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Old 06-03-2011, 08:02 AM   #1
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Should I seek a 2nd opinion?

I just recently seen my neurosurgeon about my renewed back pain, had a discectomy in Nov 2010, and I feel he is not trying. I have horrible shooting pain all the way from my lower back into the foot of my right leg. My MRI which I will post below stated I had degenerative joints and a herniation and some bulging discs; now my neuro said he seen nothing on the MRI; which to me makes no sense as no MRI Tech can make so many errors on an MRI report and be that dead wrong. My neuro diagnosed the pain as Inflammation in the SI Joint yet after researching it myself I do not match the symtoms. I have no groin pain and my pain is worse when sitting not when standing and is not relieved at all by laying down. He also gave a very vague of thats what I think it is when refering to the SI Joint and gave me no amplyfing data on why he thought it was the SI Join and not something else. He also wants me to take Anti-Inflammatorys for a month which I have already been doing for 2 months with no progress. I am not a fan of repeating treatments that do no good. He also mentioned that in a month if pain is still present wants to stick a shot in the SI Join which I am not fond of getting a shot in a joint that proably is not the issue.

Sorry for the cluster but do you all think I should get a 2nd opinion? The MRI report is below for your information and on a side note the X-Ray I recieved also had the results of Multi Level Degenerative Disc Disease.


Findings: The conus ends at L1. The size and signal intensity of the distal spinal cord is normal. The vertebral bodies are well aligned. Disc space narrowing and desiccation is present at the L5-S1. A right L5 laminectomy has been performed. Adjacent soft tissue/muscular and subcutaneous enhancement is present. No discrete fluid collection is seen.

L1-L2: Minimal posterior bulging disc.

L2-L3: Mild posterior bulging disc.

L3-L4: Mild posterior bulging disc.

L4-L5: Mild posterior bulging disc. Mild ligamentum flavum hypertrophy. Mild bilateral joint facet degeneration.

L5-S1: Decreased size/resection of the posterior herniated disc. Posterior disc bulging/herniation with lateralization to the right. The disc touches the right S1 nerve root. Left ligamentum flavum hypertrophy. Early bilateral joint facet degeneration.

Impression: Postoperative changes at the L5-S1. Posterior bulging/herniated disc at this level lateralizing to the right tourching the right S1 nerve roots. Overall size of the herniation is improved.

Last edited by bringers; 06-03-2011 at 08:04 AM.

 
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Old 06-03-2011, 09:42 AM   #2
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Re: Should I seek a 2nd opinion?

Other than financial reasons, I cannot think of any reason why anyone should not get more than one opinion when dealing with spinal issues. The spine is a complex system and there is room for interpretation when looking at imaging and putting a patient through tests which are somewhat subjective in nature.

Remember, none of us are doctors...just fellow spineys so take what you read here with that in mind!!

I think what your doctor was telling you is that he doesn't see anything significant that would be causing the symptoms you describe to him. Nothing in your radiology report jumps out as being a red flag. Everyone beyond the age of twenty has a little bit of disc bulge....It's just that most people don't have a MRI, so they are not aware of it. Degenerative disc disease is a bit of a misnomer -- we all develop DDD as we age. It's just that some people do not have any symptoms.

Where you may have pain generators is in the lowest segment at lumbar 5-sacral 1, where I assume you had the past surgery. There is still a significant herniation there and the MRI report states that it is pressing out sideways to the right, and is touching the S-1 nerve. Also the MRI shows that you have degeneration in the facet joints at this level. That too can cause pain.

I can see him ordering a steroid injection, but I would think that he would want to try it at the L5-S1 segment first. You may have something that was found on physical exam that indicates a problem with your SI joints -- but it is not indicated on the MRI report...so I don't understand why he is suspecting that as the location of your problems.

If there were SI joint problems, most people have difficulty walking, pain when standing, etc. Do you have pain radiating down your leg?

In any case, I would suggest you try an orthopedic spine surgeon for a second opinion. (This is not a general orthopedic doc who does joint replacements, etc. The ortho spine surgeon devotes his practice to problems of the neck and back.) In some areas they are not plentiful, in which case, try another neurosurgeon...but I think it would be useful to go get another opinion!!

 
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Old 06-03-2011, 11:40 AM   #3
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Re: Should I seek a 2nd opinion?

