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dawsonba 01-18-2008 07:07 PM

What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
I just received the results of my MRI which reads: DDD in the lumbar spine with slight sparring at L3-4. There is an annular tear in the disc space at L4-5 and L5-S1. There is a small left sided disc herniation at L4-5 causing mild impression on the thecal sac. There is a small right-sided disc herniation at L5-S1 causing mild impression on the thecal sac and slight impression on the right S1 nerve root. Just to give a little history...I had a bad fall back in March of 06 where I fractured my sacrum and wrist and have had back problems ever since. I also required carpal tunnel release surgery and a transposition of the Unlar nerve surgery and a TFCC repair in my wrist. It was a pretty hard fall. My questions is; did the fall cause the tears??? Or are the tears part of the DDD? In 2006 after my fall I was seeing a Clinical pain management doctor who administered the spinal injection for the pain...two days later after suffering severe headaches I was told that I was leaking spinal fluid from the injection and was given a blood patch in the injection site to stop the leak. Needless to say I never returned for another injection. I am currently taking steriods, vallium and percocet for the pain after an ER visit on Wednesday. Where do I go from here? Any advice through experience would be greatly appreciated.

Rolex 01-18-2008 08:50 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
My MRI from 06 says I have annular tears disc L4-5 and L5-S1. I was rear ended in 8/05 and have been in pain since then. I had three steroid injections in 06, not much help. I am having another MRI on Monday and setting up surgery to have a microdiscectomy. I feel for you, I know what you are going through. I am taking vicodin, it helps a little.
I hope the micro D can give me my life back. Right now I do nothing but work and nothing else and it is getting hard to work everyday.

Good luck to you, hope you get better soon.

Justoneofus 01-18-2008 09:13 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Hi and welcome the boards. You found a great place to chat with everyday people with spine problems of varying types, and majority of us live with chronic pain 24/7 or have at some point.

your annular tears could be caused from the fall, or the DDD. The DDD is an unhealthy disc and the the fall could have then set it off. I doubt you will ever know where the chicken came before the egg on this one or not.

Who ordered your MRI and have you had a followup with that doctor yet? If it was done by a general practioner, it's time to be seeing a spine surgeon. Not to schedule surgery, but to be under a spine specialist's care. So this can be a neuro or orthopaedic surgeon. Both can specialize in spines. If surgery ever becomes eminent for you, make sure that specialist is a spine fellowed surgeon, which means that have been through the premium educative process for spines.

Do they have you on a prednisone medrol dose pack at the moment? These are a feel good quick fix to reducing inflammation which often reduces pain levels. But this is not something you can take often or should. Oral steroids reak havoc on your body, particularly your bones. Steroid injections are the least harmful to have in your body actually (minus what happened to you of course).

The valium will act as a muscle relaxer and the of course the "percs" are narcotic pain relievers.

Unfortunately, as bad as your MRI sounds, to many docs, you may get that they don't think they are that big of a deal. So dont be surprised if this happens. Doesn't mean you dont hurt and obviously you have 3 levels that are a problem. More likely, physical therapy will be ordered, along with asking if you would consider injections at some point to get inflammation under control and lube the areas. Plus give you more meds of varying types. And see how you do.

Having DDD along with the tears alone can create great pain. They give off a chemical that adversely stimulates the nerves sending a signal to the brain causing pain. Unfortunately you can't prevent DDD nor stop it. But you can get your body (especially the core muscles) as healthy as you can to hopefully lessen the risk some. Being fit and active does help to staving off bone spurs. Once you have them.. you can't do anything physically that will make them go away, but you can help to stave off future ones by working your body and bones.

I was in peak physical condition (washboard abs and all) and I still was labeled with DDD and blew out a disc. This is often linked to genetics in many too. Some people pass on bad feet, knees, some bad spine health.

I hope this helps some. You need follow up with your doctor and see what he/she recommends. Surgery is always a last resort and needs to be. Surgery won't guarantee a fix of the problem and all conservative treatments must be tried before pursuing surgical remedies.

Please keep posting and keep us updated on how you are doing. Welcome.:wave:

dawsonba 01-18-2008 10:19 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Dear Justoneofus, Thank you so much for your detailed response. I am new to message boards! Just looking for some insight to my issues. I am not sure I am responding to your reply correctly. My first MRI was in March of 06 2 weeks after my fall...I had such bad back pain I knew that there was more going on that what x-rays showed. I did visit a Neurosurgeon who ordered the MRI the results are as follows: There is a large amount of bony edema seen within the S3 segment. The patient has a history of recent trauma. This finding is suspicious for a fracture. There is evidence for a central disc herniation at L4-L5. It is slightly asymmetric towards the left. At L5-S1 there is a broad based paracentral and posterolateral disc protrusion. It is extending into the right neural foramen. It is causing asymmetrical narrowing of the right neural foramen and slight mass effect on the right nerve root. There is also slight asymmetrical narrowing on the left neural forament a L4-L5. On April 22, 06 I had a Bone Scan performed which reads as follows: Changes suggest an H type of insufficiency fracture involving the sacral prominentory region ad portions of the proximal Sl joints. Clinical consideraition should dictate further management. My next visit was with the Clinical Pain Management doctor and I was told that it would heal on its own with time. I had physical therapy for about 8 weeks which I continued at home. Constantly taking Motrin to help relieve the pain. I am very sensitive to pain killers (they make me sick to my stomach) and give me headaches. It is hard to function during work hours when taking meds...and I am afraid to drive while on these meds. My job has me sitting at my desk for 8 hours...many times I have to get up and move buttocks and thighs and legs always hurt as well as my back. Then there is the issue with the heavy use of the mouse and keyboard which hurts my wrist and elbow from the surgery. Gee, I feel like I rambling on about all my aches and's just nice to vent to someone who will listen and who understands what I am going through.
Your question on the medpac...I was given IV steriods initial dose at the ER and was given a prescription (bottle not pak) of Prednisone to take 6 the first day 5 the next then 4..each day the dose is lower. I've read that continued use of steriods is not good! This weekend I will do some research on finding a good Ortho or Neurosugeon who specializes in the spine. I may even contact my hand ortho dr. who performed the surgery on my wrist and elbow for a referral. He is the number one doctor in the city of Philadelphia. It did however take a while for an appointment but I believe it was well worth the wait. I was amazed when I did a web search on his name. "Dr. A. Lee Osterman" if your interested. Amazing reading what this doctor has achieved! Well, I have rambled on long enough and it is late...again thank you so much for your response! Bye for now!

