Upstate NYnew here...

[stefanie]

Well everyone has their story....so here goes. I had an incident with my son this winter while kissing my buddy goodbye. He proceded to jerk backwards fooling around and something happened and I knew it was not good. I was not in excruciating pain right away..it developed over the next week. Got worse then got better with PT then proceded to get worse again. I am now started injections and the word discectomy was brought up in my last appointment.

My questions being...is it even worth it to get a discectomy? Most of my symptoms are lower back burning pain especially, especially with continued sitting or standing. when it gets further irritated then it starts down the thighs. I am wondering for predominantly lower back symptoms for the most severe pain if discectomy will take care of that pain? Will having a previous discectomy make it less likely for a successful ADR? And...does anyone know of any good surgeons in Upstate NY?

[Harrison]

Stephanie, welcome but sorry you are here. And wow, what a tough situation you described. For starters, to address part of your question, search previous topics that may help you answer your question:

1. Go to advance search (it’s in the top navigation): http://www.adrsupport.org/forums/search.php

2. Search by keyword, select titles only;

3. Type in discectomy;

4. Search!

I believe you will find 15 topics of immediate interest. Of course, you will find many more if you search through entire posts.

When you have some time, please visit this multi-page post: ADR Risks, Complications, Disqualifications. This is a good primer topic too.

Happy reading!

[hey_look_its_dave]

Hi Stefanie,

You can find a recent discussion at Tierney's "New guy, looking for answers" thread on this New Members board, but I can think of a few things to add.

It seems to me, the decision to do discotomy or not depends on the situation. Shocking - I know!

For example, as you get older your discs dry out (go darker on MRI) and become less likely to continue to bulge after discotomy. If your discs are nice and hydrated, they'll be more likely to bulge out. The guts of the disc is like calamari (rubbery). So hydration is a factor.

The disc is surrounded by a fibrous ring that normally keeps the calamari innards in, but when it tears there is a reduction in hoop strength of the disc, and more heniation is likely. Depending on how much of the fibrous ring is torn, also affects the likelihood of post-discotomy herniation.

Also, it depends on how the disc was damaged to begin with. If you fell, the disc can be fractured inside, breaking the rubbery stuff into pieces that can spit out the tear in the fibrous ring. If it has deteriorated over a long time, it may not be fractured and bits won't be spit out in time (I think....Harrison, correct me if I'm wrong on this)

If there is damage to the innards of the disc it is likely to be a significant cause of pain. If it just dried out over many years and barely bulged and was not fractured inside, it might not be a pain source. A discogram can determine if there is pain from inside the disc. A discotomy will not solve pain originating from the disc ("discogenic pain"). Obviously, if the bulge is pressing on a nerve root, that'll be painful.

Finally, if you've lost a lot of intervertebral disc height, the tissue through which the nerve root passes will be compressed. Any movement will be squishing the nerve root, even though the MRI may or may not show that the herniation is touching the nerve root. I had this situation. They claimed the nerve root pain (sciatica) was due to nerve root scarring because the discotomy removed the lateral pressure from the herniation. Once my interverbral space was restored though, the sciatica improved 90% so far (roughly 2 months post-op). So if you've lost a lot of intervertebral disc space, I would go for ADR. If it's minor reduction AND it doesn't look like the disc will continue to collapse (based on all the crap I mentioned above), then discotomy might be a sensible and conservative approach.

So, basically, it's a freakin' mess to figure out.

Dave

[stefanie]

Harrison-Dave~
Had the EMGs today, repeat MRI tomorrow. The EMGs showed nothing significant. From what I have read I think the trauma to the L4-5 with a herniation to one side and annular fissuring to the other I have the feeling it is discogenic pain.