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  • This is no fun! :(

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    Old 03-05-2014, 01:31 AM   #1
    Ba308
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    Ba308 HB User
    Unhappy This is no fun! :(

    Hi guys,

    New here but did a search and so happy I found this forum. I desperately need and thought, advise, etc some of you might be able to give me.

    Ok so how to keep this under twenty pages long? Hmmmmmm

    Short history: Herniated L5-S1 back in 2008, ended up getting a microdiscectomy early 2009. Had a bulge in my neck but it wasn't serious at the time.

    Over the years my back and neck pain have gotten worse. Within the last year or so it has gotten very bad.

    I haven't had insurance and while going to school made very little, and the ex took half of that. Otherwise, I'd have seen docs to get help.

    Recently, the pain got so bad I've been nauseated and have vomited a few times from it. After having shooting pain down my arm and numbness I went to the ER. I was told I needed an MRI and was given a script. Finally found a place that would let me make payments and got it done. (interpretation below)

    I can't afford to go see a doc and specialists yet so I'm trying to understand what the MRI is saying and if it's serious or not and what my options are to treat my back and neck.

    I tried applying on healthcare.gov but they referred me to Medicaid and was told I'd be contacted, nothing yet.

    Ok so symptoms:

    **The best way I can describe it is that I have a hot knife stuck in my neck and back and on top of that it feels like someone has taken a dozen needles and injected acid into my neck, traps, middle back and lower back. (This is chronic and is present every day and night, it just varies in severity depending on the day)

    * chronic headaches

    *muscle weakness and decreased size of triceps right side

    *nausea

    *depression (I pray every night I don't wake up and have to live like this anymore)

    *occasionally I will move just wrong and lightning will shoot up my neck and into my head. My neck pain will be at a 9-10 and I won't be able to turn my head a couple hours without bad pain. Then it will stiffen for a couple days.

    *occasional sciatic nerve pain and numbness of right buttock down usually the mid thigh.

    *Tightness and aching from neck to lower back

    *I can not flex my pelvic floor. I try doing kegals but I can hold it for maybe two seconds. (Thankfully I can still hold my urine)

    * not really a symptom but more of a side effect from the pain, I've ground the enamel off all touching surfaces of my teeth.

    * I'm sure there is more but I'm struggeling to think right now.



    Ok so here is the Radiologists interpretation. I left out the normal discs.



    L4-L5: minimal disc desiccation.

    L5-S1: mild loss of disc height and hydration. Moderate sized paracentral/subforaminal disc protrusion with annular fissure exerts mass effect on the thecal sac and transiting nerve roots within the right lateral recess. Facet arthropathy I'm conjugation with disc protrusion results in severe right neural foramen stenosis.

    Impression:

    1. Degenerative disc disease and facet arthropathy at L5-S1 resulting in spinal stenosis and neural foraminal stenosis, asymmetric to the right.

    C3-C4: unconvertebral and facet arthropathy is present asymmetric to the right. There is moderate right and mild left foramen stenosis.

    C-5-C6: small posterior disc osteophyte complex effaces the CSF ventral to the spinal cord. There is moderate right and left neural foramen stenosis.

    C6-C7: moderate sized posterior disc osteophyte complex effaces the CSF ventral to the spinal cord. There is unconvertebral and facet arthropathy bilaterally.

    Impression:

    1. facet and unconvertebral argtropathy results in moderate-to-severe neural for animal stenosis.

    2. Mild spinal canal narrowing at C5 through C7.



    I tried to do research and make sense of the report and this is what I've come up with.



    C3-C4: Degenerative arthritis in vertebral joints. There is moderate right and mild left spinal nerve compression on the C4 spinal nerves.

    C5-C6: Small group of bone spurs putting pressure on the CSF of the spinal cord. There is moderate right compression and mild left compression on the C6 spinal nerves.

    C6-C7: Moderate-sized group of bone spurs putting pressure on the CSF of the spinal cord. There is degenerative arthritis in vertebral joints. There is severe left and right spinal nerve compression of the C7 spinal nerves.

    L4-L5: Minimal disc degeneration.

    L5-S1: Moderate-sized right disc bulge with a tear in the cartilage of the disc (that surrounds the “jelly” inside the disc) exerting “mass effect” (pressure) on the CSF of the spinal cord and the S1 nerve root. Joint arthritis in conjunction with disc herniation results in severe right spinal nerve compression. *The L5 nerve may be compressed as well, not sure.


    If anyone can help I'd be very grateful.

    I'd love to know if I'm understanding things correctly, how serious this is (obviously it's very serious for me because I'm just dying but I mean medically), is there risk of permanent damage or paralyzation if I don't have surgery soon and what my options might be when and if I get Medicaid or insurance.

    Thanks so much in advance!!

    Brandon

    P.S. I have tried chiro, PT with no relief.

    The one injection I got back in 2009 actually made the pain worse in the lower back.

    Massage helps somewhat and would get one daily if I could. I use a massage pillow daily and have actually worn holes in my skin from pushing back on it so hard to get deep enough. (Love Bed Bath & Beyond! They have a great return policy. I have a friend that sits one hers to massage her glutes never had a problem. I've returned 7. Lol!)

