New recruit, ready for adr action
 

Hi guys,

Just joined this forum. Hoping to get interesting experience and support.

As signature says, not doing very well. Trying to get 2 level adr lumbar. My situation is a bit two-sided. On one hand, I look perfectly fine and can even go to the gym and do some things. Not taking any pain meds currently. On the other hand, cannot sit at all. If I am not in motion, there will be pain. Tired of spending all time horizontal.

I am sure many people would say that I look way too healthy, but they don't know that I spend 20 hours a day in bed. That is not acceptable.

If anyone has good scientific papers on discs, feel free to share with me. I am very interested in this revolutionary tech. I have also read a fair share myself, so can recommend some I found useful.

Planning surgery abroad, living in Europe. The plane trip will be hell anyway. How do you guys who live in US survive the plane trip to Europe??? For me 30 mins seated is pain lvl 9-10... Add turbulence, and the fellow passengers will think a werewolf snuck onboard...

Welcome.

There is plenty of research here.

As far as flying, that is where your pain meds would come in handy, lot's of them :)

Thanks Romakis, and good point. Now I am happy I still have some Tramadol left, at least it cuts a little edge off the pain :o

Flying is brutal, no doubt. I cross my fingers for no turbulence and stand most of the flight. Take pain meds preventatively vs waiting for things to climb. Then If there is turbulence, more pain meds.

I encourage you to look closely at the research on sitting outcomes. My surgeon warned me that sittin issues are the most resistant to surgical treatment (leg pain and walking improvements much easier). Sadly in my case, although my sitting did improve, it is still unacceptable... I know I'm more rare,
However. There are lots of success stories on here.

If it is possible at all, I suggest trying to decrease the time you spend in bed.
If you are at 20hrs, try for 19.5. Take meds to start a physio program so that you can go into surgery a bit stronger.

Good luck.

Welcome,

I was in the same sitution seveal years, ended up working from home with treadmill desk. I had microdisectomy got rid of that problem for 5 years. Don't rule out a simple surgery first.

Have you had a sitting MRI?

Thank you Disc replacement 2015. Sad to hear that sitting problems are harder to tackle. You mentioned some research on outcomes. Do you mean posts on this forum or somewhere else?

Hi WakesurfMike and thank you for your ideas. I have joked to some colleagues about setting up a treadmill under a desk, but never though that such would actually exist! I will definetely look this up.

Simple surgery is tempting, but is microdisectomy really that much simpler? I also get impression that many people with severely degenerated/dehydrated discs end up with further surgery later, because microdisectomy treats a (serious) symptom=bulge, but does not fix the failing disc that is acidic and torn up. Right?

I was looking at sitting MRI possibilities some months ago. Only found one in the country, few hours drive, and its quality seemed questionable. They advertise it as something for people who are claustrophobic. I asked orthopedists at few ocasions about it, but they replied that all necessary info is seen in the traditional MRI. I am myself a bit unsure though... If the pain is mostly gone lying in the tube, but intense when sitting, it would logically make perfect sense to analyze the spine status while in pain. It is hard to argue with doctors when their argument is often of the class: "because I believe so". Can't argue against their belief :(

Adr
 

What's your MRI say? Make sure you need ADR n not your sacrum. I seen a few get ADR n it didn't help w sitting as it was their sacrum that hurt when sitting! Just my 2 cents. Your signiture is lacking?

Hi GKTM
Yes, it is important to know the source of pain. In my case the discs are black in the MRI, so it is quite clear. When discs get nutrition and space it relieves pain, which is typical for disc problems.

I will cross my fingers and hope adr helps. It is my final hope.

Just to be clear, you can have dessicated and dark discs -- and not have them be the pain generator. It's not the norm, for sure.

Do you plan on having a discography? Some doctors don't recommend them while others do. See:

http://www.adrsupport.org/forums/showthread.php?t=7979

Hi Harrison,

You bring up two good points. A black disc only means it is dehydrated and most likely behaves mechanically different from a healthy, water-filled disc. But it does not alone equate to pain. I think the painful combination is when you also have annular tears. Then there is a way for the acidic fluid to leak out from the disc. I read that dehydrated discs use a different chemical process to produce energy, which leads to inflammatory proteins as a by-product. If these proteins can leak through the annulus they will irritate the nerves, causing pain.

Some doctors I have spoken to did not recommend discogram, because it does not bring any new significant information (according to them). At least in my case one can clearly see which disc is black&torn-up and which is intact&healthy. I also worry about provoking healthy discs.

Harrison, I see you have been into this subject for a long time, so I wanted to ask you one thing. Do you know any patients with ddd and annular tear and pain for years that have eventually managed to fully heal with conservative methods (spontaneous fusion does not count). Doctors claim they exist, but I am having difficulty finding the evidence. Surely they cannot all be trying to pull wool in front of my eyes?

Nucleus Propulsus as a pain generator
 

I know you weren't addressing me, but I wanted to weigh in regarding your disc with the annular tear. This would indicate to me that the nucleus propulsus is leaking, and this could be your pain generator. The NP secretes a substance that is highly irritating to nerve tissue, and can be a huge pain generator. Even if you don't have obvious compression on MRI, you can still have massive pain from this source.
GC

reference
 

Hi GirlCaptain,
　
Yes, that is the thing that many will miss. There are a lot of articles such as the one you linked. The one you linked is a bit older and pay-to-read. Having to pay to read publications, especially in medical field, is i.m.o. not morally right, but that is a whole different topic to discuss. :)
　
Here is another similar article, a free one:
Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators
http://www.bjj.boneandjoint.org.uk/content/84-B/2/196.short
　
They find that
"Our study has shown that significantly more IL-6, IL-8 and PGE2 are produced by discs from patients with low back pain compared with discs from patients with sciatica."
　
In fact I don't have sciatica at all, which is quite in-line with this diagnosis. I belive sciatica is common especially for people with large herniations resulting from trauma. A single traumatic herniation may heal in time, but a degenerating disc may be trickier (as I read on this forum people whose condition keep getting worse over the years...).