Thanks and will look into the orthopedic spine surgeon for a 2nd opinion. If my neuro had actually conducted a physical exam and explained why the SI joint, I wouldn't be doubting it but he did not even conduct a physical exam. Just felt the back and nothing else. But also for the MRI he told me he did not see any degeneration of the joints and did not see any type of herniation, so it was more like just saying the MRI report from the radiologist was wrong. I also understand people read them different just wierd that 2 people would be so way off on what they see.

As said the mention of SI joint as the reason for pain just felt out of right park to me and he gave no real explanation for it.

As to answer your questions, I have weakness in my right leg (physical therapist rated my strength in right leg at 60%), pain radiating down it specially when sitting, driving or laying down. Walking is okay just have some leg drop that causes me to limp, or after waking up or after standing up from sitting for a while my leg is slightly numb and tingly causing me to limp. Walking is okay at short distances but walk long enough and start getting the shooting pain, and standing for a period of time also causes the pain in my right leg to increase. Have also been taking Naproxyn, Norflex, Ultram, and Tylenol which I have not seen any results from yet. I have also had the elctrodes at PT which they switched to ultrasound as the electrodes were showing no results either just making my right foot go numb.

Last edited by bringers; 06-03-2011 at 11:41 AM.

 
Old 06-03-2011, 11:57 AM   #4
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Re: Should I seek a 2nd opinion?

By all means seek a second and a third opinion. I have had 3 faild back surgerys. Now I have the pump which the Dr who is very good changes up the dose to give me more relief. The next time I g see him he is going to add another drug to the morphine to help with the pain. Right now I feel like giving up and just staying in bed all day.

 
Old 06-03-2011, 12:52 PM   #5
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Re: Should I seek a 2nd opinion?

[QUOTE=snopea123;4769618]By all means seek a second and a third opinion. I have had 3 faild back surgerys. Now I have the pump which the Dr who is very good changes up the dose to give me more relief. The next time I g see him he is going to add another drug to the morphine to help with the pain. Right now I feel like giving up and just staying in bed all day.[/QUOTE]

When you say you had three failed back surgeries do you mean the surgery failed or did the surgeons operate on the wrong level or place?
James

 
Old 06-03-2011, 05:36 PM   #6
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Re: Should I seek a 2nd opinion?

[QUOTE=james079;4769671]When you say you had three failed back surgeries do you mean the surgery failed or did the surgeons operate on the wrong level or place?
James[/QUOTE]

 
Old 06-03-2011, 05:50 PM   #7
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Re: Should I seek a 2nd opinion?

The first 2 were done by the same surgeon. I felt after the 2nd one he just really wanted to cut and did not get the job done by not repairing the problem. The 3rd one the surgeon really knew what he was doing. I don't want to mention his name as he is very well known, I good hint is that he works in texas now. He rebuilt my lower back from the middle down. It took me from not being aable to walk to my mailbox to where I was walking everyday. My wife, daughter and soon to be son in law even went to Paris and walked our butts off. But now 18 months later I am at a 7-8 pain level even with the pump. I was told that the punp would bring the level down to a 2-3 which I can handle no problem. But until he gets the meds right I am back at a 7. I am hoping that the next adjustment works to where I will be able to function again with a couple of advil if needed. The first surgeon joined a large group and even though I was told by lawyers that he messed up nobody would touch the case and now it is to late to do anything about it. I can go into more detail about the opperations if you like.

 
Old 06-06-2011, 09:33 AM   #8
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Re: Should I seek a 2nd opinion?

I am still waiting to hear from my primary care doctor about getting a referral to see a second doctor to get my 2nd opinion.

An update though to my pain; yesterday I started getting pain in my left leg. I have never had pain in the left it has always been the right. Its a minor pain, kind of a tingling, that goes all the way to the foot on the left. Just curious what might be the cause of this. Also I have noticed recently being the past week that when my back is really throbbing that I have to go to the restroom more often and my stools tend to be on the watery side. Just curious what might be causing this as well. No uncontrollable bladder or bowel movements just the need to go more often.

I plan on letting my doctor know this information when I see him again but just hate it when more pain pops up.

 
Old 06-07-2011, 12:01 AM   #9
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Re: Should I seek a 2nd opinion?

bringers,

Sorry to hear about the problems you're having, and I hope you get some answers and resolutions soon.

