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  #1  
Old 09-02-2011, 06:24 PM
Spine Journey Spine Journey is offline
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Default Dilemma have the lumbar ADR now, or wait?

Hello Community! Wow, I'm SO happy to find you. I'm so conflicted with to have or not have lumbar ADR right now. I'm curious to know if anyone else has had, or are having the lumbar pain symptoms that I'm having. Sometimes it handicaps me and other times it's just there, but I get around with ALL of the referred pain symptoms. In addition, I struggle with chronic Cervical pain as well (post 2008 cervical disk decompression at 4 levels) so I'm always in pain. After the cervical minimally invasive surgery that left me with a chronic condition, I'm very nervous about the lumbar ADR. My lumbar ortho surgeon ( for ADR) is Dr. Blumenthal at Texas Back Inst.

Original back pain started after a car accident in the 90's. Had conservative treatment ( chiro) was young and bounced back. Got back to running etc. Re-aggravated the lumbar in 2003 MVA and diagnosed w/ DDD L5/S1 w/ 3m mild protrusion w/major sciatic pain that hovered just above the R. thigh. Rhizothomy in 2004 got me 100% pain relief til 2010. Current Lumbar diag DDD L5/S1, mild at L4/5, 3.5m protrusion. Epidural calmed the sciatic, but low back pain is sometime debilitating. Other times it's a constant dull pain in the low back with referred pain that travels down the side of my thighs. This prevents me from walking more than 1 -2 hours or standing 1-2 hrs. I’m thin and 5’7 and otherwise healthy, but the side leg pain is often worse than the low back pain. I'm told this is a symptom of the L5/S1 DDD. 2011 Discogram was concordant with discogenic pain at L5/S. My dilemma is to choose to have ADR right now, or wait b/c I don't always have the handicapping low back pain --meaning the type of pain where I can't get out of bed, but the side of the thigh pain is horrible.

My other issue: in 2007 I started having neck pain. Was pulling my hair back to put into a pony tail and heard a neck snap and felt excruciating pain. Diagnosed w/ cervical DDD, desiccated disks at multi levels c3-7, mild cervical spondylosis, 2.0 - 3.2mm protrusions protrusion within multi levels w/mildly pressing the thecal sac. 2008 had Plasma disk decompression c3-7. It cured the occipital migraine headaches, but I have chronic neck pain every day. Today's Ortho Dr.'s say there are 2 many damaged levels, need to find a good pain management dr b/c they will not do another cervical surgery-Bummed!

Back to the Lumbar, my neurologist suggested I wait and journal my back pain to see if the referred leg pain will calm down since the back pain isn't always handicapping, but it's there. My ortho at TBI, says I’m the perfect candidate b/c the lumbar issue is precise, the disk is DDD, w/ tear and discogram was concordant at L5/S1. Although L4 shows signs of DDD as well.

Anyone out there with this lumbar dilemma? Lumbar pain is there but not always handicapping, but the referred pain is typically worse than the low back pain.
__________________
‘03 Lumbar: DDD L5/S1, 3m bulge narrowing foramen, protrusion mldly descending S1 nerve, annular tear,L3 & L4 w/ mild facet arthropathy. ‘04 Rhizotomy w/99% pain relief till ‘10.
’07 Neck pain: desiccation c3-7,mild spondylosis, c4-5 bulge, bone spurs.
‘08 c3-7 cervical plasma disk decompression left w/ chronic neck pain.
‘10 Lumbar pain retnd worse. DDD L5/S1, sm disc protru, annular tears, L4-5 mild facet,L5/S1-Injections min relief.
Dec 2011 Prodisc L/5 S/1 Dr. Blumenthal
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  #2  
Old 09-03-2011, 01:08 AM
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MeggieLynn MeggieLynn is offline
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Hello and welcome. I'm sorry for all your troubles, continuing pain, and I imagine you'll remain conflicted for some time yet, while you're in this decision-making process. I'm not a lumbar patient, but it certainly does sound like your leg pain is some sort of sciatica irritation from your L5-S1 disc. However, have any of your doctors considered any of the non-discogenic causes of sciatica - see this link www.sarapin.com. I think it would be worth while to read through the various syndromes mentioned in this article to see if any of them fit w/your symptoms. It's possible to have any one of these syndromes in addition to the L5-S1 problem.

