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  • FRUSTRATED: Disc Tear or Epidural Fibrosis

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    Old 10-12-2012, 04:48 AM   #1
    Strike554
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    FRUSTRATED: Disc Tear or Epidural Fibrosis

    I had a microdicectomy in 2010 for a herniated disc. All was well for about a year and a half and then the pain returned. It returned the morning after I played golf (which the surgeon said was fine to do). I had played several times before with no issues.

    After waiting for it to go away on its own for 3 months I finally had another mri. It shows a very minor bulge at the l5/s1 level, where I had my previos surgery. All doctors say this bulge is too meniscule to be causing the pain.

    After 3 visits to the surgeon and him telling me he was not sure what is causing it, he said I could possibly have a small 'tear" that is not showing up on my mri. Why wouldnt he have said that the first visit?

    I had an appt with my physiatrist who quickly debunked that theory and said if I had a tear my back would surely hurt. (I HAVE 0 BACK PAIN, ONLY NERVE PAIN).

    My physiatrist now thinks Its the epidural Fibrosis "ABUT" s1 nerve root causing pain. My surgeon acknowledged the fibrosis but wont give me a clear answer on everything.

    THE first visit to both the physiatrist and the surgeon both ruled out epidural fibrosis as a cause of the pain, after 3 visits to each they both seem to acknowledge its a possibility. Again it is just "abut" the s1 nerve root.


    SO WHAT DO YOU GUYS THINK? DO I HAVE A DISC TEAR OR IS IT THE SCAR TISSUE??????

    REMEMBER I WAS PAIN FREE FOR A YEAR AND A HALF AFTER SURGERY. VERY LITTLE TO NONE WHEN IT COMES TO BACK PAIN.


    WHAT SHOULD I DO??????

     
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    Old 10-12-2012, 08:14 AM   #2
    teteri66
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    The fact that you were pain-free for such a long time is the reason why I don't believe the new pain is caused by scar tissue, at least from the discectomy.

    It could be that the golf was an activity that your back was not used to doing...and that the twisting may have just tweaked something enough that it is causing some inflammation. It may be that there is enough swelling in surrounding tissue that the SI nerve is now being pushing into the patch of scar tissue.

    There is no good way to deal with epidural fibrosis. Because the formation of epidural fibrosis is the body's natural way of dealing with a surgical procedur or accident where tissue is removed from the body, there is no way to really eradicate it. It is just collagen tissue just like we have throughout our bodies. Depending on where it is located, you could look for someone who does body work to see if there is a way to address it.

    There is a procedure done by pain management doctors called a lysis of epidural adhesions...you can look it up and read about it. I personally do not recommend it as it is extremely painful and doesn't provide permanent pain relief. Also, I have a friend that had a really bad adverse reaction to it...so I always have shied away from it.

     
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    Old 10-12-2012, 08:21 AM   #3
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    teteri66,

    Thanks again for the reply. You seem very knowledgeable in regards to this kind of stuff.

    The surgeon said he thought my body was going through a period of high inflammation as well. And several people have told me they think i just "tweaked" something while playing golf.

    But dont you think if it was inflammation it would have resolved itslef after all these months???

    I hope its not a TEAR! that sounds horrible.

     
    Old 10-12-2012, 10:31 AM   #4
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    Quote:
    Originally Posted by Strike554 View Post
    .

    The surgeon said he thought my body was going through a period of high inflammation as well.

    I hope its not a TEAR! that sounds horrible.
    I wonder if you can check your MRI report yourself and look for words like inflammetion, thecal sac or dural sac narrowing, arachnoiditis? Sometimes epidural fibrosis goes along with a VERY SELDOM mentioned condition called arachnoiditis that causes neuropathic pain, numbness, tingling etc. No one told me for 30 years. Hope not the case!!! But check your report. Glad your not having back pain. I have seen reports that say annular tear. Seems a tear would show up.

