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Old 11-30-2011, 07:40 PM   #1
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ESI before Spinal Cord Stimulator!

Just had a 1.5 hr session with my PM. He looked at myelogram pictures and came to the conclusion that I have a possible osteophyte at the L2-L3 level. He believes that with a epidural steriod injection at that level might help me with my back and leg pain. Because of the hardware in my back it shadowed the nerve root endings to where the pictures were blurry. My PM has never been wrong yet at diagnosing me so I'm going to have a ESI on the 13th of december. If it helps then I will ride that horse until I can't go no more.

My spine surgeon wants me to try the spinal cord stimulator for 5 days and then if it helps tremendously then have the permanent one installed. I have reservations about that at this time. I'm hoping this shot will help even though I've had these in the past with very little difference.

I have not discussed this finding with my spine surgeon or the nuero that operated on me last dec. I would not be surprised that I have a bone spur because I did have 5 or 6 months where my right leg did not bother me. So, it would seem that something had to develop after that time to bring me to this.

If the shot does nothing for me, then my PM wants me to have a EMG to check where the nerves are damaged and how bad they are damaged. He will be able to determine where the leads to the SCS were to go which in turn would help in blocking the pain signals.

So, in 2 weeks I will have the ESI and hope and pray it helps where I can resume my life. It has been one tough year. I'll be in touch with results.

Keith

 
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Old 12-01-2011, 08:32 AM   #2
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Re: ESI before Spinal Cord Stimulator!

That was a very long session with any doctor! Is he working in tandem with your surgeon? Could you clarify about the surgeon? You mentioned a couple surgeons in your post and I am confused as to who is treating you.

I was rereading through an older post where you go over MRI results, etc. (I think it was from Sept.) You tend to refer to pain in your middle back that is burning. When you say "middle back" I tend to think of lower thoracic issues, but I think you indicated you were referring to maybe L2 -- would that be correct or do you have thoracic issues, too? Where is you pain now?
Where in your leg? When does it hurt?

Regarding your questions in the above post...I suppose you might as well try the epidural injection or you could ask him about having a diagnostic nerve block at that level to see if you can pinpoint where the pain is coming from. Actually, that would be a good idea, as you could find out about the pain and with the additional of the steroid, the injection would then function just like the ESI.

I told you how much difficulty I had tracking down what was causing my pain. More than any testing I had done, the diagnostic nerve blocks proved to be the most accurate, that and a really good physiatrist (which would be like your PM doc).

Will the PM be the one to install the SCS?

 
Old 12-01-2011, 09:42 AM   #3
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Re: ESI before Spinal Cord Stimulator!

Hi teri. Thanks for posting to me. I posted this mainly to you since you understand my position. No my PM is not working with my spine specialists. My surgeon (s) I was talking about are the two that operated on me. One is a orthro spine specialist, the other is a nuero.

When I last seen my orthro and we looked at my myelogram, ct-scan, he thought he would be seeing a problem at L2-L3. He also said that the myelogam pictures were not that clear because of my hardware shadowing the nerve root endings at L2-L3. He sent me down to the nuero so he could look also and make sure that my orthro was not missing anything. After that discussion, he sent me to a PM doctor in there group who discussed the SPS. Well as I wrote in previous thread, I was alittle apprehensive in having the SPS implanted without talking with someone else. So I went and seen my PM that I have been seeing for about 2 yrs. The same PM that told me last october that I was looking at a 2-level fusion sometime in my near future. This same PM doctor set with me for a hr. last october and we both looked at my mri, myelogram pictures that I brought to him and discussed what I had going on with my back. He was very detailed and took his time with me like no other doctor. Most doctors will see you for maybe 10 minutes tops. But not this PM doctor. So, I was very impressed with him and have stayed with him for my medications since.

