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    Old 09-07-2015, 07:44 PM   #1
    Jack Lithgoe
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    New guy here with lumbar pain and sciatica

    Nine months ago I hurt my back with an improper lift. Unlike several other back sprains, this one won't go away. Low back pain, and bilateral sciatica. Mostly dull pain, but shooting pain down legs when I bend backwards, or step into a hole that jars my back. Doctors have to play by the insurance company rules, so they treat with meds, then Phys Therapy, then guessing, and before you know it you have been hurting for 9 months. So I had an MRI that revealed a herniated disc with central canal stenosis and 2 other bulging discs.
    How does one choose the method of treatment, or the type of medical pro. If you go to a surgeon, he wants to cut, to a chiro, he wants to crack and twist, you get the point. I'm being stoic about the pain, because I am concerned about side effects and drug dependency, but it's time to get this fixed and get on with my life. I would like to think that the body is equipped to heal itself. But, maybe not.
    Thanks for any suggestions,
    Jack

     
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    Old 09-08-2015, 07:01 AM   #2
    teteri66
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    Re: New guy here with lumbar pain and sciatica

    Welcome to the board. You raise a question that many of us "spineys" have grappled with as we seek treatment for our issues.

    First, I wonder if you played sports like soccer or football or were involved in an activity where your back was in extension like gymnastics or diving? Have you had a flexion/extension x-ray? This will check for spondylolisthesis, which is a condition when one vertebra slips over the top of the adjacent vertebra. This can create an instability which often results in a pinched nerve. There are three types of spondylolisthesis, one that is not uncommon in young athletes.

    Is there more information on your radiology report? If you do not have any other issues, you may be able to heal your discs or at least keep them from getting worse through specific exercise to strengthen the core and back, keeping weight average, not smoking ( smoking is damaging to the health of the discs), and perhaps certain lifestyle changes.

    Some exercise is good for the spine while others can exasperate any back problems and need to be avoided.

    I cannot tell from your report just how badly herniated the disc is, or how severe the central canal stenosis is. If the stenosis is only caused by the disc, it is possible that if the disc material is re absorbed, the stenosis will lessen or go away completely. It is this narrowing that is at least partially responsible for your pain in both legs. In some cases the stenosis continues to narrow the canal, which puts more and more pressure on the nerves. This results in the pain being so severe that the person can no longer stand or walk. If left compressed for too long, it can cause permanent nerve damage.

    If you are fed up with doctors, you could get a copy of Robin McKenzie's book "Treat Your Back" and faithfully follow his program for several weeks to see if it works for you. McKenzie is a well-regarded physio from New Zealand who created a system for evaluating and treating herniated discs that is used by many physical therapists around the world today. Many people have had success treating their own backs with this program. One caveat: if you have spondylolisthesis you should not do these exercises as having the back in extension is not to be done! It can make the situation worse.

    One idea you need to get your mind around is the idea of "getting this fixed" so you can get on with your life. If at age 24 your discs are already showing signs of degeneration, you will always need to be aware of your back, keep it healthy and think before you do anything that might be potentially harmful. Once a disc is herniated it tends to not be as strong as a perfectly healthy disc.

    Also, do not make the mistake of believing that having a back surgery will return you to the way you were, prior to onset of pain or injury. "Good as new" does not apply to spine surgery!

    So, what to do? I believe in going to a well trained, experienced spine specialist for an accurate diagnosis and plan of treatment. This could be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back. In my experience, there will always be a few who want to perform surgery but most will treat with conservative measures until they have been tried and have failed. Surgery should always be a last resort.

    My husband ruptured the disc at L5-S1 about twenty years ago. He was able to let it heal naturally and has been OK ever since. He is careful to monitor his activities and chores and limits the amount of time he spends doing those things that he knows makes his back hurt....raking, gardening, carrying heavy things, etc.

     
    Old 09-08-2015, 07:16 AM   #3
    teteri66
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    Re: New guy here with lumbar pain and sciatica

    (Continued). I, on the other hand, had a spondylolisthesis at L4-5 and severe central canal stenosis. Due to the instability my only option was to have a fusion. I waited several years before having surgery. My leg pain became so bad that I could only stand for a couple minutes and was driving down the driveway to collect my mail because I couldn't stand to walk that far. I got a number of opinions before agreeing to surgery, from both ortho spine and neuro surgeons before I found one I liked and trusted. Then I relied on his referrals for the treatments I tried before resorting to surgery.

    I am a big believer in exploring all options before proceeding with surgery as it is a life-changing process!

