How long has this been going on??
My wife is in a similar position from a pain perspective but has 2 levels toast at the ripe old age of 23, so we are looking at the A-Mav ball and socket, at L4-L5 and ALIF at L5-S1.. We like the M6, but it is not available in New Zealand, and the life span of the core may not stand the test of time for someone so young. Additionally multi level ADR is experimental here so we wouldnt get a double A-Mav funded.....
I would hunt down a surgeon known to do ADR and get his opinion. You may also be up against the view that the disc is not a cause of pain, as some "old school" specialists would be looking for the bulge to be compressing nerve roots, without that contact, they are probably shrugging there shoulders and leaving you to your own devices. My wife has only suffered for 2 years, but it is constantly getting worse, there is an emotional component, which has amplified things, but at the end of the day, I feel remove the pain generator, and the emotions will come right....
medications??? My wife is on 20mg Oxycontin morning and night, 2100mg of Gabapentin a day, 50mg of Nortriptylene, and it's still spiralling out of control, it also stuffs with your head. If you aren't on any, keep away from the opiates, they will make you more depressed, and tolerance sucks, (we called an ambulance for one flare up, and she barely felt 100mcg of fentanyl
Armchair Amateur Diagnostic opinions..........
how much disc height have you lost in that level? you may want to nip facet joint problems in the bud by fusing or ADR to restore disc height.
You would possibly want a Discography with the fluroscope thingymabob to assess how bad your disc tear and the working internals are (internal disc disruption) This is not viewable on MRI but google chirogeek fore more info.
Additionally there is a small chance some of the pain is caused by sacro illiac joint and facet joint issues, a diagnostic nerve block may cross these off your list, homing in on the elephant in the room.......
Discogenic pain is typically relatively non specific, there is "dermatome" maps that show where all the main nerves from the back go, and these are concordant with nerve root compressions, but referred disc pain is all over the place. My wife has various referred symptoms, heavy legs, numb patches, hot spots (heat lamps above the skin) etc through L4-S1, and when its bad even L3-S2 dermatomes, so the orthopaedics ignore her as it is "in her head" some of your sensations sound similar to hers.
If you have a persistent pain on the left, that may be an indicator that a facet joint is started to wear, if this is secondary, it can reverse slightly if you deal with the elephant in the room.
Dont give up- a one level fusion at your age and weight is acceptable, (you are at the halfway mark of your life, so long term risks are less than my wife's) but an ADR is better.
Keep off the opiates, and get some cash behind you for the surgery, if the M6-L looks like your thing, as it is for so many others, be prepared for a trip to europe, and amazing reversal of your fortunes!!
Kia Kaha (be strong)
|