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  #1  
Old 03-09-2010, 03:20 PM
ctwitmer's Avatar
ctwitmer ctwitmer is offline
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Join Date: Mar 2010
Posts: 4
Default going on two years and that's long enough

Hello. My name is Chris and I'm new to this board. I've been poking around the last few months as this page always comes up when doing any back pain related searching. I probably should've signed on several months ago as I'm discovering there are a lot of things I don't know. Had I known those answers before, perhaps I would've spared myself some grief.

Anyway, I am here because I've been having ongoing back pain. I can't sit or stand for long periods and just forget riding my bikes. I've been more diligent with all of my physicians because things have been getting worse in the last 6 to 8 months.

I've had back problems since high school, but nothing like the last two (1.75) years. Even the car accident wasn't this bad. There is a burning/pain that sticks close to the spine on the right most of the time. When things are really bad it goes to the left across my lower back just above my butt. It doesn't migrate to my legs or anything, usually, but I do have little flashes run down them every couple of weeks if I turn or sit the right way.

I started out seeing my primary care doc and he referred me to PT. Went to PT and didn't see any improvement. Actually, when I do a lot of ab work, I end up worse. Was referred to the neurosurgeon #1, had an MRI and he said there wasn't anything they could do. Was referred to the 1st pain clinic. They tried an injection, but that made me feel worse. I really didn't particularly care for that clinic because I only saw the PA. I never once saw the physician with the exception of him doing the injection. I asked for a second opinion from my primary care doc from a different neurosurgeon. This particular doctor, neurosurgeon number #2, specialized in nonsurgical interventions. He recommended McKenzie physical therapy. While it has a very snake oil-esque feel to it, it actually improved my baseline. (Even if it was just placebo, I'll take it) I never did make it back to riding my bike. I still continue to do the exercises, but I don't see any improvement. Again, it's only been getting worse the last 6 to 8 months. I went back to see neurosurgeon # 2 and he referred me to neurosurgeon #3 for possible disc replacement.

Neurosurgeon #3 referred me to have a discogram at pain clinic #2. I had the discogram yesterday and I'm still in a lot of pain. Overall, that was not a positive experience. Everything people said about it is true, it hurts like heck. I also wondered if other people had an experience similar to mine. They gave me Versed (I'm not sure how much) so I ended up pretty dopey. They didn't come right out and say it, but I don't think I gave them very good feedback. The actual process didn't really hurt that much until he got to the last disc. Now he said that he hit a nerve and so that's why it hurt so bad there, but I can't really recall from there to being back in recovery. Once I got to recovery it felt exactly like my worst symptoms. And those symptoms continue today. The doctor came in after and showed me the images and said that my discs held up pretty well. He did say that I have a septum in the lower vertebrae (I cannot remember which ones) so that's why he had to do two injections at the last vertebrae. He did the first injection and I didn't feel anything, but the second one, again, that really felt terrible. I told him it felt terrible and I had that radiating pain on the left, but then he tells me that it's just because he hit the nerve. I told him that hurt, but again, he just dismissed it as him hitting the nerve. Have other people had that experience? Why did it hurt then when the other four or five spots didn't?

I still have yet to get copies of the follow-up CT scan and main reports, but the impression I got from the pain clinic was that I didn’t seem to be a good candidate for ADR. I had the pain everyone said you should expect, but unfortunately the test didn't give me the answers I was looking for. Part of me wonders if I should ask for a do over with less medication. I know that's crazy because I experienced pain as it was, but in order to adequately report, it seems like I would need to be less sedated. Has this happened to anyone else?

I have a follow-up with neurosurgeon #3 next week on the 17th and I'm not sure what he's going to suggest. Obviously, I don't want to have surgery if I'm not a good candidate, but I really want to start feeling better. It’s clear that I need to start educating myself and I plan to continue reading posts.

This seems like a good group. Take care, all.
Chris
__________________
Chris Witmer
92 Skiing Injury
03 MVA transverse process fracture @ T1 +T2
6/7/08 Long day biking and pain ever since.
11/08 - 2/09 PT
03/12/09 MRI
Degeneration at L3-L4 and L4-L5.
Slight herniation at L4-L5
4/09 Injection
6/09 Tens Unit
6/20/09 x-rays: Scoliosis
7/09 - 10/09 McKenzie PT
3/08/10 Discogram
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  #2  
Old 03-09-2010, 07:17 PM
2cool4U 2cool4U is offline
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Join Date: Oct 2008
Posts: 141
Default A couple of answers

Chris,

I can confidently address a couple of your questions. Hopefully others will chime in on things, too. The Mckenzie method of mechanical diagnosis and treatment (MDT) has been well-tested in peer-reviewed physician, sports medicine and physical therapy journals. It seems to have better short-term (6 mos.-1 yr.) results than stretching/strengthening regimens, but the numbers fall back to nearly identical chances of success and failure after 12 months. Some have speculated that this could be due to patients stopping the program b/c they are doing better and then experiencing recurring symptoms. However, I haven't come across definitive proof of that. It may be out there, I just haven't seen it. Overall, the various PT methods result in improvement in about 40%, no change in 40% and worsening of symptoms in 20% of patients according to a few references I read 2 years ago that I didn't keep.

