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  • increasing pain, L5-S1 disc bulge w annular tear

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    Old 07-19-2013, 06:37 PM   #1
    froggie91206
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    increasing pain, L5-S1 disc bulge w annular tear

    I am at the end of my rope with dr at this point. I began falling in march at work after feeling like I was being struck in the lower back.with a baseball bat then losing control of my legs. When it began happening numerous times a day I went to the dr and got a lumbar MRI which showed mild facet arthrosis at L4-L5, then at L5-S1 disc degeneration without disc space narrowing, mild disc bulge with posterior midline annular fissure. No spinal canal or foraminal stenosis.
    My dr sent me to physical therapy and a pain dr who completed 3 epidural steroid injections, which resulted in no pain relief. The pain dr told me today at my followup that there is no reason I should be in pain because the MRI showed no stenosis. When I explained to him what my PT told me about the MRI not being able to show compression while sitting, bending or moving since it is done while laying flat, he again said I should have no pain and treated me as though it was all in my head, then said, "well let's do a nerve block then the pain will be gone". I am beyond frustrated since as of last week I am now on medical leave at work due to increasing pain and new symptoms in my upper body an now awaiting a cervical MRI.
    I have finally convinced my primary care to send me to neurosurgical for a consult since he said I am now showing signs of nerve root irritation. I am not sure if anyone else is dealing with dr's telling them it is not that bad, due to what scans show, and if so how do I move forward so that I am able to function and get back to work and being a pain free mommy. Too young for this!

     
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    Old 07-20-2013, 08:00 AM   #2
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    Welcome to the board.

    People can waste a lot of time by relying on their PCP or even a pain management physician to diagnose a back problem. These specialties are OK if the problem is simple and routine, but they do not have additional training beyond medical school in he specific mechanics and diseases of the neck and back. If they are simply relying on the MRI to provide sufficient information to make a diagnosis, they are working with just one piece of the puzzle.

    I urge you to set up an appointment with either a fellowship-trained orthopedic spine surgeon or a neurosurgeon. Be sure the doctor's practice is limited to the neck and back.

    From what you have said about the MRI, I would have to agree that nothing pops out as being able to cause the symptoms you are describing. There are no obvious signs of nerve compression. Of the things you mentioned from the MRI, the only thing I see that could be causing most of your symptoms is the annular tear. In some people they do not cause pain, but sometimes they can cause symptoms, primarily in the back, but sometimes in the legs as well (for lumbar annular tear).

    CT scans are better for showing the extent of the annular tear, particularly when a dye is injected. A nerve conduction study can tell whether there is nerve compression or damage. While it makes sense that a positional MRI would be better at showing nerve compression when a person is sitting or standing, in reality it doesn't make much difference.

    It is a bit unusual for an annular tear to cause the kind of pain and weakness that causes one to fall. That is more typical of nerve root compression. It is possible to have some nerve compression without it showing up on MRI but usually there is some stenosis.

    One thing that does cause this type of reaction is spondylolisthesis. This is a situation where one vertebra slips over the top of the adjacent vertebra, which can result in a nerve getting caught and then released. This is most common at L5-S1, followed by L4-L5. The best way to see if you have spondylolisthesis is with a flexion/extension x-ray.

    Just for future reference, ESIs are given in a set of three, but when there is no response after two, most doctors skip the third injection.

    Unfortunately I think many people have had the experience of a doctor who can't find the pain generator being told that it's in their head or it's not that bad....that's why you need to see a spine specialist (as mentioned above) for a proper diagnosis and plan of treatment.

    Good luck.

     
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    Old 07-20-2013, 08:55 AM   #3
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    I don't understand, you have an annular tear and he says you shouldnt have any pain? I had two of those and the pain was terrible with muscle spasms all the time. I would check into getting a tens unit, it really saved me at work. It tricks the brain into feeling the pulses of the unit instead of spasms.

    Another good thing is lidoderm patches they are a topical pain patch with lidocaine. Takes the edge off.

    You could also ask about a radio frequency ablation. This burns the nerve causing the pain. Takes about 2-3 weeks to work and can last 3 months to about a year. I've had several of those.

    There's also another test he can run on you to see how bad your tear is, called a discogram. They inject dye recreating the pain then take a ctscan. It is painful for about 60 seconds.

    As far as the legs giving out the discogram might give some insight. Good luck let us know how it goes cathy

     
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    Old 07-20-2013, 09:24 AM   #4
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    Thank you so much. I have been referred to a neurosurgical dr. He has my records and will look over them and I should hear from his office on Monday concerning a consult. I just started neurontin last night and am hoping this helps cause the vicodin just makes the pain bearable. Me right arm is really bothering me today, all the way to my fingers, tingling, cold and a shooting pain. Hopefully the cervical mri is authorized soon so I can either get some answers or rule some things out. It is the weirdest and scary feeling to lose nearly 50% function in my arm in just a short time. I want to hold the babies in my family or just unload the dishwasher without dropping things. It's really starting to affect my emotions now. I will keep you posted and any information or suggestions is greatly appreciated!

     
    Old 07-20-2013, 04:59 PM   #5
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    Don't let them get away w/o sending you for a cervical MRI immediately. Do NOT let them 'wait and see' and do NOT let them fob you off on PT or 'Pain Management'.

     
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    Old 07-20-2013, 05:11 PM   #6
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    My mom actually works with the neuro dr that I am going to see. As of last week she became very frustrated with my pcp because they refused to do cervical mri, so she had me go sit in their office the next day and see the head dr in the office and request a physical exam. After he did that it was his suggestion that I get the cervical mri. He also expressed his apologies that the PA didn't do an exam and refused my request for the mri. I know now that if I want to get things done then he is the only one in the practice to go to. As for the pain managment dr, I have spoken with my mom about that and will not be returning to him. She agreed with your replies that I should never have been given the 3rd injection and highly doubts that the mild facet arthrosis is the culprit for the pain, as he suggested. I hooked up to my tens unit on my right side of neck and shoulder and on my lower back for 2hrs today and was able to relax, too bad I can't keep it on 24-7. Thank you so much for the support.

     
    Old 07-20-2013, 05:28 PM   #7
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    << As for the pain managment dr, I have spoken with my mom about that and will not be returning to him. She agreed with your replies that I should never have been given the 3rd injection and highly doubts that the mild facet arthrosis is the culprit for the pain, as he suggested.>>

    Huh... so the PM guy thought your problem just happened to be something that he could do something about, for a hefty fee. Funny how that happens so often...

     
    Old 07-23-2013, 12:16 PM   #8
    froggie91206
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    Cervical mri scheduled for the first, sooner if authorization happens before then. PT said yesterday he thinks it is a herniated disc causing compression on spinal cord and he dc'd all thoracic therapy. As I was writing this I got a call from neuro surgical office and have my first appt tomorrow! So glad to finally get in and be evaluated by someone specialized in the back, besides pt. I will keep you posted.

     
    Old 07-23-2013, 08:46 PM   #9
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    Re: increasing pain, L5-S1 disc bulge w annular tear

    Hi thats great! I was rereading everything didn't see where anyone mentioned applying ice. Might want to try it. Just 20 min at a time use a towel protect skin. Good luck tomorrow! Cathy

     
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