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Old 08-31-2020, 01:56 PM
smythrj smythrj is offline
Junior Member
Join Date: May 2020
Posts: 5
Default Lost and grateful for insight

My name is Ryan and I am 36 and live in Atlanta, GA. I have been dealing with low back pain with debilitating spasms since 2012. I was able to stay active and manage the pain, when I wasn't locked up from a spasm, until 2016. Since then, I haven't been able to run, bike, play golf, play basketball, and only minimally hike. It has taken away a significant amount of joy in my life. I also have two young boys and my ability to be active with them is greatly limited.

My pain has always been flexion-intolerant and fortunately only had minimal sciatica. I would describe my back pain like a permanent turned-ankle; when I bend or twist it is a sharp and broad ache across my low back. If I push it too far my body will lock up for days.

Since 2012, I have tried multiple epidural steroid injections, facet radio-frequency ablation, chiropractic, PT, massage, acupuncture, Egoscue, and Rolfing. I have even had stem cells shot into my degenerated disc. I have only continued to worsen.

In that time I have developed mild depression which is primarily rooted in my pain. It makes me irritable and quick to lose my patience. I feel like a worse dad and spouse because of it and desperately want to be free of the daily burden. I am sure many of you can relate.

This year I started considering ADR at L4/L5 where MRI has showed a degenerated disc since 2012. Given the imagining of my spine and flexion-based pain, my providers have mostly focused on the L4/L5 disc. However, a recent discogram didn't create pain at L4/L5 but did create pain at L5/S1. The results have paralyzed my decision making not knowing where my pain is actually coming from. All imaging points to L4/L5 but the discogram points to L5/S1.

Which brings me to today. I feel at a complete loss as to what to do. A two-level ADR feels aggressive at 36. Choosing between the discs feels like random guessing. And I have exhausted all conservative/experimental options. I can still function at my job and take care of myself, and therefore assume I should wait before taking the risk of surgery. But in the meantime, I know I am losing out on joy with my family and increasing my depression. I often feel hopeless.

How have many of you made the ADR decision? How confident were you in the pain diagnosis? I am searching other posts to learn from your stories. Any insight you have would be dearly appreciated. Thank you all.
2012 - frequent, severe back spasms; DDD at L4/L5; ESIs and PT used

2016 – intermittent pain becomes always present yet no change on MRI; RFI for L3/L4/L5 facet nerves has no impact

2018 - stem cells injected into L4/L5 disc with minimal impact

2020 - ADR at L4/L5 considered but discogram is not conclusive

2021 - L4/L5 replaced March 31st
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Old 09-01-2020, 10:17 AM
annapurna annapurna is offline
Senior Member
Join Date: Dec 2004
Posts: 1,646

About a decade ago, Zeegers was presenting at an event in California and threw up a MRI image of a patient, properly marked out so the audience couldn't tell who it was. One disk looked horrible on the MRI; the adjacent disk shows slight changes. He asked the audience which was the pain generator and, after everyone pointed toward the horrible disk, explained that it was the other, the slightly damaged one. For that patient, the horrible disk was so badly degenerated it no longer generated pain and the slight damaged one was the one that hurt. He went on to say an important phrase, one that I'm slightly paraphrasing, "We treat patients not films."

Go with what your pain tells you. Understand, though, that leaving in an adjacent badly damaged disk might lead to problems at L34. Laura ended up needing two level cervical ADR at around your age and nearly required 2 level lumbar ADR, which was only fended off with a stem-cell like procedure for her L45. I'm not telling you to get the 2 level surgery, just that the argument that you're too young to need two level is specious and you need what your body tells you it needs.

One more thought - the decision to actually get surgery is up to you but I'd strongly suggest investing time now, while you feel that you're functional, in getting yourself fully ready to get surgery. Find a surgeon you trust and establish a relationship with them. Investigate the ADR(s) they offer. (I'd recommend checking it out in that order as disk placement and surgeon skill dictates success more than ADR type if you believe the eyeball statistical analysis of outcomes on this forum). Basically get yourself ready and use the feeling that your doing all of that to regain control in your life to address some of the depression you're feeling.
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

Last edited by annapurna; 09-01-2020 at 10:21 AM. Reason: added thoughts
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Old 09-04-2020, 10:40 AM
JackBauer JackBauer is offline
Join Date: Aug 2018
Posts: 91

1) Without posted imaging, even though we are not doctors and you should not take our opinions as medical advice... It is difficult to share insight without such imaging to see things like remaining disc height, etc.

2) You should join the Facebook ADR group... Has more volume of posting, even has a surgeon or two who hangs out in there on occasion.
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".
Four central disc protrusions in thoracic spine.

C5-C6, C6-C7 bulging, bone spurs. Imaging not looking good. Successful CP-ESP's placed in Oct 2019 by Dr. Desai.

Delayed lumbar surgery to work on bone density. Considering options now, some but minimal bone density improvement. Will only use LP-ESP.
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Old 09-12-2020, 12:31 PM
kaifram kaifram is offline
Junior Member
Join Date: Jul 2020
Posts: 2

Hey Ryan - I feel like I'm in a similar position as you. I've had about two "back attacks" every year over the past 12 years or so that would greatly reduce my mobility for a few days. Over the years, these incidents have gotten more painful and last longer. But, between each episode, I can generally take care of myself, sleep ok, etc. But, my quality of life has significantly decreased. I'm 38.

So, while my day to day pain probably hovers between a 1 and 3 on any given day, I can't ride my bike, go hiking, lift weights, the list goes on and on. For this reason, I've decided to pursue a two-level replacement. I know it's no guarantee, but doing nothing doesn't seem like a great option either.

History of LBP since 2009
2018 MRI showed herniation at L4-L5 and DDD at L3-L4
2020 MRI showed basically the same
Considering ADR in December 2020 with Dr. Zigler
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Old 09-13-2020, 09:20 AM
kirkb1tw kirkb1tw is offline
Junior Member
Join Date: May 2020
Posts: 9

Hey Kaifram! I am going to tele visit tomorrow morning with Dr Zigler to get an opinion. Same deal as you, relatively low pain, maybe getting acclimated to it, but look out if I do any sort of activity. I folded laundry and did light cleaning yesterday and now paying for it. I will be interested in your results.

2013 minimal L4/5 bulge, small central protrusion L5/S1
2014 major injury, no changes on MRI
Normal EMGs
Normal exams
2019 another injury, L5/S1 degenerated
Caudal epidural helped a little
2020 Surgeon #1 “no surgery”, #2 and 3 pending
PNMR doc “no surgery”, doing SI injections, PRP or stem after?
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Old 09-24-2020, 11:06 PM
GDB GDB is offline
Junior Member
Join Date: Sep 2020
Posts: 7
Default ADR Success and Choosing an EU Doctor

This post deleted, but started as a new topic for GDB. Say hello to him on his new thread!
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