I said my pain was in the middle of my back because that's where it feels like but it is actually at the incision site of L3-L4, from last surgery. I do not have any thoracic issues that I know about. My pain now is at the L3-L4 and my leg pain is right quadricep. My quadricep really hurts when I get up from a sitting position. It takes an hour to drive to PM's office and when I got out of car my right quadricep was so weak and I felt like I wanted to just curl up somewhere. My back felt like it did before surgery, slight burn and feeling like a fist in my back )at the L3-L4 level).My leg hurts so bad sometime that I'm almost sick. Monday of this week I went down to gym to walk. They have a walking trail inside and I walked for 20 minutes. Not very fast at all. While walking I do feel my right quadricep burning alittle and feeling weak but it was alot worse when I got in my car. I felt so terrible with the throbbing pain in my right quadricep. Below my knee, no problem! When I'm laying on the couch I feel what feels like a fist in my back. My leg aches but not to bad.

I am going to research the diagnostic nerve block and maybe call my PM about that. Thanks teri for that info. That's why I like corresponding with you. You give out so much valuable info. Let me ask you. Is the diagnostic nerve block like a EMG? I ask because my PM told me that the EMG would tell them where, if I have I try the SCS, to put the leads for better pain block.

I know teri how much you went through to find out your cause of pain. Instead of just going with what a doctor (s) say and being done with it we have to as patients be so persistent in getting to the bottom of our pain. After all, we are the ones in pain, not the doctors. If pictures are not clear cut what the problem is then more times than not, they just want to push you out the door. So, I'm going to be persistent as h***. I want my normal life back. At least as much as I can get back. I don't want to be on permanent disability but if I end up that way it won't be because I gave up easily. I'll go down with a fight.

To answer your question regarding if my PM would be installing the SCS (if that is necessary), no. He is only qualified to do the trial. He talked highly of the other PM which is in with the group of doctors who performed my 2-level fusion. My PM is just here for me to do evaluations as he sees. He will be doing the ESI. Once that's done (december 13th) I will see if it helps at all. IF it doesn't help then I'll be seeing the other PM for the SCS trial which from what I've been told would be next year before I can get that done. Thanks again teri for all your help.

Keith

Last edited by parman; 12-01-2011 at 09:47 AM.

 
Old 12-01-2011, 10:50 AM   #4
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Re: ESI before Spinal Cord Stimulator!

The diagnostic nerve block procedure is really similar to getting an ESI. The difference is that right after the procedure, you feel quite numb in the leg. You are instructed to keep a pain journal, and instead of resting when you get back home as you should do after an ESI, you are supposed to go about your regular routine (and do activities that would normally cause pain). The idea is that if you are not reproducing the pain while doing these activities, it is not the particular nerve that was injected.

Then you note when the pain begins to return, if you don't have it immediately while doing the activities.

I had a bunch of these diagnostic injections when we were trying to figure out which levels to fuse -- everything indicated that L5-S1 was causing my problems...but it turned out to be L3-L4.

With the quad muscle, it can be a couple things -- it can be a nerve coming from L2 or L3, possibly even L1; it can be damage to the femoral nerve that could have occurred during surgery...but since your pain didn't start for 6 months post-op, I don't think that's it.

After my first fusion at L4-L5, 12 hours post surgery I developed pain in the front of my thigh which I had never had before. It was and remains the absolute WORST pain I've ever had in my entire life...and it never went away until after my 3rd surgery. It turned out to be coming from my L3 segment-- the facet was worn down to a little nub, which was not visible on any imaging, for some strange reason.

 
Old 12-01-2011, 11:35 AM   #5
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Re: ESI before Spinal Cord Stimulator!

[QUOTE=tetonteri66;4888110]The diagnostic nerve block procedure is really similar to getting an ESI. The difference is that right after the procedure, you feel quite numb in the leg. You are instructed to keep a pain journal, and instead of resting when you get back home as you should do after an ESI, you are supposed to go about your regular routine (and do activities that would normally cause pain). The idea is that if you are not reproducing the pain while doing these activities, it is not the particular nerve that was injected.

Then you note when the pain begins to return, if you don't have it immediately while doing the activities.

I had a bunch of these diagnostic injections when we were trying to figure out which levels to fuse -- everything indicated that L5-S1 was causing my problems...but it turned out to be L3-L4.

With the quad muscle, it can be a couple things -- it can be a nerve coming from L2 or L3, possibly even L1; it can be damage to the femoral nerve that could have occurred during surgery...but since your pain didn't start for 6 months post-op, I don't think that's it.