    Good luck.

     
    Old 09-08-2015, 11:19 AM   #4
    Jack Lithgoe
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    Re: New guy here with lumbar pain and sciatica

    teteri66
    Thank you for such a "seasoned" reply. You brought up many thoughts and questions.
    Since I am new to this board and its conventions, let me ask, can I respond only to you, or must I reply to the entire board? My response will likely be as comprehensive (i.e. long) as yours. Would you accept a PM?
    Thanks again,
    Jack

     
    Old 09-08-2015, 11:21 AM   #5
    Jack Lithgoe
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    Re: New guy here with lumbar pain and sciatica

    teteri66
    Thank you for such a "seasoned" reply. You brought up many thoughts and questions.
    Since I am new to this board and its conventions, let me ask, can I respond only to you, or must I reply to the entire board? My response will likely be as comprehensive (i.e. long) as yours. Would you accept a PM?
    Thanks again,
    Jack

     
    Old 09-08-2015, 11:55 AM   #6
    teteri66
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    Re: New guy here with lumbar pain and sciatica

    I will read a PM but unless there is something you wouldn't want known publically, people usually converse on the board. That way we all learn from each other and you may get opinions from others that will include ideas not expressed by me.

     
    Old 09-08-2015, 02:48 PM   #7
    Jack Lithgoe
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    Re: New guy here with lumbar pain and sciatica

    [QUOTE=teteri66;5382194]I will read a PM but unless there is something you wouldn't want known publically, people usually converse on the board. That way we all learn from each other and you may get opinions from others that will include ideas not expressed by me.[/QUOTE]
    Only wanted to PM so that I could attach the MRI as a word doc and not have to type it again.
    But since you asked...Yes I played football, soccer, spring board diving etc.
    Never had a flex/ext XR, but recently had an AP and lateral XR of lumbar that revealed the vertebral bodies, pedicles, spinous and transverse processes all to be in tact. Slight narrowing of L3-4 and L4-5 disc space. Facet arthritic change bilaterally at L4-5 and L5-S1 level. No evidence of spondylolisthesis. No abnormal paraspinal mass noted. Calcifications are evident wall of aorta.
    MRI performed 2 weeks ago
    L2-3 Mild to mod facet arthropathy and a disc bulge w/ the foramen and lateral disc herniation to the right. No contact w/ nerve root. Central canal is patent.
    L3-4 Broad disc herniation extending 8.0 mm beyond the margin of the disc space w/ disc material extending above and below the disc space level. The central canal is further narrowed by epidural lipomatosis. Disc material extends into the foramen but there is no foramen nerve root compromise. There is moderate facet arthropathy.
    L4-5 Disc bulge w/ annualat fissure formation. There is also rather severe facet arthropathy aqnd ligamen flavum redundancy causing a moderate degree of central canal stenosis. Disc bulge extends into the foramen but there is no foramen nerve root compromise. There is lateral recess narrowing.
    L5-S1 Disc bulge mod to severe right and moderate left facet arthropathy and ligamentum flavum redundancy. The central canal and foramina are patent. There is annular fissure formation midline and to the right extending into the right foramen. No signs of paravertebral abnormalities or spondylolisthesis.
    IMPRESSION
    1. Disc bulge w/ right sided annular fissure formation L5-S1
    2. Disc bulge w/ annular fissure formation midline at L4-5 where there is lateral recess narrowing and moderate central canal stenosis due to dorsal and ventral compromise of the thecal sac.
    3. Disc herniation at L3-4 w/ lateral recess stenosis as well as central canal stenosis. This is the most severe abnormality depicted.
    4. Disc bulge with a subtle foramen disc herniation to the right at L2-3. No contact with the nerve root.
    My son was a sales rep for a major back surgical component supplier in Houston, and observed many back surgeries. He convinced me that I didn't want to ever have even the best back surgery. He warned me to never climb on the roof of my 2 story house. It is a bad statistic for me over 45.
    My primary doc sent me to a spine diagnostic and treatment center. They are all fellowship trained anesthesiologists. This is pain management. I don't want to treat symptoms by killing a nerve.
    I had some improvement with a massage therapist (not swedish or Rolfing) that used his knuckles and elbows to get deep into muscles to release them at trigger points. He believes the iliopsoas muscle is causing some of my pain in back, legs and hips. When he first looked at me he concluded that my problems were due to lifting something heavy with my left foot turned outward, and the object probably didn't move.
    OK, that was probably a guess. Ray Charles could see my back was messed up. But...the MRI results can't be dismissed. Now my fingers hurt from typing.
    In case I didn't mention it, I'm afraid of knives in my back and drugs. Mostly the side affects of drugs.
    Comments?