As far as the discogram: If the physician is certain that your report of pain directly correlated with placement of the needle next to or within a nerve root, then it certainly could have been due to that. No injection is even needed. Even routine lumbar punctures (spinal taps) can result in sudden severe back or leg pain if the needle contacts a nerve root. It almost always resolves very quickly when the needle is repositioned. There have been rare occurrences of permanent nerve damage, particularly if a caustic agent or medication is injected directly into the nerve root. However, most of the time even complications from direct injection into the nerve resolves over time.

Hope this helps.

-tc-
__________________
L5-S1 rupture 11/04, left leg pain for 2 wks
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
Massage, heat, ice, TENS, etc
L5-S1 Charite Jan. 19th, 2009, very happy w/decision
New back pain in upper back though.
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  #3  
Old 03-11-2010, 11:16 PM
ctwitmer's Avatar
ctwitmer ctwitmer is offline
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Join Date: Mar 2010
Posts: 4
Default discogram results

okay. I received the reports on the discogram. As Dr. M said, he did not see any leakage or any problems with the discs, but looking at the CT scan, apparently there is.

I realize I still have to review these with the surgeon, but I'm looking for input from others. Here's a summary of the reports:

L2-3 was the control disc and that was classified as a grade one disc.

L3-4- "[I] did complain of some discomfort on the right side, but this was not concordant, noting that it was higher than [my] normal pain. the contrast did appear to be confined within the central portion of the disc."

L4-5 it is noted that filling was entirely on the left side of the disc. [I] had no significant discomfort although there was a feeling of tightness on the left side. Because of this, a needle was replaced on the right side entering at L4-5. opening pressure was approximately 30. Initially, 1.75 cc of contrast was injected with the peak pressure of 65. [I] did complain of a burning sensation. With another .5 cc of contrast, peak pressure was 90 with increasing symptoms. [I] state[d] this is the same pressure sensation [I] get although it is not a burning pain [I] get. [I] rated [my] pain as fairly severe at 9/10. (I don't remember that part. When they wheeled me to recovery before I went to the CT scan, the pain was simply unbearable. I can't believe I said 9/10. Felt like a 37.) again, discography did not appear to show any significant spread of contrast posteriorly, consistent with the grade 1 disc.

in summary, I have essentially normal findings at L2-3.

There is discordant pain at L3-4 and fairly severe concordant pain with septum at L4-5. Again, L5-S1 could not be accessed because of significant degenerative changes and sacralization of that level.

Those are the findings of the discogram.

From what I read about others, there could be other pain generators at L3-4 because the pain is discordant.

L4-5 has concordant pain, so that means it's because of the disc.

and there could be a variety of things wrong with L5-S1 because of the degenerative changes and sacralization.



the impression from the post CT scan is more revealing. I've not actually seen the images, but here is the impression:

"1. Disc bulging and superimposed Dallas grade 3 annular tears at the L3-L4 and L4-L5 levels."
2. apparent variant anatomy [L5-S1]

so I take away from that that while they may not be severe, the tears are likely the cause of my problem. perhaps then that means that the pain at L3-L4 is in fact concordant and not discordant??

again, I go back to my earlier point. Is there any sense in redoing the discogram sans versed so I'm able to report better? Or since the CT scan revealed tears that I just concentrate on that? What do you all think?


finally, I should note that I took Tuesday off completely because of pain and had to leave work early yesterday. I made it through the day today only leaving a few minutes before five, but I called the pain clinic and asked for something stronger than the ultram.

this past week has been really difficult because it's been all consuming. The pain is all I think about...
__________________
Chris Witmer
92 Skiing Injury
03 MVA transverse process fracture @ T1 +T2
6/7/08 Long day biking and pain ever since.
11/08 - 2/09 PT
03/12/09 MRI
Degeneration at L3-L4 and L4-L5.
Slight herniation at L4-L5
4/09 Injection
6/09 Tens Unit
6/20/09 x-rays: Scoliosis
7/09 - 10/09 McKenzie PT
3/08/10 Discogram
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