     
    Old 10-12-2012, 10:40 AM   #5
    Strike554
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    Quote:
    Originally Posted by gmak View Post
    I wonder if you can check your MRI report yourself and look for words like inflammetion, thecal sac or dural sac narrowing, arachnoiditis? Sometimes epidural fibrosis goes along with a VERY SELDOM mentioned condition called arachnoiditis that causes neuropathic pain, numbness, tingling etc. No one told me for 30 years. Hope not the case!!! But check your report. Glad your not having back pain. I have seen reports that say annular tear. Seems a tear would show up.
    Gmak,

    I have read the mri report. There was nothing on there saying anything about arachnoiditis or a tear. Again, the physiatrist was not sold on the whole tear idea. I just feel like this should have resolved on its own.

     
    Old 10-12-2012, 10:58 AM   #6
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    I think his symptoms would be more severe if he had arachnoiditis. Also, it very seldom is mentioned on a MRI report unless it is just devastatingly obvious. It seems like half the physicians learned about it in med. school but haven't thought about it since...and half of the other half think it is much ado about nothing. It can be very difficult to get it diagnosed even when it is present...and then surgeons don't always agree.

    Inflammation can be a very insidious problem. I ruined one surgery, a small foraminotomy between my two fusions, due to a family medical emergency. I had no choice but to hang around a hospital ER and ICU for about five days just a week after surgery when I wasn't even supposed to be driving yet. By the second day I could feel the inflammation already, called my surgeon who told me "do what you have to do and we'll deal with it later." He also put me on oral prednisone...but it was too late and I never recovered. The nerve itself began swelling.

    I'm not saying this is what is going on with you -- just site it as an example of how inflammation can cause more problems than it seems it should.

    The thing with the L5-S1 segment is that when there is a problem, it can be hard to figure out if it is actually the L5-S1 disc, the SI joints or the piriformus muscle....given how much torque is involved in a golf swing, it could probably be a problem with any or all three.

    After my last 3 level fusion, I spent two years recovering. This was my third and what both I and my surgeon regarded as my last chance to get it right. My surgeon did his part and then when it came to rehab, he was extremely conservative. He ordered the PT (who works for him) to do NOTHING that would aggravate my sciatic nerve. So there was a limit to what he could do with me. I would go for about six weeks and then I would take about 3 months off to just work on my own, mainly walking. I thought I would never get rid of the "pain in my butt" and was to the point that I was about to try either prolotherapy or a protein-rich plasma (***) injection into the SI joint. Then I realized it was gradually slowly, slowly going away....and it did. But, it took almost 2 years!! Every little thing I would do for the first year would cause a flare...which my body guy felt was inflammation.

    I am going to suggest you look into a "far infra-red" heating pad. They are expensive but I couldn't have made it without it. The heat waves are such that it penetrates a lot further into the tissue rather than just heating the surface. It won't hurt anything and it just might help promote healing.

     
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    Old 10-12-2012, 11:32 AM   #7
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    Inflammation can be a very insidious problem. I ruined one surgery, a small foraminotomy between my two fusions, due to a family medical emergency. I had no choice but to hang around a hospital ER and ICU for about five days just a week after surgery when I wasn't even supposed to be driving yet. By the second day I could feel the inflammation already, called my surgeon who told me "do what you have to do and we'll deal with it later." He also put me on oral prednisone...but it was too late and I never recovered. The nerve itself began swelling.

    I'm not saying this is what is going on with you -- just site it as an example of how inflammation can cause more problems than it seems it should.

    The thing with the L5-S1 segment is that when there is a problem, it can be hard to figure out if it is actually the L5-S1 disc, the SI joints or the piriformus muscle....given how much torque is involved in a golf swing, it could probably be a problem with any or all three.




    Does inflammation show up on an MRI???? IM GOING TO POST MY MRI on this board so you guys can read it

    Thanks

     
    Old 10-12-2012, 02:41 PM   #8
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    THANK GOD! I was concerned that someone hadn't told you. So happy that their is no MRI evidence of that. Have you had an EMG? To see if you have nerve root irritation? Teteri is right about arachnoiditis. Also i think infra red heating pads can be gotten @ medical supply stores. They ordered mine. Have you had PT lately? Supposedly ultrasound reduces inflammation. What about anti inflammatories? Did the dr mention those? I hope they find something to help you or it just resolves. Dont think the word inflammation is on mri report but words like swelling or edema, presence of fluid or increased bloodflow, hypertrophy etc.I hope you get better and this resolves for you. There is a dermatome chart showing which area of body is served by which level of nerve. Will check for it.