     
    Old 09-09-2015, 10:05 PM   #8
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    Re: New guy here with lumbar pain and sciatica

    I can see why you didn't want to type all that. Your radiology report is among the longest and most detailed I have ever seen! I don't have time to devote to it now, but promise I will do so tomorrow. I briefly skimmed it now but want to devote more time to it when I feel fresher!

    I will mention that anyone can name their business a spine clinic regardless of their training and educational background. I would encourage you to see a spine specialist as I think I defined earlier....ortho spine or neuro surgeon. Many anesthesiologists are now taking a bit more training and hanging out a pain management sign because the hours are more civilized and there is lots of money to be made. They learn enough to do the procedures that pertain to the spine such as epidural steroid injections, implanting pain pumps and neuro stimulators and handing out pain killers, but they do not have the years of advanced learning and training in the mechanics and diseases of the spine.

    I strongly believe in starting out with a spine specialist to get an accurate diagnosis and plan of treatment. One can waste a lot of time if one's symptoms do not happen to match up with the somewhat limited knowledge of the spine of the well-meaning General practioner, family doctor, PCP, internist and pain management doctor. I wasted over a year with my internist who kept assuring me my MRI did not show anything out of the ordinary for my age. All the while, my sciatic pain got worse and worse. Finally, and probably because he got tired of me showing up every month complaining of pain, he referred me to a spine surgeon. I waited six weeks to get into see him. He took one look at my MRI, sent me across the hall for a flexion/extension x-ray and told me the only solution available to me was a fusion. I had spondylolisthesis. He told me that when I had surgery was up to me, but there was no lesser procedure of treatment that would ameliorate my sciatic pain. I was so stunned and shocked that I waited almost three years (and seven other spine specialists in three states!) before I decided to proceed. By then my sciatic pain was so bad that I couldn't stand long enough to chop an onion and I was driving to my mailbox, down the driveway, to get my mail. I was close to becoming a shut-in.

    I will get to your MRI tomorrow....promise!

     
    Old 09-09-2015, 10:20 PM   #9
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    Re: New guy here with lumbar pain and sciatica

    I just re read your original post and think I misunderstood when you said sciatica. The original post indicates you get a sharp pain on occasion that runs down your leg. Does this mean you do not have leg pain when standing or walking?

    Last edited by teteri66; 09-10-2015 at 09:06 AM.

     
    Old 09-12-2015, 03:33 PM   #10
    Jack Lithgoe
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    Re: New guy here with lumbar pain and sciatica

    I have low back pain constantly, but the nerve pain in my hamstrings and knee area, and sometimes below the knee (but not in feet or toes), changes somewhat daily depending (I think) on the position I slept in. My hips also hurt, I suspect because of the iliopsoas and other low back muscles inflamed due to guarding. It does NOT mean I get relief when standing or walking, just the opposite. About the only relief I get is sitting.
    I responded to an online "free MRI" eval from North American Spine for a laser procedure. After reading the report they said I was not a candidate for laser, but that I need a laminectomy and discectomy. They want me to send the actual MRI images. I will probably choose to see a local specialist in orthopaedics, or neurology, but I'm still interested in YOUR observation as one who has been there and has the Tee shirt. I typed my entire MRI for your reading pleasure, just in case you have trouble sleeping. For me, this back pain is a pain in the neck!
    Jack

     
    Old 09-12-2015, 06:21 PM   #11
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    Re: New guy here with lumbar pain and sciatica

    Oops....I have read your MRI several times, but didn't get back to you. You seem knowledgable about spinal issues so I don't know how much detail to go into. I will say that it is important to remember that a MRI or CT scan is just one piece of the diagnostic puzzle. It is fairly inconclusive without the data correlated with the physical exam, a basic neurological exam and after the doctor listening to your description of symptoms and their impact on your daily life.

    Particularly with bulging discs, there are many false readings. What is important is whether the issue is causing the person a loss of function or pain that keeps one from daily activities. Sometimes a huge disc bulge causes no pain or problems, and conversely a tiny bulge that appears to be "no big deal," in reality is extremely painful. This is one reason why I recommend going to a well-trained, experienced spine specialist for an accurate diagnosis. If the doctor recommends surgery, get at least one other opinion to see if there is agreement as to what needs to be done.