I have had terrible SI joint problems and had an SI joint fusion, along with low back problems. I've now had 6 surgeries between my low back and SI joint.

My main symptoms have been inability to sit and terrible sciatica down my left leg. I didn't have major problems with standing or walking prior to having my SI joint surgeries. I also had no groin pain.

Inability to sit or difficulty sitting is one of the biggest symptoms of having SI joint problems. You also get pain located if you go to the bottom of your spine, then about 3-4 inches to one side or the other of your spine (near the top center of your buttock). SI joint injections and CT scans of the SI joint are other tools a surgeon will use to diagnose SI joint problems, as well as the clinical evaluation. SI joints that have problems often show gas bubbles on the CT scan (black areas in the SI joint which indicate severe osteoarthritis), or assymetry between the sides.

If your neurosurgeon doesn't do SI joint fusions, you should visit a neurosurgeon or orthopedic surgeon who does spine surgeons. I see you're in Missouri, and I know there are doctors who do SI joint fusions in Omaha, NE, and also in Texas. There may also be doctors closer to you who do SI joint fusions. At this point get an examination and evaluation by one of these doctors, and perhaps even see more than one surgeon who does SI joint fusions. Seeing one of these doctors doesn't mean you necessarily have to have surgery. However, severe SI joint problems almost always can only be fixed by fusing the joint. You can ask the surgeon if you have SI joint problems, and if so, how severe they are.

Your lumbar MRI doesn't indicate problems which would explain the pain you are experiencing according to your neurosurgeon, so I think this would be your best course of action at this point. It would be good to have the SI joint injection prior to visiting these surgeons.

I'd be happy to answer any questions you have about SI joint issues, and wish you the best in your road to getting some answers.

Last edited by twohands; 06-07-2011 at 12:05 AM.

 
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Old 06-07-2011, 09:44 AM   #10
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Re: Should I seek a 2nd opinion?

Thanks for that info about the SI Joint. My issue is not just sitting but standing, walking, pretty much everthing but floating in the pool causes pain. No groin pain and no pain in the buttocks. My back pain is all in the lower back mainly on the right side and is very sensitive to pressure.

I am actually in Illionois as I am in the Military. I am stationed at a base about 20 miles from Saint Louis. I would imagine that STL has plenty of doctors that can conduct SI Joint Fusions if that is the case. I am still going to seek a 2nd opinion and if he says its SI Joint then will fully pursue that path as the pain is unbearable and is affecting my work performance and my family life. I just want to get rid of this pain.

 
Old 06-07-2011, 10:32 AM   #11
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Re: Should I seek a 2nd opinion?

The best way to rule in or rule out SI joint involvement is to have an SI joint block, which is what I assume the doctor was suggesting as "the shot into the SI joint." If the numbing agent takes away your "usual" pain, you know that the problem is coming from that joint. If you have the injection, go through activities that usually cause the pain, and it hurts just as usual, you will know the pain generator is not the SI joint.

I would guess the doctor has suggested this to rule it out as much as for any other reason.

 
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Old 06-07-2011, 11:08 AM   #12
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Re: Should I seek a 2nd opinion?

Thanks everyone that has helped explain things to me. Really helps alot. Most I can do now is wait until my next appointment and get the shot in my SI Joint. Will keep you all posted when I find out more.

 
Old 06-07-2011, 11:09 AM   #13
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Re: Should I seek a 2nd opinion?

[QUOTE=tetonteri66;4772504]The best way to rule in or rule out SI joint involvement is to have an SI joint block, which is what I assume the doctor was suggesting as "the shot into the SI joint." If the numbing agent takes away your "usual" pain, you know that the problem is coming from that joint. If you have the injection, go through activities that usually cause the pain, and it hurts just as usual, you will know the pain generator is not the SI joint.

