New to DDD

[banhorn]

Hey guys

I finally got the guts to sign up online after a few months of trolling!

I'm 33 years old and live up in the Great White North (Canada). Shovelling all the snow sure is getting to be a chore!

I'm not sure where I'm going or how I'm going to try and treat my condition, but there have been a number of you that have helped me to come up with a general course of action.

My Diagnosis:

L5-S1. No Malalignment or destructive marrow leasion. Developmentally narrow lumbar central canal, particularly at L3 and L4 due to short pedicles. Conus terminates normally at the L1 level.
Discs and facet joints at L1-2 and L2-3 are well maintained with no evidence of spinal or foraminal stenosis.
At L3-4 the disc is well preserved. There are mild-to-moderate hypertrophic degenerative facet joint changes bilaterally with mild thickening of the ligamenta flava, without significant aquired central spinal stenosis. Foramina remain patent.
L4-5: There is mild disc space narrowing, desiccation and a combination of fatty and edematous endplate signal changes. No paraspinal soft tissue swelling. There may be very minimal enhancement of the disc and adjacent vertebral bodies but this is quite subtle. There is a mild disc bulge identified, eccentric to the left along with a central annular fissure. Mild to moderate degenerative facet joint changes are seen bilaterally with mild thickening of the ligamentum flavum resulting in mild acquired central spinal stenosis and left lateral recess stenosis. There is moderate left and severe right foraminal stenosis predominantly related to encroaching facet degenerative change.
At L5-S1, the disc appears well-maintained. Mild-to-moderate degenerative facet joint changes. Spinal canal and foramina are widely patent. No impingement of the descending roots.

The long-short is that it hurts like heck to bend/twist and absolutely aches when I'm sitting and in bed. The NSAID's help a little, but I've read that they can interfere with cartilage healing in the long run and they kill my stomach. Damned if I take them and Damned if I don't.

I've been exchanging emails with Mike86 and have read all about Tyler's experiences with the M6 and Mr. Boeree in the UK. I've exchanged a number of emails and phone calls with surgeons and have settled on Mr. Boeree IF I decide to go the surgery route. However:

1) I'm trying to exhaust any and all non-surgical treatments first
2) The surgery isn't covered by our government healthcare

My symptoms have lasted just over 6 months and are getting worse as I become more and more inactive. Pre-injury(DDD), I was up to 3 nights a week of hockey and a couple of nights of yoga per week, while I sat in a desk all day.

I'm living with the pain, but the tingles and numbness in my toes/hamstrings are concerning me greatly... they come and go, but I've read that is a troubling sign.

I've had a history of back problems at L4-5 and the first bulge/protrusion happened about 10 years ago. Losing 40 pounds and picking up yoga along the way kept in check until last September when this current bout of pain began. I'm currently at 6' tall, though I've lost 1cm in this ordeal somehow, 165 pounds and until September, was in the best shape of my life. My core strength is still pretty good, so making it stronger has been of no help.

I'm not sure where this leaves me, but any pointers will be greatly appreciated... Why can't cartilage just repair itself!

Until my appointment with my local specialsts here in Calgary (3 month waiting list - I'm in on April 8th), I'm popping glucosamin, chondroitin, MSM, omega fatty acids and collagen supplements in hopes that my lame disc can rehydrate itself - if even just a little. Gentle excercises hurt a bit, but I'm trying everything I can to get the transfer liquid and nutrients in and out of the disc. Physio has been a bust.

Cheers,

-Brett

[Harrison]

Hi Brett, thanks for finding us. Hope we can help.

Quick questions: do you feel LESS pain in the morning? Are you doing any traction exer. like chin -ups, hanging, or water therapies? Also, do you find that you feel much less pain after taking any type of NSAID?

Don't forget what the TLA stands for -- DDD is a disease process. Most people want to forget about this as they are in such pain. If one looks it as a disease, it may help in the information gathering process before treatment decisions are made. More on that some other time...

[banhorn]

Thanks for the welcome, Harrison.

Definately more in the morning and throughout the night as I try to sleep along with sitting at work. I guess it seems like the less I move, the more it hurts, as long as I'm not bending or twisting. Walking definately makes it feel better. More than the pain though, I'm worried about the tingles and numbness down my left hamstring and big toes. It comes and goes but seems to be happening more frequently. Should I be alarmed?

I'm also getting what one surgeon called "referred pain" accross my sacroiliac joint and left groin/hip - it seems my muscles are mad at the nerves who are in turn mad at the inflammation.

I've tried swimming and definately need to get out more with that. The NSAID's really do help with the pain, but these 550MG Naproxens feel like they're eating a hole in my stomach.

I bought one of those Spinal Stretch devices as well to try and decompress each night before bed, but I haven't seen any results yet - though it's only been a month with that thing mind you.

TLA... terms of the license agreement!? I didn't ever sign a DDD contract I hope! Sorry, I'm not sure what you mean.

