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Old 08-05-2019, 02:32 AM
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Owain Owain is offline
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Join Date: Jul 2019
Posts: 3
Default Unusual sciatica - 16 years of illness

Greetings from Poland!

I join you because I'm getting ready to exchange an ADR disc (I do not know, maybe).
My horror is probably quite strange, and for many doctors in Poland does not exist, or the problem is ambiguous. I will describe my case, maybe I can help someone.

I'm 44 years old. My ailments first began in 2003 with pulsating, piercing pain, on the right side, around 6-7 cm from the medial line of my back and around 2-3 cm underneath the illiac crest. Then next came the pain in my buttock and leg. The conclusion from MRI was: back-right bulging disc L5-S1 around 5mm. I had 2 years of rehabilitation with mixed outomes. In March 2005 I piked up a piece of furniture that made it worse again. In April 2005 I had PLDD procedure (disc L5-S1) which again made things worse. Between May-June 2005 and in April 2006 I had three times performed microdiscectomy of L5-S1 (2nd and 3rd surgeries were aimed at removing the internal scars).
From the last surgery, for the period of 11 years the symptoms were not too bad, the pain was only occasional. However, from 2016 the pain was more and more frequent.
From May 2018, after lifting the weight in rotation and inclination to the left, the pain persists for a year all the time, I can not stand for more than an hour or sit for more than half an hour. Most pain in the butock, anterion and posterior thig (depending on the position), pins and needles in my foot. I have had muscle weakness in buttock (gluteus medius) for several years. No significant new circumstances were found in the MRI.

Characteristics of pain:
Pain occurs in bad static positions, not immediately - only after a few or several minutes. The pain most often is caused by sitting, sitting in the car, lying on the right side, lifting in a slant and rotation to the left. Relief in pain brings lying on the left side, on the back but with the lordosis, hamstring stretch of right leg. I have never had a positive Lasègue symptom.
The relief is also brought by heat patches, while cold causes an increase in pain. In the morning the pain is usually gone, but it reappears gradually after taking the vertical position.
From October 2018, I am taking Pregabaline 2x150 - with no effect.

Blockers (lignocaine + steroid) - iniections of iliosacral joints (iliosacral joints is rather not the cause, twice the blockers and pressure tests did not work), injections of iliolumbar lignament (good result after lignocaine, less so after steroid). Best effect was after transforaminal epidural injections of L5-S1 and a little after facet joint block (L5-S1 level). Cryolesion of superior cluneal nerves - with no effect.

The current diagnosis includes iliolumbar lignament dysfunction associated with disc degradation of L5-S1 and/or stenosis and/or instability and/or static disorder of the spine (also caused by disc degeneration but without additional bulging disc), related to the spine scoliosis and a sudden change in the angle between the sacrum and the L5 vertebra (with the rotation of subsequent vertebrae). I think that my facet joints are healthy because extention backwards does not cause pain, but even a little relief.

Despite the fact that supposedly the type of pain indicates the sacroiliac joint, they are certainly excluded, block injections was completely ineffective, as were multiple compression tests. The only prerequisite that these could be from sacroiliac joints are dermatitis in front of the thigh, but apparently it can come from the iliolumbar lignament.

Some doctors warn me against surgery, but do not propose any alternatives, while some try to bring about ALIF (stand alone cage) to allow for straightening scoliosis, increasing lordosis and avoiding additional scars in interverbal foramen. Some doctors even found irritation of the nerve S1 in the spinal canal through the bone parts of the facet joints of L5 vertebra (caused by the tilt of this vertebra).

It seems to me that I have two options. Or ‘stand alone’ cage via ALIF in Poland (where even the best doctors only have 20 such treatments in their careers) and the chance to straighten of the spine, less tension of the iliolumbar ligament, quadratus lumborum etc., but living with fear about "adjacent segment disease". Or an ADR, with the chance that irritation or failure of my old disc will disappear and after rehabilitation I will have a chance for normal position of my body. But with the risk that the flexible disk will tilt in my body and the pain will remain.

My surgery in Poland would be completely private, because our public health service does not offer such uncertain and complicated procedures as ALIF. And my Polish doctor says that may need a second surgery after ALIF - adding screws from the back.

Thus, ADR could be the same in terms of price.

I have received two answers so far. Dr. Rischke thinks I'm good at LP-ESP, but its price is too high. Dr. Ferrandez says ALIF will be better for me because I have a small scoliosis and a L5 tilt.
Now I am waiting for the opinion of dr. Desai and I will have to make a difficult decision.

Let me also attach a few pictures.



Here is my postural problem. A large angle between the axis of the L5 vertebra and the sacrum. And raised right hip.


The same can be seen on the CT, in particular the tilt of the L5 ver.



My MRI and the L5-S1 looks good for some, but for others there is a small, but persistent remnant. The disk is damaged, cracked inside, split.

__________________
It all started in 2003 with a pulsatile prick, a few cm from the center of the body at the level of L5-S1.
In 2005 1xPLDD of L5-S1
In 2005-2006 3x microdiscectomy of L5-S1.
11 years quite ok. May 2018, after lifting the weight in rotation - pain persists for a year all the time.
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