    I ice, use a TENS unit, ibuprofen and do TONS of stretching.

    I do the best at strengthening my core but often my lower back seizes up before I can get my abs good. Thank goodness for planks.

    Also on gabapentin and on rare occasions use opioids when I have a chance. (ER visit, friends)

    Last edited by Ba308; 03-05-2014 at 01:57 AM. Reason: Additional info

     
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    Old 03-05-2014, 09:22 AM   #2
    teteri66
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    Re: This is no fun! :(

    Welcome to the board. You are right -- no fun at all.

    I think you did a good job of finding definitions of the words you didn't understand, but I am not convinced you understand what the definitions mean, so I am going to be basic in my explanations. If it is boring to you, perhaps it will be of help to a new member who knows little about spinal anatomy and what can go wrong, especially as we age...which, incidentally, begins in our 20s when it comes to the spine.

    When people have problems in both the cervical and lumbar areas, I like to explain the difference in stenosis between the levels.

    The spinal cord runs from the head and ends in most people around the Lumbar 1 level. Above this level, when the cord is compressed or injured, there is a possibility for paralysis. Below this level, (where the cord terminates) the nerves continue on down the back, but they bundle together in one large mass that is called the "cauda equina." When a level along the cauda equina is compressed, it can cause great pain and individual nerve damage, but it usually does not result in paralysis.


    Stenosis is a narrowing. There are two areas where this is a problem in the spine: the central canal or the foramen. The neural foraminal openings, the foramen, are located at every level of the spine, at the end of a vertebra, and are openings through which the spinal nerves leave the spine and go out to a particular part of the body to innervate that part of the body. For example, the L4 nerve innervates in a particular route down to the big toe. When either of these areas becomes narrowed by something like a bulging disc, an enlarged facet joint, inflammation, etc. the nerve passing through at that point ends up getting irritated or compressed.

    Also in the world of radiology there are specific adjectives used to describe an issue in the spine that serve as a type of ranking: minimal, mild, moderate and severe.

    So:

    "L4-L5: minimal disc desiccation.

    L5-S1: mild loss of disc height and hydration. Moderate sized paracentral/subforaminal disc protrusion with annular fissure exerts mass effect on the thecal sac and transiting nerve roots within the right lateral recess. Facet arthropathy I'm conjugation with disc protrusion results in severe right neural foramen stenosis. "

    The disc between lumbar 4 and 5 is drying out. This is the first sign of a disc degenerative process. Since it is judged to be "minimal" it can pretty much be ignored.

    A second sign of disc degeneration is when the disc loses moisture, it flattens and loses disc height...which is going on at L5-S1. There is a moderate sized protrusion of the disc and that disc has an annular tear, which is a tear in the outer layer of the disc. This allows material from the disc to leak out...which is causing tissue to exceed the disc space. In this case, it is pressing into the thecal sac and also pressing on the spinal nerve roots that cross the disc at this level. This results in the radiating pain you feel in your buttocks, leg and foot. The facet joints located at this level are showing signs of arthritis, which causes them to enlarge...so this takes up more space than normal, and along with the bulging disc, it is causing SEVERE stenosis in the foramina on the right side.

    In the cervical area you again see the words "facet arthropathy." This, along with the development of little bone spurs is causing stenosis in the cervical area as shown on the report. Again, these things are a part of degenerative disc disease, but in the cervical area, when there is stenosis in the central canal, it can push into the spinal cord.

    "Impression:

    1. facet and unconvertebral argtropathy results in moderate-to-severe neural for animal stenosis.

    2. Mild spinal canal narrowing at C5 through C7."

    The narrowing in the foraminal openings is judged to range from moderate to severe.

    In the spinal canal there is narrowing from C5 to C7 that is evaluated to be mild.

    The pain in your arm etc. is from the cervical stenosis. You can go online to see a "dermatome map." It will show you which spinal nerve innervates which area of the body. If the spinal cord is impacted, a cervical compression can cause leg pain, but usually cervical is from about shoulders up, and lumbar is from the waist down...for individual spinal nerve roots.

    You will want to see a spine specialist when you can to get these things evaluated.
    Depending on how severe the compression is at L5-S1, the surgeon may want to decompress those nerves...and depending on the extent of the stenosis in the neck, the same would hold true here.

    Unfortunately when one has severe stenosis, you are limited in what you can do to help your condition. Stretching will have no affect, but if it temporarily makes it feel better, it probably isn't hurting unless there is some instability...which is not indicated in the MRI report.

    Remember that an MRI is just one piece of the diagnostic puzzle. The spine surgeon will correlate what he/she finds upon physical exam, basic neurological exam and after listening to your symptoms with the MRI images to reach a diagnosis and plan of treatment.

    This can be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back. I personally would not get started with a pain management doctor until you have a correct diagnosis from a specialist who knows the most about the spine.

    Hope this helps, and I hope you get insurance so you can begin treatment soon.

     
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