me epidural injections..listen i wont tell you to replace ur pcp but maybe if you ins allows go to a spine specialist with the results of mri your self ..and if ins wont allow go to another pcp for a second opinion you should be allowed that. I was also told that my annular tear cld not be repaired and i believed it until i saw in ths forum someone had theres repaired so i went to my spine specialist and said it is possible to repair some annular tears with surgery..unfortunately with me I am high risk as i suffer from RSD wich is a progressive nerve damage and surgeries have been known to make it spread qicker ..pleas go for the second opinion you owe it to yourself..good luck my friend and god speed
The Following User Says Thank You to painman2009 For This Useful Post:
[QUOTE=painman2009;4709263]hey sorry to here of your problems ..my spine specialist pulled me from work and im out on diability for a bunch of thing herniations and annular tear is one of them..physical therapy is the firt step. then they gave me epidural injections..listen i wont tell you to replace ur pcp but maybe if you ins allows go to a spine specialist with the results of mri your self ..and if ins wont allow go to another pcp for a second opinion you should be allowed that. I was also told that my annular tear cld not be repaired and i believed it until i saw in ths forum someone had theres repaired so i went to my spine specialist and said it is possible to repair some annular tears with surgery..unfortunately with me I am high risk as i suffer from RSD wich is a progressive nerve damage and surgeries have been known to make it spread qicker ..pleas go for the second opinion you owe it to yourself..good luck my friend and god speed[/QUOTE]
Thanks for your comments. I will add some update after I reply.
I am definitely going to request a new PCP and second opinion on the possibility of fixing my back, and seek a referral to spine specialist for definitive medical opinion. I can only speculate as to why these PCP docs would lie about the ability for it to be fixed surgically. If none of them will agree it's fixable then I will ask them to put that in writing and support my seeking disability. I can't do my previous work ever again, and due to pain I can't sit in most chairs longer than 30 minutes nor drive longer than that. I can only stand about 10 minutes before serious pain starts shooting down my legs (update: after a recent PT session, for the first time I started experiencing sciatica down my left leg as well)
Thank you for your comments.
-PT has been stopped due to worsening pain and that it is spreading to new areas and symptoms.
-Had first appointment with Pain Management specialist. Prescribed lortab 10's, a muscle relaxer to help me sleep at night, and I am scheduled for some sort of injection at three levels on my right spine since that is the center of the pain. The lortabs don't help much with the sharp/stabbing type of pain (nerve compression I presume), only the aching and arthritic sort. Oh, they also gave me a shot of Toradol or something like that, said it was for inflammation I think? I couldn't tell any difference in pain sensation after getting it.
-Spoke with office of a SSDI attorney firm. They advised me to put in app for SSDI directly myself, then get letters of support from my PCP, PM, and psych docs - then call them back to get started on my case.
-Previously my psych status wasn't at a disabling level. GAF score was something like 57, which is "functional" range albeit with difficulty in relationships and work and such. I disagreed that I was even that functional, because I haven't been able to work since last August due to depression and pain, and have a lifelong history of being unable to maintain employment due to relapsing/recurring major depression episodes.
-After hearing this news about my back and my doc saying it can't be fixed, and then the same day hearing that I will be losing my medical coverage as a single adult with no kids and because of state budget cuts, I had a breakdown and became suicidal and admitted to my therapist that I had planned out ending my life if I lost medical coverage which would stop pain management and psych therapy. I went to an inpatient tx center for a day at my therapist's insistence (would have petitioned me had I not agreed to go voluntarily). I'm not sure yet what this crisis event will do to my GAF score or diagnosis, but my therapist said that since it happened I have been recategorized as "high risk" and this may mean that I won't lose psych treatment and medication even if/when I lose my other medical coverage and treatments. This would at least keep me alive long enough to try to get disability and full medical coverage again, and hopefully surgeries to fix my back and get this crushing weight off of me.
A lifetime of emotional pain and depression, now compounded with so much physical pain and limitation and financial ruin from being unable to work, has been hard to deal with even with full medical coverage - and the likelihood of losing that coverage was more than I could handle emotionally that day.
I am gald you are moving foward and taking a more sturdy position in your heakth care , i am sorry for your depression,, along with my back issues i suffer from RSD in fact that is where I post the most, I see alot of depression and suicidal tendancies there, and we speak to each other using the forum as a form of therapy I would advise that to you as well. we on the RSD side have formed a family and im sure you can find that here. Heck I myself am lookin for answers to try to keep me from falling into depression. any way I wish you luck on you adventures and I prey for you as well.. good luck and god speed
The Following User Says Thank You to painman2009 For This Useful Post:
Well I saw my PCP again and did manage to get a referral to an Orthopedic Specialist. I questioned his saying before that "it can't be fixed" and he kind of weasel-waffled on it this time, saying it can't be fixed but they can treat it. Um ok, I'm like 'so what's the difference?'