I would guess the doctor has suggested this to rule it out as much as for any other reason.[/QUOTE]
I have been through the course of my treatment to 3 different doctors who gave me injections which did not help. That is why I had the first surgery. The second sugery the same Dr who did the first one inserted a "ball" between my dics, which in turn because it was not placed correctly. made my dics start to splinter and that started until I was unable to do almost anything for myself. I do not know the medical term for this ball, but it is like a ball bearing that is sapposed to make it easier to move. The last sugery that I had as I have stated my entire or most of my lower back was replaced and fused together. I have rods and pins and screws and cement keeping me together. That is why I decided to go with a medtronic pain pump. It is filled with morphine which goes to the spinal canal so you really do not feel the effects of a drug. Now it has been 11 months and we are still working to get to the right amount of the drug or a combination of another drug to take away the pain that still shoots down my leg and into my back. Hopefully I will be able to get back to the Dr in the next 1 to 2 weeks to work this out. I did mow the lawn on Sunday and after my wife and I got back from runnung some errends I had to be helped to the bed where I had to lay for 4 hours just to be able to function again. It is very hard to explain unles you have or are going through the pain. I got real tired of taking pills and walking around like a zombe that's why I went with the pain pump. You just have to go until the dose is correct for your body so the pain will go away or be kept at a 3-4 level. My pain now is a 7 sitting at the computer and I have to go lay back down. I am lucky as I am able to work from my home. I just need to be able to enjoy life a bit like a normal person instead of someone being in constant pain always.
Good luck to all but listen to everybody's opinion as everyone does have something to say whether you agree or not it is worth it just hearing that person out.

 
Old 06-07-2011, 12:31 PM   #14
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Re: Should I seek a 2nd opinion?

[QUOTE=tetonteri66;4772504]The best way to rule in or rule out SI joint involvement is to have an SI joint block[/QUOTE]

This is actually an area of a lot of debate. Some surgeons who do SI joint fusions consider this a golden test to determine SI joint problems, and others consider it one of many pieces of a puzzle to determine if SI joint problems exist. For the SI joint block, it is considered positive if the block takes away 75% or more of the pain in that area in the first few hours as a temporary numbing agent is put in the injection. However, where this test can fail is when there are multiple problems in the same area, such as a herniated lumbar disc or hip bursitis. This is why a lot of doctors don't just rely on this test alone. For SI joint problems, the heaviest weighting is put on the clinical examination for most SI joint surgeons to determine whether the SI joint is a problem area. There are some specific provocative clinical tests that will almost always be positive when examining a patient with SI joint problems. The science of SI joint fusions is in its early infancy compared to spine fusions, but there are a lot of doctors and companies now studying it as they are finding approximately 20% of all patients who complain of back pain actually have SI joint pain instead of or in addition to actual back pain.

Bringers, be aware that MOST spine surgeons know little to nothing about the SI joint as they have never received training in this area. I saw at least 6 doctors before getting my SI joint dysfunction diagnosis by an SI joint fusion surgeon. Therefore, you will need to research where there are surgeons who do SI joint fusions and be examined by one of them, not just by any spine surgeon. Minneapolis and Chicago have SI joint fusion surgeons, and you may find one also closer to you. One of the leading companies for SI joint fusions right now is SI Bone with the IFuse method. Contact SI Bone to find out if they have any surgeons near you who can test you. Their SI joint fusion method is minimally invasive and takes about an hour. Check out their website also. There are also other surgeons who use other minimally-invasive methods, and some who do major abdominal surgeries to fuse the SI joint. You are obviously best off being evaluated by one who does a minimally-invasive approach. Many major metropolitan areas don't yet have surgeons who can do SI joint fusions, so you may need to travel to see one.

Also, the symptoms from patient to patient who have SI joint problems can differ quite a bit, so just because your symptoms don't match up exactly with my symptoms or the symptoms you have read online doesn't mean you don't have an SI joint problem.

HTH!

 
Old 06-07-2011, 12:46 PM   #15
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Re: Should I seek a 2nd opinion?

I am aware that not all symptoms will line up. As stated earlier the only reason I have doubts about the diagnosis is that my doctor just came up with it out of the blue it seemed and had no real reason when I asked him about it why he thought it was the cause. My MRI stated I had a re-herniation so I assumed it would be the first starting area as the pain and everything is the same just a lot worse this time around. He also mentioned that after shot if no pain relief would then just move on to testing my discs. I figured there would be more to testing the SI than just a shot. I do appreciate your explanations though and if truly the SI joint I will ask my doctor about his experience in treating those and honestly look into seeing a doctor that specializes in the SI Joint.

Thank You So Much!!!

 
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