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Old 01-08-2013, 11:28 AM   #1
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Lower back issue... decision time?

I've been dealing with lower back pain (bulging disc) for 6 years. I've been to a chiropractor, tried p.t. 3 x at 3 different pt centers, tried acupuncture, saw a neurosurgeon who didn't want to do surgery (unless I insisted on it) and sent me to the pain center for shots. I've had various shots in my lower back, tried the radiofrequency (yikes!), and then had facet joint injections. I just did a search here re: facet joint injections & kept seeing comments about this kind of injection really not being effective. Now, my secondary insurance company is refusing to pay the balance due on two sets of these injections, stating that this treatment really isn't effective. I'm tired of not being able to take long distance car trips (more than 2 hours) or not taking a trip overseas, not being able to do things that require standing (museums, art galleries). I think I'm going back to the neurosurgeon & telling him I've tried everything....see what he says. (but so many folks warn me that back surgery can bring on more problems and to avoid it). For the past 2 years when I've needed to travel (plane) I get trigger pt injections which last 2 weeks (so wonderful to be misery free). Does any of this sound familiar? Any thoughts? Advice? Suggestions? Thanks.

 
Old 01-08-2013, 08:43 PM   #2
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Re: Lower back issue...decision time?

First I would suggest that you make an appointment with another spine specialist, perhaps an orthopedic spine surgeon, for another opinion.

Epidural steroid injections can be effective. It just all depends on what is causing the pain. I would imagine you have something else going on other than a bulging disc. Have you had a MRI?

 
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Old 01-08-2013, 09:05 PM   #3
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Re: Lower back issue...decision time?

I've had 2 MRI's (May 2011 and December 2011) showing the bulging disc. I asked my pain center dr if I could have an epidural (some friends had them with good results) & he said that type of injection would not help *my* back condition. I thought a neurosurgeon is safest to use when one is dealing with discs.

 
Old 01-08-2013, 09:23 PM   #4
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Re: Lower back issue...decision time?

Perhaps there is something unique about your bulging disc that caused the PM doctor to say that...but in general, are given all the time to try to shrink a bulging disc, alleviate the inflammation and get the tissue to move off the nerve.

There are orthopedic doctors who specialize in different areas. Fellowship-trained orthopedic spine surgeons and neurosurgeons are the two specialties that have the most training in the mechanics and diseases of the spine. You always want to find one whose practice is limited to the neck and back. In some areas of the country, one specialty may be more common than the other...but the training is very similar. I always think it is a good idea when considering surgery to get an opinion from one of each as sometimes they have slightly different approaches to an issue.

I think it depends more on the person's educational background and training and then his/her personality than it does if the doctor is a neurosurgeon or an ortho spine surgeon.

 
Old 01-08-2013, 11:57 PM   #5
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Re: Lower back issue...decision time?

Several things come to mind when I read your post.

First of all, you are the only one that answer whether you want to go the surgery route or not. Spine surgery does come with risks so don't take the surgery idea lightly.

It is difficult for us to give a complete opinion without the benefit of reading the MRI. It is upto you as to whether you want to post the actual report or not. I know you had MRI's in the past. Not sure whether enough time has passed for you to have another one or not to see if there are any changes since the last one was done or not.

As to epidurals I can only comment on them from my personal experience. I've been told several times that they usually will limit injections to 3 injections within a certain period of time. I went thru several rounds years ago. I usually got some relief after the 1st injection for a few days.So we proceeded to the 2nd injection. And every time I did this I never received any relief on the 2nd injection. So the doctor and I decided NOT to proceed to the 3rd round since they either never worked or were only short lasting for me. So bottom line for me it is not a consideration for future treatment.

As to whether to use a neurosurgeon or an orthopedist. I think a lot of people tend to get worried on which doctor to use. Both are equally qualified to treat spine related issues. I would recommend either one as long as they are "Trained" and they routinely "Treat" spine related issues. I think the big difference that people dont think about is that yes neurosurgeons have more specialized training because they will treat people with some form of brain injuries/disease where the orthopedic obviously isnt trained in this area.

I have been thru 5 major spine surgeries. Two of the surgeries were done by the same doctor who was a neurosurgeon. He did surgery on me for herniated discs and stenosis in the neck area.

But the following 3 surgeries that were done were by far more drasitic. I had surgery on the neck and low back where Harrington Rods had to be implanted. the neck surgery alone was a 12 hour surgery and this was done by an "orthopedic" surgeron.

So please dont place too much emphasis on the "title" just concentrate on whether they are "TRAINED" IN SPINE ISSUES. That is what is most important.

One last thing if you are looking for more input, many of us will post the actual MRI report on line here as to what the radiologist wrote. This way we can have a better idea of what was found. But that is your decision on if you feel comfortable enough to post the report.

Good luck in making your decision.

 
Old 01-09-2013, 12:33 AM   #6
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Re: Lower back issue...decision time?

I am in my 7 th week post back surgery for a compressed nerve from a herniated disc so my thoughts are that you need an MRI to determine the exact cause. Any back surgery is scary but I had no real choice as my left leg was loosing muscle and I always had the risk of another attack of severe pain from the compression. For me the cause was I hope successfully removed but I still have the effects (constantly told they will go one day!). Overall it is about risk as you could make matters worse or better so can you spend the rest of your life with this discomfort?

 
Old 01-09-2013, 04:16 AM   #7
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Re: Lower back issue...decision time?

Zee703....I am posting to you because I am in the exact same position that you are as far as making a surgery decision. I agree with others about the specifics of your MRI, and whether you have consulted with a surgeon that has gone over your MRI with and fine toothed comb...and explained it all to you?