Also got in to see pain management. Scheduled for injection next month. The 10mg hydrocodone pills do nothing whatsoever for the sciatic/nerve type pain. It only relieves the general arthritic kind of aching pain in the lower back, which is welcomed of course, but the sharp pains are still quite alive. Hopefully I'll get some relief from the injection.
My PCP doc office needs pre-approval from my coverage for bariatric specialist referral, which will probably get denied of course. My state will stop covering that surgery altogether on Oct 1, which is when I'll likely lose my coverage.
I'm wondering though, if they can even do lumbar spinal fusion on someone my size (414 lbs now - gaining more since PT stopped and the severe depression down-spiral). In my google searches is seems they can do it on someone my size, but some surgeons won't because of the much higher fusion failure and complications rate.
I'm also concerned about having spinal surgery just a couple months before (likely) losing my medical coverage. Failure rate on someone my size is said to be something like 46%... and then I'd lose coverage soon after that failed surgery.
duuuude. I am very happy you can start moving foward getting better care..i understand your fear of loosing insurance. as of right now I have only comp. no medical for possible complications due to this..and im sure comp wont cover it.. but we should press on with the things we can..sw your doctor re you concerns im sure there is an answer there. sw with the billing dept maybe they can direct you to health programs.. keep me up to date on your progress and good luck dude.....
Sigh.. Nothing but a parade of bad news about all this.
The latest is that the Orthopedic Surgeon I went to said "No surgeon in the valley would operate on you right now" - because I'm so big (416 lbs).
And then I learned I was DENIED for Bariatric Referral for gastric bypass surgery to lose the 180 lbs needed to satisfy the spinal surgeon.
So, this won't be fixed anytime soon.. I haven't been able to work since last August.. I am undergoing pain management but it's not really controlling the pain.
I've had the first round of epidural injections recently, two levels on both sides. It helped for about 5 hours, then the sharp pain returned and I couldn't get up from the couch again.
The following day was my monthly followup for take-home meds. I told the NP that the hydrocodone wasn't anywhere close to controlling my pain, that I had to take twice the prescribed dose just to make it through the day (which they chastised me for, of course). So she then added 15mg of Morphine Sulphate twice a day, as the base controller of pain, and refilled the hydrocodone 10 mg 3x/day for the breakthrough pain. I have to take both, there's always breakthrough pain. I went to the ER after a collapse/immobilization from the lower back down being in extreme pain. They gave me dilaudid, valium, and toradol and I STILL could not get off the bed and walk on my own.
I'm scheduled for the second round of epidural procedure next Wednesday. They put me out for them, so I don't remember anything, which is fine with me. I don't expect them to help much again.
I don't know what else to do but apply for disability :-((( I'm on state medicaid but they won't pay for the surgeries I need to get me fixed back up into a productive tax-paying citizen again. I don't want to be disabled :-(
I don't even know if disability Medicare is any better. I have to lose about 200 lbs and not being able to walk hardly, let alone exercise, is going to make that nigh impossible without gastric bypass surgery. I am short of breath just walking to the bathroom because of the leg pain and shuffling. I need bariatric surgery and lose that huge amount of weight so that the spinal surgeons will operate and fix/stabilize my back and cut the discs out so the pain down the legs stops. I hope disability will do that, because I don't want to be disabled forever - I want a real life, productive, normal, active :-(
I've already been doing individual psych therapy for depression but now at the request of my therapist I'm entering his "Healthy Coping" weekly group as well. I don't have anybody here to depend on, all alone in this struggle. Don't even have a pet for
companionship, can't even afford to take care of a kitten.
I wish disability didn't take so very long, with multiple denials. I don't know if I have to strength left to go through all that.
ok.. its rediculouse i know the ins. and state and all bite off their nose to spite their face. all of my epidurals failed..nerve blocks also failing.. i suffer from not only back issues but issues with a nerve infliction called RSD plus carpul tunal, migrains, etc.. i know pain is hard to escape.. I go to physical therapy every day and push past pain so i can strengthen my core as best as possible.. it has taken alot but after years i can sometimes get relief with some of the things they give me to do.. i know i know moving is painful..but it is necessary to live and believe it or not small movements more often during the day might be better then one long hump once a day if you know what i mean.. unti lyou get what you need try a little more every day.. and trust not the drugs.. i gained weight on some of the drugs they gave me and i too am a large man..was much larger 1 mnth ago.. a change in drugs and daily habit including the types of food i eat made a difference.. lap ban or such is not an option for me as it will make rsd worse.. i really feel your pain my friend and i see the depression its bring you to.
i hope you can find some support in the "healthy coping " group.. because that is a help.. reach out there as well .. we can give you words of advice, wisdom, support etc here but we cant really be (there) for you like the people in a support group you attend..
a good mix of us is good too. as far as diability. we can only play the game unfortunately some one else writes the rules.. the best chance we have is to learn them and how to fight against bad ones that hurt people who need it but dont want it..
I am truely sorry for your latest *****.. but i have faith in you that you can make it through and find the help you need... good luck friend and feel better