New MRI, do I need surgery ASAP?

teteri66

Welcome to the board.

May I ask what the trial is studying?

tradeof1jack

I got a stem cell injection directly into my L5/S1 disc. Supposedly the hope is the cells can regenerate the dead disc. Its double blind so its 50/50 whether I got the cells or placebo. Its a 12 month study, but if I got the placebo they'll give me the real thing at 12 months so somewhere between 12-24 months I'd have to wait for the surgery.

teteri66

Do you have a copy of the radiology report from the recent MRI? Sometimes people copy the report so that people can see what else might be going on, the extent of the nerve compression, size of herniation, etc.

Are you allowed to receive other conservative treatments during the trial, such as a course of physical therapy?

My husband ruptured L5-S1 about twenty years ago. Through lots of patience and by faithfully doing his back and core exercises every day, he was able to heal the disc without any intervention.

tradeof1jack

L5-S1: The disc is mildly diminished in height and is diminished in signal intensity. There is a 6 mm central disc protrusion with an annular tear indenting the thecal sac and abutting the traversing S1 nerve roots. The spinal canal is normal in diameter. Facet joints are unremarkable. No significant encroachment on the neural foramina.

Impression: L5:S1 - there is disc dessication. There is a 6mm central disc protrusion with an annular tear abutting the anterior thecal and traversing S1 nerve roots.

Nothing significant at any other levels. X-Ray just showed "mild disc narrowing at L5-S1"

teteri66

Do you have pain running down the back of your leg? What specifically are your symptoms?

tradeof1jack

Excruciating back pain & nerve pain from right him all the way down leg to the foot. Hip & knee the worst of it. Now the right leg has started to atrophy.

teteri66

Keep in mind that we are not doctors as you read people's comments. Judging by the report, which is just one piece of the diagnostic puzzle, it would appear that you can afford to wait. There is no central canal stenosis or foraminal stenosis, but the disc protrusion, while not large, is big enough that it is abutting the S1 nerve. This and the annular tear are probably the source of your pain.

Since there are no guarantees with spine surgery, I can't say this with any certainty, but to minimize the chances of permanent damage to the leg, it is probably a good idea to have surgery sooner rather than later...but I don't have any personal experience with disc replacement. I was not a candidate so never bothered learning much about it. It sounds good, when it works out...but pretty bad when it doesn't.

The atrophy indicates nerve damage -- many times, when the problematic nerve is relieved of whatever is compressing it, with appropriate exercise, the muscles can rebuild itself. If you had foot drop, I would be more concerned that the muscles wouldn't recovery.

Regarding this statement: [B]The doctors all agree I need surgery ASAP to get pressure off the nerve, but think its ok to wait the 12-18 months to see how the clinical trial works out. [/B]

It would seem to me that if the spine surgeons think you need surgery ASAP, one could not afford to wait 12 to 18 months. Perhaps that suits the clinical trial's needs, but does it suit yours? It seems to me that the MRI report does not indicate that the compression is severe enough that it would require surgery immediately. As surprising as it is to back patients, pain is not a consideration.

[B]The spinal canal is normal in diameter. Facet joints are unremarkable. No significant encroachment on the neural foramina.
[/B] These are issues that can cause nerve compression...but in your case, these things are all normal.

Perhaps it would help you make up your mind if you get another opinion from a spine surgeon who has no connections to the trial or to the doctors conducting the trial. And be sure you have done lots of research on disc replacement. If you do choose to go ahead with the replacement, be sure the surgeon is well-versed in the procedure and has successfully done it many times.

tradeof1jack

Wow -- thanks for all of that info. And yes, as of 6 months ago we were all in agreement to wait on the surgery and just keep checking as the damage progresses. I'm certainly in no hurry.

The reason they've changed their mind is seeing my right leg and the noticeable atrophy. I think they would probably agree with your assessment that the back damage in and of itself is not enough to need surgery, but combined with the advancing leg atrophy relieving the pressure on that nerve has become paramount.

So that's where we are. Those that see my leg combined with the MRI have said relief of that nerve is needed, but we all want to give this trial a shot too. And thats where we're stuck.

Lynette57

My left leg had become quite useless for the past 18 months. Pain as you mentioned left butt and leg 24/7.

I too was afraid that the damage would be permanent. It seems to me that some good advice given here about when to worry was loss of control of bowels and bladder.

I had surgery 2 weeks ago and my left leg sort of woke up like a light. That's not to say there is no pain or weakness. I tried so many things since back surgery is never a 100% solution, and as mentioned can open up future issues.

Teterri66 is a wealth of knowledge.,..she rocks.

tradeof1jack

Thanks Lynette -- what surgery did you have? And was it on L5/S1 too?

Lynette57

It was disectomy L4-5. However when they got inside they found bone fragments, bonespurs and a ligament all irritating the nerve. So they had to clean all that up too.