My experience with injections has been excellent, in that I always responded to them, and coupled with PT...I have always gotten better. However...I would then ...out of the blue...with one movement, find myself in horrific pain. It could have been a few months later, or more recently...a few weeks. My MRI now shows the disc has a fragment, and it is the culprit that is pressing on the S1 nerve, causing pain (which does get better with time and medication), and extensive numbness and now weakness in my left leg and foot; inability to lift my weight from my left foot. So.................I am electing after 5 years pain free, and the last year of having one episode after another, to have a microdiscectomy. I see the surgeon next Monday.

I feared this for the last year. I am just like Pasck52...I have been living with the risk of another attack...and I'm ready to rid of that fear. When it comes to surgery, I am staying positive that I will have an excellent outcome, and given that I have been up and down over the last year, I know I can deal with the few weeks or months that the recovery will take. I'm looking forward to the symptoms getting better this time with less risk of a fragment moving ...since it will no longer be there. Fingers crossed!

I am seeing an orthopedic spine surgeon. I had the same concern initially over spine or neurosurgeon. I had been going to an orthopedic hospital, and found I couldn't get in to a recommended neurosurgeon for weeks, even to have an initial consultation for a second opinion. So that was the decision maker for me, and I feel confident that my fellowship trained spine surgeon is highly qualified. I guess I do find comfort in knowing he only deals with spine surgeries.

I agree with others about posting your MRI results here or finding out if you need a new one. Within a few months, mine changed...that's how we knew there was a disc fragment.

I would also say, to push and advocate for yourself...and don't feel badly about asking a zillion questions. I know some doctors don't like that, but....from other experiences in my life I do know that being your own advocate, and asking and asking until you have answers or explanations that make sense to you and you can make sound decisions is critically important.

You noted that you were told that injections wouldn't help "your" back condition. If you have any questions about that "condition" whatever it is, then keep asking until you fully understand! Good Luck. This board is extremely helpful!

 
Old 01-09-2013, 09:08 AM   #8
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Re: Lower back issue...decision time?

Wow - thanks, everyone! I've needed to hear/read the information you've shared. I'm going to print off all of your posts. Back problems and the medical terms used have always seemed foreign to me & I need to get more knowledgeable like you all are. OK here's the "Findings" of my 2nd MRI (12/2011; the first one was done at the same place, same dr wrote report). I've typed this from the report. MRI of the Lumbosacral Spine w/o Contrast:

Mild nonfocal posterior disc bulge is noted at L3-L4, L-4-L5 and L5-S1. The bulging discs compromise only slightly, the lateral recesses of the spinal canal. This finding is more prominent at L3-L4 and L4-L5. Mild anterior type of disc bulge is also noted at L2-L3. The bulging disc at that level does not compromise the spinal canal. There is evidence of early degenerative arthritis in the facet joints of the lower lumbar spine. This abnormality is noted in the facet joints at L4-L5 and L5-S1. No other bone abnormality is identified. The distal end of the cord is visualized and appears unremarkable. Ther are a couple of perineural meningeal cysts in the sacral canal. This is developmental in nature.

Impression:
Disc degeneration of mild degree is noted at L3-L4, L4-L5 and L5-S1. This is manifested by ild posterior disc bulge. The bulging discs compromise, slightly the lateral recesses of the spinal canal. This finding is more prominent at L3-L4 and L4-L5 where in addition the bulging discs also compromise, slightly the neural foramina.
Mild anterior type of disc bulge is noted at L2-L3.
Early degenerative arthrosis is noted in the facet joints at L4-L5 and L5-S1.
The above described abnormalities were also present in the examination of 05/03/2010 and there has been no significant interval change.
There is no evidence of disc herniation at the present time.

 
Old 01-09-2013, 01:03 PM   #9
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Re: Lower back issue... decision time?

Since the MRI is over a year old, something may have progressed past the "mild" stage...but, as this MRI reads, I can see the dilemma. You have small issues at a number of levels. None of them are significant enough that surgery would be recommended. In radiology language there is a ranking system that is accepted by doctors: minimal, mild, moderate and severe. When a disc bulge or stenosis, etc is described as minimal or mild, it usually indicates that it is something worth following, but not a significant finding. Moderate can go either way and severe usually means that surgery may be in the person's future.

My guess is that your discomfort is coming from the degenerative changes in the facet joints more than from the mild disc bulges. Arthrosis in simple terms means that there are arthritic changes going on at L4-L5 and L5-S1 facet joints -- this can include development of bone spurs, enlargement of the joints, etc. This can prove to cause a great deal of pain.

My guess is that a spine surgeon would look at this and recommend conservative measures for treatment and pain management....but, of course, I am just guessing since I am not a doctor!!

 
Old 01-09-2013, 05:29 PM   #10
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Re: Lower back issue... decision time?

Thanks teteri66...that's been the recommendation of my chiropractor, my neurosurgeon and the spine & pain center doctor. I haven't been to my chiropractor since this past summer but I think I'm going to return to him and continue treatment with him plus injections when needed. Actually, my chiropractor has been after me to start walking across the shallow end of a pool for gentle exercise which I've been leery of doing (afraid of causing more problems I guess!). I do need exercise and maybe I need to take his advice.

 
Old 01-09-2013, 06:55 PM   #11
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Re: Lower back issue... decision time?

It is especially beneficial if you have access to a therapeutic pool that is kept warm. That is the exercise of choice after lumbar spine surgeries. It is helpful and will help to strengthen muscles of the back, core, pelvic girdle, legs...and this will gradually help the back pain.

Another thing you may find useful is the use of a far infrared heating pad. They cost quite a bit more than a regular heating pad but they penetrate more deeply and can really help with pain, particularly the facet pain.

 
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Old 01-10-2013, 09:44 AM   #12
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Re: Lower back issue... decision time?

Thanks Teteri66 - I'm going to look into this.

 
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