They also comment on discography:
"Provocative discography is currently the method of choice for diagnosing discogenic low back pain. It is a subjective test relying on the radiologists’ and patients’ perceptions to determine the result.29-36 Many patients with such complaints have associated psychological or psychiatric disturbances which may or may not be associated with medicolegal factors. All of these decrease their ability to give an accurate opinion as to whether the pain produced at discography is that of which they are complaining."

pay to read?
 

Sorry if that link came up as a pay to read site. I linked to the article summary, which I found helpful.
GC

Hi, as you can see I had ADR on L5S1 6 months ago. I'm off pain meds, but still not back to work. I still feel the same pain as before and nobody has a clue why. It could be memory pain, but I hardly believe in it. I had pain stting/standing/lying/walking. But, I never had regrets about the ADR. A black disc won't heal. When you're older (they told me above 60 years) hardly anybody has working discs and they naturally fuse with time. But when you're in pain and you qualify as an ADR patient, I'd go for it as long as you have tried all conservative methods. You wait too long and your facet joints will start to get damaged and then you won't get ADR anymore. At least not from a good surgeon as they know this disqualifies you.

Here's some scientific results on the disc I have.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567327/

I agree with Harrisson
 

The disc can look dark from regular aging...What I would want to see is the view looking down through the top of your spine to see if any nerves coming off the spine are infringed. I have heard that discography aren't always conclusive, but for insurance purposes it may be the first step in proving necessity for any surgery. Then some may want to do a CT mylogram. They may consider doing micro discectomy before disc replacement. Surgeons here with exception:raspberry: of a few will only do fusion. Although some ADR surgeons feel that M.D.'s only prolong what really needs to be done. Keep updating and I pray you find your answer.

Ive had 2 microd's and never had a discogram
I would Never allow a healthy disc to be compromised:chainsaw:

Hi Chris,
I read your story and it is very saddening that you did not get enough help from the disc. On the brighter side, at least it did not get much worse I assume? I really hope your recovery will continue and give capability to work. Even part-time standing,laying,fromhome could help?

I agree fully that waiting is not risk-free at all. It is only risk-free for the dr.

The LP-ESP device sounds very technical and thought has definitely gone in developing it. It is surprising that despite all the work on the elastomer discs, the outcome is not amazing.

In your article, only 59% had 25 % ODI improvement in 3 months. It seems that waiting 12 months gives 82% of patients 25 % ODI improvement. Maybe the one year mark may be the point where many start to feel better.

Once a disc is dehydrated, wouldn't it have less inflammatory substance to leak out? I thought annular tears mostly cause pain due to the nucleus pulposus leaking out and causing inflammation with the nerves. I've also heard that the tears cause nerve fibers to grow within the disc, which can contribute to discogenic pain and even referred pain down the leg.

If the disc is dehydrated, I don't see how there would be more fluid to leak out. Isn't this why they say that as you get older, discogenic pain tends to decrease, because the disc stiffens and there is less movement and/or leakage? I'm dealing with an HIZ tear in a degenerating discright now, so if you've come across any info regarding this, I'd love to see it.

I have understood that dehydration of the disc permanently changes the chemistry inside the disc, causing the substance to be even more inflammatory (?). Unless your disc is completely gone, there is still plenty of substance to leak out. Additionally, I read that the dehydration causes the anulus fibrosus to become mechanically weaker, making it difficult to keep intact/prevent further tearing. You are correct that eventually the disc should stiffen and turn into bone (auto-fuse) when you get old enough. Then the pain should subside. But it may be a long wait and there may be a risk of the disc wearing out before fusing, which may cause other problems as well (spinal stenosis?).

One of the doctors I visited noted that I have High Intensity Zone visible in my MRIs. I can't remember if it was L4L5 or L5S1 or both, but looking at my old MRI now, I think I see it at L4L5. Here is an example of an article discussing this issue:
http://europepmc.org/abstract/MED/10766075

It is tricky. One doctor will say that the pain comes from HIZ, another says it is the fluid mechanically pressing on the nerve root, a third doctor says it is the end plates and the fourth doctor says it is inflammatory proteins. I suspect that the exact role of pain generation in discs is not fully agreed on yet. ADR surgery should fix all these potential pain generators, so it may not be necessary to know which one was the culprit.

This pretty much explains a lot.
http://www.chirogeek.com/000_Anular_Tear_1.htm
I've followed this guy for 10+ years

Yes, chirogeek is great! I actually had a personal consult with him and he was very informative. He told me - and it's on his site - that eventually time can heal a tear, but it takes a longgggg time....and it will never be fully healed. I'm talking years of time, and most in severe pain can't afford to wait.

Blizzaga, I've read studies showing that HIZ is a pain generator up to 90% of the time. My guess is that your pain at least somewhat comes from the tear. It's a fairly good indicator imo.

This is the first I've heard that a dehydrated disc would cause more pain from a tear going forward. This concerns me for sure.