    Last edited by gmak; 10-12-2012 at 03:10 PM. Reason: didnt let me type

     
    Old 10-12-2012, 08:04 PM   #9
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    Quote:
    Originally Posted by gmak View Post
    THANK GOD! I was concerned that someone hadn't told you. So happy that their is no MRI evidence of that. Have you had an EMG? To see if you have nerve root irritation? Teteri is right about arachnoiditis. Also i think infra red heating pads can be gotten @ medical supply stores. They ordered mine. Have you had PT lately? Supposedly ultrasound reduces inflammation. What about anti inflammatories? Did the dr mention those? I hope they find something to help you or it just resolves. Dont think the word inflammation is on mri report but words like swelling or edema, presence of fluid or increased bloodflow, hypertrophy etc.I hope you get better and this resolves for you. There is a dermatome chart showing which area of body is served by which level of nerve. Will check for it.
    I will say this, certain movements sometimes such as bending over and squatting down does cause a quick stabbing pain that is noticeable over the constant ache I have. Its like certain movements cause the pain to increase which leads me to believe its something like scar tissue touching it?

    What do you guys think?

    Also I am not sure what an EMG is, but I have been taking advil, aleve, tylenol etc with little to no relief.

    Here is my MRI report....

    This was done this February.

    There was Intravenous gadolinium or "contrast added"

    Findings: The alignment of the lumbar spine is within normal limits. The vertebral bodies are normal in height and signal characteristics. The conus medullaris terminates at the expected anatomic location of L1 and is normal in signal and configuration. The nerve roots of the cauda equina seperate in a normal fashion without evidence of adhesive change.

    At the level of L5/S1 there is degenerative disc disease with partial loss of normal disc height and hydration. There has been interval left hemilaminectomy with removal of the previously seen central disc protrusion. Mild T2 hyperintensity and enhancement along the posterior disc margin is compatible with sequela of microdiscectomy. Small annular disc bulge is present without evidence of recurrent/residual disc herniation. Minimal enhancing epidural fibrosis abuts the descending left S1 nerve root sleeve. Spinal canal and neural foramen are patent.

    The remaining levels demonstrate preservation of normal disc height and signal without disc herniation, spinal canal stenosis or neural foraminal stenois.

    Impression:
    Internal left hemilaminectomy and microdiscectomy at l5/S1 without evidence of residual/recurrent disc herniation. No spinal canal stenosis at any level.

     
    Old 10-12-2012, 09:29 PM   #10
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    The good news is that nothing shows up on the MRI. The bad news is why are you still in pain?

    The good news is that there are no signs of arachnoiditis. The nerve roots of the cauda equina seperate in a normal fashion without evidence of adhesive change.


    The cauda equina is the area below the L1 level where the actual spinal cord stops. From this point on down to the sacrum, the nerves bundle together to form the "cauda equina," so named because it was said to resemble a horse's tail.

    The nerves look as they should and are not clumped together. There are no signs of them adhesing together.

    The only finding that one could suspect of possibly causing pain is the sign of disc degeneration and the small annular bulge. Nerve pain is caused by irritation or compression of a nerve.

    An annular bulge can be painful even though the disc is remaining within the disc space due to nerves that are present in the outer part of the vertebral disc called the annulus. The rest of the disc does not have any nerve endings...but the annulus does.

    But apparently your doctors do not believe this is a cause of your pain.

    Last edited by Administrator; 10-14-2012 at 06:40 PM.

     
    Old 10-13-2012, 07:25 AM   #11
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    As far as chemical irritation goes I do believe that is a possibliity. Again I am not in as much pain as I was while my disc was herniated pressing on the nerve. It has been mentioned to me in the past that my muscles may be weak and there could be inflammatory molecules in my blood aggrevating my nerve. Thats what the pysiatrist did say.

    I just wish I knew how to calm things down in there. Its really stressing me out. I know my wife is probably sick of me complaining but it is so annoying.

    As far as the arachnoiditis goes that sounds ABSOLUTELY awful and I feel terribly bad for anyone that is experiencing that. I have one nerve in pain I can imaging having a handfull clumbed together with scar tissue.

