ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > New Member Introductions

New Member Introductions If you just joined, please introduce yourself here. Please add a signature describing your spinal history (use the "User CP) and ask us how we can help you get started.


Reply
 
Thread Tools
  #1  
Old 08-05-2019, 03:32 AM
Owain's Avatar
Owain Owain is offline
Junior Member
 
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.
Reply With Quote
  #2  
Old 08-06-2019, 08:35 AM
JackBauer JackBauer is offline
Member
 
Join Date: Aug 2018
Posts: 63
Default

After you speak with Dr. Desai, your mind will be very much at ease as far as making a decision.


I'm only struggling as I'm not in pain 24/7. Just discomfort at times - and some QOL limitations... (Avoid bending, go out less, can only do certain exercises, etc...)


If I was in any amount of real or constant pain / discomfort... My decision would have already been made.
__________________
L4-L5 Broad Diffuse Bulge, mildly contacting left L5 nerve root
L5-S1 Broad Central Disc Protrusion mildly impinging left S1 nerve root
"Mild scoliosis of lumbar spine". Does not feel mild to me.


C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good.


Surgery scheduled with Dr. Desai in mid-late October.
Reply With Quote
  #3  
Old 08-09-2019, 05:45 PM
JohnT JohnT is offline
Junior Member
 
Join Date: Jun 2019
Posts: 13
Default

Dr. Desai is probably a good option for you. His price is on the low end (he works for the hospital) and your case does not seem complicated. ADR is done anterior so your many scars from previous surgeries don't matter. You should address it as soon as you can. Postural problems aggravate faster the condition.
__________________
[SIZE="1"]Canadian - ADR not available in Canada
L4/S1 DDD since 1994 - right side sciatica
L4/L5 herniation and discectomy in 2006 - success
2017 bilateral and sacral pain and numbness, cannot sit
Dec 2017 L4/S1 (2 levels) Interspinous implant (IntraSpine Cousin Biotech) - no result
permanent pain and numbness
Narrow spinal canal, scarring, L5/S1 started autofusing
Implant must be removed, decompression needed
Decision time - discussed with Dr B, Rischke, Desai
Reply With Quote
  #4  
Old 08-10-2019, 12:19 PM
Owain's Avatar
Owain Owain is offline
Junior Member
 
Join Date: Jul 2019
Posts: 3
Default

Unfortunately, I have received very laconic information from Dr. Desai that he recommends neither fusion nor ADR, only further rehabilitation. Despite informing him that after 14 months of exercises, injections, ablation etc. I don't see any chance for improvement, I didn't receive another email. I know from a friend who received the approval of the ADR procedure, that after returning from vacation dr. Desai is very busy and I'm afraid they won't look at my case closely enough.
I received one more opinion from Prof. Dr. Bertagnoli, but his diagnosis was very laconic: "Degenerative disc disease with desiccation and protrusions. To preserve the function and mobility of your spine and for longer-lasting results, Prof. Dr. Bertagnoli recommends an ADR surgery (total discectomy, vertebral remodeling removal of troublesome osteophytes and shaping the vertebrae to mate with the ADR) stability at L5-S1 ". Unfortunately, I do not know how to relate it to the words on the page of Dr. Bertagnoli that on L5-S1 he does not see the point of setting up elastic ADR like LP ESP.
Currently, my recommendation looks like this:

Prof. Rischke - ADR
Dr. Ferrandez - ALIF
Dr. Desai - rehabilitation
Prof. Bertagnoli - ADR
Dr. Clavel - on vacation.

Unfortunately, I'm preparing for a fusion in Poland using stand alone cage - Synfix (DePuy Synthes).

Anyone have any advice for me in this situation?
__________________
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.
Reply With Quote
  #5  
Old 08-10-2019, 12:29 PM
JackBauer JackBauer is offline
Member
 
Join Date: Aug 2018
Posts: 63
Default

Personally I wouldn't go anywhere near a ProDisc - well, considering the ESP exists. (cobalt, lack of cushioning, wear debris, etc...)



There's a reason why more and more physicians seem to be moving to the ESP.


And even with all that, I'm still very cautious and haven't made up my mind yet.
__________________
L4-L5 Broad Diffuse Bulge, mildly contacting left L5 nerve root
L5-S1 Broad Central Disc Protrusion mildly impinging left S1 nerve root
"Mild scoliosis of lumbar spine". Does not feel mild to me.


C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good.


Surgery scheduled with Dr. Desai in mid-late October.
Reply With Quote
  #6  
Old 08-10-2019, 12:37 PM
Owain's Avatar
Owain Owain is offline
Junior Member
 
Join Date: Jul 2019
Posts: 3
Default

From Prof. Bertagnoli site: "The lack of control of the center of rotation is also a reason elastomer discs should not be used in segments with a spondylolisthesis (less than grade 1) or in the l5s1 spinal intervertebral disc space, which is the segment of the spine with the greatest shear force. There is simply no way for these devices to maintain stability and the patient has a higher risk of device failure."

Maybe fusion on L5-S1 is a good idea, though? Maybe at this level it is too big bone angle and it will fall apart in a dozen or so years? Maybe after 40 L5-S1 is not so mobile anymore? Maybe that's why many doctors make a hybrid if it concerns L4-S1?
__________________
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.
Reply With Quote
  #7  
Old 08-10-2019, 02:33 PM
JackBauer JackBauer is offline
Member
 
Join Date: Aug 2018
Posts: 63
Default

I'll admit - that assuming I do get surgery... I won't be doing any heavy lifting... While there are apparently no failures of the ESP disc out there, and has been tested in the lab to 40 million cycles...


I have no desire to press my luck.
__________________
L4-L5 Broad Diffuse Bulge, mildly contacting left L5 nerve root
L5-S1 Broad Central Disc Protrusion mildly impinging left S1 nerve root
"Mild scoliosis of lumbar spine". Does not feel mild to me.


C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good.


Surgery scheduled with Dr. Desai in mid-late October.
Reply With Quote
  #8  
Old 08-12-2019, 12:24 PM
annapurna annapurna is offline
Senior Member
 
Join Date: Dec 2004
Posts: 1,562
Default

Quote:
Originally Posted by Owain View Post
Maybe fusion on L5-S1 is a good idea, though? Maybe at this level it is too big bone angle and it will fall apart in a dozen or so years? Maybe after 40 L5-S1 is not so mobile anymore? Maybe that's why many doctors make a hybrid if it concerns L4-S1?

L5-S1 doesn't move that much, which prompts many doctors to recommend fusion instead of ADR. The forces generated by fusing L5-S1, though, are high and prone to mess up your SI joints and hips as well as risking L4-5.


That said, spondy changes things. If you have a joint that isn't moving correctly to begin with, putting in a high degree of freedom prosthetic might cause more problems. With that, I can see Bertagnoli's argument. I can also see why fusion might be the best bet.


If you didn't have spondy, the argument for fusion over ADR isn't very good. Any of the arguments that I've heard about limited motion at L5-S1 depend on a faulty understanding of mechanics and the effect of locking that joint. As you do have spondy, you're into a situation where you have to pick the lesser of two evils. I would suggest, though, if you chose ADR, especially a elastomer disk, you need to plan on limited lifting and lots and lots of core strengthening as that core strength will be what controls your hypermobility.
__________________
Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

"There are many Annapurnas in the lives of men" Maurice Herzog
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -4. The time now is 10:38 PM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.