I think I understand that it is a disease and I'm terrified of it progressing further at L4-5 and squeezing these nerve roots even more and/or causing adjacent level issues. That's probably why every ADR surgeon I've spoken with has indicated I'm a good candidate. Then the hole quagmire of surgery rears its head. There seem to be a real mixed bag of outcomes and I'm not sure I'm willing to risk coming out worse than I am now... BUT will not doing anything now leave me crippled in 5 years anyway?

How does anyone know they are ready for surgery? Serious nerve compression and pain make sense... but is surgery the real answer for someone just trying to ski and play with their 20 month old daughter again? Is it unrealistic for me to want to be as active as I was a year ago?

I don't know... sorry for the rant.

[Hooch]

You're not approaching the injury correctly. If you decondition it will hurt you more. You have to learn how to unload the spine as much as possible and give it time. Most of the time it will settle to a point that is good enough.

Stuart McGill is a professor of biomechanics based in Canada, and has done a lot of work on core stabilisation. Find a physio who's up to date on his stuff and that will be a good starting point. From there head to pilates.

If you want a good cheap book on it, buy 'Spinal Stabilisation' by Jemmet off Amazon for $40.

These are all good options to explore before you subject yourself to invasive surgery.

Good luck

[banhorn]

I'll look into it for sure... I've already been doing lumbro-sacral stabilization excercises and the rebuild your back program. Every minor flexion (forward or backward) seems to aggrevate the tingles and numbness.

Like I said earlier, I've dealt with approximately 4 injuries (bulges/protrusions) at the same level over the past 10 years. I was overweight for quite a while and didn't care for my lower back properly. Each injury required months of rest and physio to get bck up and running. Yoga really helped to stabilize my core over the past 5 years and I've been doing great until my dog tripped me down the stairs last August. It seems to have been the final straw that "broke" both the camel's and my back. This one doesn't seem to be getting better and the redicular symptoms are actually getting worse. Hence my concern about nerve damage. I guess that's why its called degenerative disc disease - it keeps getting worse?

I haven't really been able to sit still for very long unless I'm on NSAID's for about 6 months and have found the only time I'm comfortable is:

1) walking - Tough to do when it's been -20C almost all winter
2) laying on a couch or on the ground to play with my kid. Getting up to chase her is another story!

Swimming really wasn't as easy on my back as I had hoped it would be... so I might try deep water running for a while.

I'll look into the McGill stuff too.

At what point does someone decide enough is enough and go for ADR surgery?

[longroadahead]

I have reached the enough is enough and am ready for surgery and has taken me shorter than most. It has been almost 3 years of constant back pain and in the last few months of now leg pain symptoms.

For me, it's not being able to do all the things I use too but more importantly being able to do things with my 9 year old son.

If I read your post correctly it has just been around 6 months of pain but prior to that you had problems 10 years ago. It's a tough decision to commit to surgery and surgeons seem to be quick to recommend surgery (or at least from my experience).

There some new exciting stuff out there for sure but may not be available 5-10 years out...

[banhorn]

I hear ya... Always something better 5 years out, eh? There never seems to be the perfect solution when you really need it!

Constant pain for 3 years must be terrible. Sorry to hear that.

Mine has only been constant for 6 months and off and on depending on the injury over the past 10 years. Probably about 4 specific times I found myself in bed and doing physio/accupuncture for months before I was able to be normal again. Sorry if I wasn't clear.

[srajan0929]

Originally Posted by Hooch

You're not approaching the injury correctly. If you decondition it will hurt you more. You have to learn how to unload the spine as much as possible and give it time. Most of the time it will settle to a point that is good enough.

Stuart McGill is a professor of biomechanics based in Canada, and has done a lot of work on core stabilisation. Find a physio who's up to date on his stuff and that will be a good starting point. From there head to pilates.

If you want a good cheap book on it, buy 'Spinal Stabilisation' by Jemmet off Amazon for $40.

These are all good options to explore before you subject yourself to invasive surgery.

Good luck

in my opinion, all these PT is completely useless. I would like to hear a case where PT has completely cured a person from his or hers back problems. Then I will consider it. Whats the point of spending more and more time and money doing PT if it doesn't guarantee success? Atleast surgery goes to the root of the problem and after doing a lot of research, i believe ADR is very benefitical for the right patients. Its even more helpful for younger ppl since they recover faster.

[annapurna]

I'm not going to touch the argument about conservative care vs. surgery. Even if you're dead set on surgery, though, a good solid core strengthening and flexiblity regime buys you time, gives you the most you can get out of your life while you're working to get surgery, and makes your recovery time shorter after the surgery. A few years back, Bertagnoli replaced every disk in one gentleman's c-spine with a mix of ADRs and fusions. The man had worked hard to remain fit and it paid off with a recovery time in weeks. I don't recall the exact time but he was up and about within some number of weeks, definitely less than two months.

[Hooch]

Even if u have the surgery thats only half way there. You still have a 'bad back' and need to work it optimally. So uve still gotta do all the PT.

I'm 3 months post op lumbar hybrid.. for me prehab and rehab isn't an optional extra.. helped keep me out of screaming pain and employed for a number of years before it all went to **** too

its just biomechanics.. all science based.. it works.