mznell 01-18-2008 11:36 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
By all means, contact the doc who did your hand surgery for a referral, assuming you are satisfied with his work! He can probably get you in sooner than if you call on your own. Make use of whatever contacts you have, as it is very important that you find a well-qualified, fellowship-trained spinal surgeon.

dawsonba 01-19-2008 04:47 AM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Hi Marlosmom, Thank you for your response. I will certainly contact Dr. Osterman!! I am very pleased with the surgery he did on my wrist and elbow. I would much rather have a referral from a physician than word of mouth our using the yellow pages!! I assume that you have or had similar back issues? I hope all is well with you! Thanks again!

dawsonba 01-21-2008 05:11 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Hi Rolex, Thank you for responding to my did you MRI go? Have you scheduled the microdiscectomy procedure? Are you under the care of a Neuro Surgeon or Ortho? I am looking for direction...should I see a neurosurgeon or ortho. My family doctor still has not called me back after reading the results of my MRI which was done on Friday....I'm not very happy right now and still in a lot of pain. All I do is take the pain meds and sleep. I was hoping for my family doctor to advise which doctor I should see first. My family physician also ordered physical therapy which I don't know that I can do right now...too much pain. After my trip to the ER on Wednesday the doctors prescribed enough medication for 1 week...tomorrow is my last for the meds!
I surely hope that you that your procedure goes well and please keep me posted.
Feel better real soon my friend!

mznell 01-21-2008 06:29 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Hello dawsonba,

I had a PLIF at L4-5 with titanium cage and BMF two weeks ago. I had spondylolisthesis (which is a slippage of one vertebra over the top of the next one) and stenosis which resulted in constant sciatic pain. By the time I had surgery I could not stand or walk for more than about 2 minutes at a time. However my pain was relieved by sitting or lying down. I put off surgery for almost 3 years...and during that time saw a total of 8 spinal specialists.

Depending on what is wrong wih your spine, I personally feel it is the doctor's training, reputation and personality that is important, rather than whether s/he is a neurosurgeon or orthopedic surgeon. When they go for their fellowship training the "topics" covered are similar. The curriculum is similar. I ended up choosing an orthopedic surgeon. In my case, of the 8 spinal specialists I consulted with, the neurosurgeons recommended the most surgery -- for example, two neurosurgeons said they would fuse from 3 to 5 levels. The orthos all said they would fuse 1 level...which was much more appealing to me.;) I figured you could always go in and fuse more, if needed, but you couldn't un-do that amount of work!!

Anyway, I am happy to report that I really did my homework prior to surgery; I tried every other option available to me prior to agreeing to surgery, and so far, I am very pleased with the results.

I'm happy to answer any questions you have, if I can.

It is a big decision and you don't want to enter into it without really exploring your options.

xx MM

dawsonba 01-24-2008 03:23 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
Hello Marlosmom....I am so sorry to hear about your back issues...mine are nothing in comparison! I surely wish you well! In an effort to continue conservative treatment I visited an Ortho doctor from the Rothman Institute today. I was given prescriptions for Lidoderm patches...which is (Lidocaine)…percocet...Skelaxin (for spasm to be taken during the day) and Tizanidine for spasm to be taken in the evening. The doc also gave me an injection of cortisone in the most painful area of my lumbar...he also ordered a tens unit and scheduled me for a lumbar epidural on Feb. 1st. Have you had any experiences with the drugs I’ve listed? I sincerely hope your procedures were most successful and you are pain free. Perhaps we can chat again?
Take care,

mznell 01-24-2008 05:40 PM

Re: What Causes Annular Tears In The Disc Spaces At L4-5 And L5-s1
I hope this combination of meds and treatments will work well for you. I think those meds are fairly standard for what ails you. I take skelaxin and have no problems with it. I have less success with the tizanidine, which was prescribed in the hospital as I was being discharged. It was too strong--affected all my senses. It may be OK to take at night when you should be sleeping -- that's how I used it the first two weeks and it worked well.

I had 3 epidural injections prior to my surgery. They didn't really have any effect on me, but they have worked great for a friend of mine. It just depends what's wrong with you!!

Best of luck. Really hope this all works well for you.

xx MM

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