After my first fusion at L4-L5, 12 hours post surgery I developed pain in the front of my thigh which I had never had before. It was and remains the absolute WORST pain I've ever had in my entire life...and it never went away until after my 3rd surgery. It turned out to be coming from my L3 segment-- the facet was worn down to a little nub, which was not visible on any imaging, for some strange reason.[/QUOTE]

So if the problem was coming from the L3 segment and imaging did not show it, how did you find out. Was it during surgery when it was found?
I know teri how that pain in the front of the thigh feels. Like I said before, I have almost gotten sick from the intense pain and weakness. I have noticed if I sit and I mean sit and not lay, too long then that is when my right thigh is at its worse.

Last edited by parman; 12-01-2011 at 11:52 AM.

 
Old 12-01-2011, 12:13 PM   #6
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Re: ESI before Spinal Cord Stimulator!

My crazy physiatrist felt all along I had instability at the level, but my surgeon discounted what he was saying as nothing showed on imaging. Of course my surgeon never laid a hand on me. The physiatrist was injecting me on a regular basis, looking at my spine under fluoroscopy and sticking needles in my spine. I'm not sure what part of that made him think I was unstable...but he knew it from the first time I went to him.

Going to him was an interesting experience on many levels. I had had ESIs previously with two different pain management docs, and had absolutely no reaction. Nothing. The very first time this doctor injected me, I had a response. It didn't last long, but at least I felt something! I'm not sure what he did differently, but every time he injected me, I had some sort of response.

So based on his diagnostic nerve blocks, my surgeon planned to do 3 levels -- well, technically I was already fused at L4-L5, but he ended up having to remove the screws as they were not compatible with the new hardware...so I ended up with new screws at all 3 levels and then new rods, of course. When the surgeon opened me up, he was shocked to see all the damage at L3...and he ended up having to perform reconstruction at that level.

 
Old 12-01-2011, 03:47 PM   #7
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Re: ESI before Spinal Cord Stimulator!

How long had the surgery been on L4-L5? I know it normally takes at least 6 months before your fused, if not longer. Your doctor had to remove all the hardware and screws at L4-L5. Is that right? Had you had any mri's, cat-scans, or myelograms in that period since L4-L5 fusion? So, there was no test to show the damage at L3.

After the reconstruction where exactly are you now? Are there any kind of test that show facet problems?

 
Old 12-01-2011, 04:45 PM   #8
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Re: ESI before Spinal Cord Stimulator!

No. I didn't explain that very well. I had surgery at L4-L5 in Jan of 2008 and was completely fused. Since my surgeon wanted to add on above and below, he needed to remove the rods so he could replace them with longer ones that would tie the whole thing together. Usually they can just remove the tulip-shaped bolt on the top of the screw but in this case, the whole screw was not compatible with the new ones, so he had to remove it. Don't ask me how he got it out because I do not know! But he gave me all the screws in the recovery room and they look pristine, so he didn't cut them or damage them (or me) getting them out. He then put in new screws to replace the old ones and bolted the whole thing together with longer rods. I have a PEEk cage at that level, but not at the other two levels.

I had several MRIs and a positional MRI since the first fusion and nothing showed up pertaining to L3-L4 except a tiny bit of bulging...it was a big surprise.

 
Old 12-01-2011, 05:03 PM   #9
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Re: ESI before Spinal Cord Stimulator!

So I know every case is different but in theory I could have a slight bulge at L2-L3 that is causing me my right quadricep pain and my back pain and at the same time not showing up on any image. Is that really possible?

 
Old 12-01-2011, 05:10 PM   #10
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Re: ESI before Spinal Cord Stimulator!

You could have things wrong at L2-3 that are irritating the nerve, but I think a bulge would probably be visible. Sometimes annular tears are not readily apparent and they can be leaking a fluid that the nerve finds very irritating.

 
Old 12-01-2011, 07:56 PM   #11
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Re: ESI before Spinal Cord Stimulator!

While I was typing this last post, my right leg started feeling so heavy and I was laying on the couch. Something is not right! I don't care what does not show. I know just like you knew there is something wrong. The heaviness then went to strong tingling in right quad. It has calmed down some since then.
The question is can my problem be determined. I will start with the ESI and then we will see from there.

Keith

 
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