    Obviously you have several bulging discs and one that is herniated. With the degeneration of the intervertebral discs often comes stenosis and facet arthropathy. Stenosis means "narrowing" and there are two primary areas where it occurs in the back. One is the central canal. The other is in a foramina, which is an opening between every pair of vertebrae in the spine that provides an exit for the nerve to move from the spine out to innervate another part of the body such as an arm or leg. Normally there is room for the nerve to move freely, but when the canal or opening is narrowed it can result in nerve compression.

    Another common source of pain occurs in the facet joints, which are located at each vertebral level and are what, along with the disc, allow the spine to bend and twist. The facet joints are fluid-filled joints, and are subject to arthritic-type changes which is referred to as facet arthropathy.

    The report indicates that the most severe abnormality occurs at L3-4. Here the disc is bulging out of its space, measured to be 8mm, and creating stenosis in the central canal and in the foramen. There is no apparent nerve compression, however, in the foramen. In addition to disc material narrowing the canals, there are epidural lipomatosis which are soft tissue growths (like fatty lumps) that are contributing to this narrowing. In addition, the facet joints are showing significant signs of arthritic change.

     
    Old 09-12-2015, 07:18 PM   #12
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    Re: New guy here with lumbar pain and sciatica

    (Continued). I feel that I should say a bit more about arthropathy as it is one of the most common causes of low back pain. It is one of those umbrella terms that refers to wear and tear of the facet joints. "Arthropathy" is used to cover a wide range of issues that affect the joint. I won't go into detail here but simply describing it as "arthritic change" as most articles do, really doesn't give it its due! Do not underestimate facet arthropathy as a major source of pain!

    At both L4-5 and L5-S1 there are annular tears, referred to in the report as fissures. This is a tear in the outer fabric of the disc, or when the fibers of that outer fabric pull apart. Annular fissures are very common and often lead to a disc herniation. At the L4-5 level, the condition of the facet joint arthropathy is judged to be severe...(the "rating system" goes minimal, mild, moderate and severe) and there is stenosis in the central canal but the foramen are open.

    At L5-S1 the same things are going on but the effects are slightly different: there is no stenosis in the central canal or foramen, but the facets are both affected.

    I can see why you mostly have lower back pain as even though there is stenosis noted, in no case does it mention specific spinal nerve root compression. I personally would question the suggestion for a discectomy with the amount of facet joint arthropathy you have. Removing part of the disc would put that much more stress on the adjoining facets. Also if more than one disc were operated on, it would create more instability and make the facets that much more stressed.

    I would suggest you find a good specialist in your area and get an evaluation!

     
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    Old 09-12-2015, 08:19 PM   #13
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    Re: New guy here with lumbar pain and sciatica

    Thank you Teteri66. You have invested significant time in reading my posts and interpreting the MRI report, and I appreciate it. I sense, from the number of posts you have made, that you have personal experience and training in spine disorders. My selfish hope is that I recovery completely and get back to golf, fishing, kayaking and the final stage of my working career, and never have reason to read another health message board. I want to be optimistic, however, I have been bothered for over nine months with no end in site so I will likely return here for dialog that should be provided by my own doctors. If nothing else happens I have a new empathy for people who suffer chronic back pain.
    Thanks again,
    Jack

     
    Old 09-13-2015, 10:24 AM   #14
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    Re: New guy here with lumbar pain and sciatica

    You should be able to get back to those things you mention. In order for that to happen, you must take time to research and locate the very best spine surgeon that is available to you. Then, if surgery is recommended and you elect to have it (most spine surgeries are considered "elective") it will be very important to follow doctors' instructions precisely, to develop patience and to give yourself sufficient time to recover fully.

    The mistake I see often is that people go to the first surgeon that is recommended to them, without giving it any thought, and do whatever that surgeon suggests without any thought or questioning. Often the doc tells them something like " you'll be laid up six weeks and then you'll be good as new and can resume all activities." I have yet to figure out why they say that as I have yet to meet someone for whom that was a true and accurate statement! Especially with discectomies, people are in a rush to get back to doing the activities they haven't been able to do for awhile. They push themselves in order to recover fast and more times than not, end up reherniating the disc or delaying their recovery.

    One thing to discuss with the surgeon is the amount of facet arthropathy you have. Usually there isn't a lot that can be done for that other than fusion to stabilize the joints. The surgeon can shave off bone spurs and clean them up a bit, but there isn't much that can be done for the aching they can cause.

    I hope you can find a spine surgeon you are happy with. Good luck.

     
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