    Teter,

    Are you now convinced I dont have a disc tear? I wrote the MRI on this post word for word.

    Also, if i was to try to do an epidural injection would it flush out all the toxins and inflammatory molecules to give my nerve a chance to calm down?

    Thanks everyone

     
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    Old 10-13-2012, 10:09 AM   #12
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    No, I am not convinced of anything due to what is reported on the MRI. Remember I'm the one who was told for years that my MRI didn't indicate anything that would indicate why I still had sciatic pain after my first fusion...then when the surgeon opened me up, he discovered my facets at L3 were basically worn away to tiny nubs...and things were much worse than he had been expecting...based on all the imaging I'd had done.

    Annular tears can be hard to pick up.

    if I were in your position, I would do what I could to get the general inflammatory response of the body to go down. I would lay on a far infra-red heating pad three times per day for the recommended amount of time. I would back off all exercise that might cause sciatic-type pain...so in my case I would be walking and I would go to a warm therapeutic pool. I would work with a PT or personal trainer a couple times in the pool to learn what exercises I could do in the pool to strengthen the muscles without causing sciatic-type pain...(I had a little routine I went through about 3 x week )...I would eat an anti-inflammatory diet and I would probably try some supplements to see if they helped calm down the inflammation.

    I'm not sure how much supplements work...or the diet either. I am always looking for ways to quiet inflammation as I tend to be prone to that...Oh, another thing you could do if it isn't a financial burder, is to have acupuncture on a regular basis. Also, I would be lying on the floor several times each day, too.

     
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    Old 10-13-2012, 11:11 AM   #13
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    teteri66...you have mentioned several things in this post that I have been considering. I have read about the infared heating pad. I don't know what the policy is here about mentioning products but if you can note that, is there one you prefer? I have been reading general reviews but there are several. Heat I have found helps me a lot, however, I have a small heat pack that microwaves with rice in it. Not bad...but I expect the other is better.

    Also...supplements. If anyone has ideas on those, I hope you will post. I currently do take vitamin D3, which should help, and also a calcium supplement but these were not initally for sciatica or herniated discs.

    I am confident that diet can help. I'm working on that as well....although I always felt I have a pretty healthy diet, and I don't have high pb or high cholesterol yet at 59, and I'm a healthy weight.

    I found it interesting to learn just recently that pineapple is a natural anti-inflammatory. Good thing I love it, and I eat a ton.

     
    Old 10-13-2012, 12:10 PM   #14
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    This is the one I have, but I am sure there are other brands. Thermotex Gold Far Infrared Electric Heating Pad for Cronic Back Pain Relief

    The thing is, it doesn't bend. It is sort of like lying on top of a board. At the time I bought mine, there weren't any that had the technology to be flexible...but I think now they may be able to make them. I haven't really looked into it.

    Regarding supplements, B vitamins are supposed to aid nerve healing. I take a product by Schiff called Move-On Ultra that helps all my joints move a little better. I've also used a variety of other supplements -- hyaluronic acid, krill oil for the Omega 3s, Zyflamed, etc. Other than the Move-On, I can't swear anything else has helped all that much. On the other hand, my feet have been numb since 2001 and everyone assumed the nerve damage was permanent, but since my last surgery in 2010, I am still getting feeling back in my toes and feet...so maybe something is helping.

    I think the infrared heat helped me as much as anything. I even take it with me any time I travel.

     
    Old 10-13-2012, 12:29 PM   #15
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    Re: FRUSTRATED: Disc Tear or Epidural Fibrosis

    White willow bark is supposedly a good anti-inflammatory herb. I use to pop advil like crazy but realized its probably horrible for your stomach etc.

    Im trying to as natural as possible. IF ANYBODY KNOWS OF ANY HERBS OR FOODS THAT HELP WITH INFLAMMATION OR NERVE PAIN PLEASE POST!!!!


    ALSO TETER AND EVERYONE ELSE, SHOULD I TRY THE EPIDURAL TO FLUSH OUT THE INFLAMMATION AND POSSIBLY GIVE PAIN RELIEF AND WILL IT BE PERMANENT RELIEF.

    THANKS ALL

     
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