I wouldn't give up completely on your neck. There are some people on this forum that have multi-level cervical DDD & have a combination of fusion with one or two ADR's. It can't hurt to get other opinions, but be sure you carefully research the proposed procedures/surgery, & be more than reasonably comfortable that it's the right plan for you.

I do think the neurologist suggestion to keep a journal is a good suggestion and a reasonable thing to do - at least while you're weighing all the options. Take care & good luck!

ML
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*C4-5 and C5-6 Mild & moderate posterior broad-based disc bulges w/small posterior end plate osteophytes, mild spinal canal stenosis.
*C6-7 Broad-based posterior disc bulge w/small focal posterior central protrusion mildly indenting the anterior thecal sac, no canal or neural foraminal stenosis.
*SI Joint issues, Fibromyalgia, Chronic Myofascial Pain, Neurogenic Thoracic Outlet Syndrome
*Tx's-PT, 2 ESI's Interlaminar & transforaminal, 2 SI Joint steroid injections, Failed LBB for SI Joint
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  #3  
Old 09-03-2011, 02:37 AM
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MeggieLynn MeggieLynn is offline
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In the sarapin link above, click advanced clinical updates.
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*C4-5 and C5-6 Mild & moderate posterior broad-based disc bulges w/small posterior end plate osteophytes, mild spinal canal stenosis.
*C6-7 Broad-based posterior disc bulge w/small focal posterior central protrusion mildly indenting the anterior thecal sac, no canal or neural foraminal stenosis.
*SI Joint issues, Fibromyalgia, Chronic Myofascial Pain, Neurogenic Thoracic Outlet Syndrome
*Tx's-PT, 2 ESI's Interlaminar & transforaminal, 2 SI Joint steroid injections, Failed LBB for SI Joint
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  #4  
Old 09-04-2011, 04:13 PM
Spine Journey Spine Journey is offline
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Hello ML, thank you for the web link for additional info. Upon quick review, I do relate to some of the leg pain symptoms. I've had pain management treatment/injections, and don't specifically recall if any where specially identified as non discogenic treatment for referred sciatic pain, but non of them have given me relief this time around. It appears that all of the non invasive treatments are to treat nerve damage, so aren't those considered a similar treatment as you suggested?

Today I do acupuncture that appears to calm down the what i call "the fire Ann ache" in the thighs, massage therapy, hot tub, lots of heat & ice, physical therapy.

I DO appreciate the encouragement for my cervical issue. It as been 4 yrs of living with chronic pain inside of pushing myself to my limits with trying to live life. It becoming impossible to hold on anymore with the top and bottom of my spine compromised.

Thank you for your interest! Wishing you positive results in your treatment as well.

I'll keep reading and researching.

Sincere thanks,

SB
__________________
‘03 Lumbar: DDD L5/S1, 3m bulge narrowing foramen, protrusion mldly descending S1 nerve, annular tear,L3 & L4 w/ mild facet arthropathy. ‘04 Rhizotomy w/99% pain relief till ‘10.
’07 Neck pain: desiccation c3-7,mild spondylosis, c4-5 bulge, bone spurs.
‘08 c3-7 cervical plasma disk decompression left w/ chronic neck pain.
‘10 Lumbar pain retnd worse. DDD L5/S1, sm disc protru, annular tears, L4-5 mild facet,L5/S1-Injections min relief.
Dec 2011 Prodisc L/5 S/1 Dr. Blumenthal
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  #5  
Old 09-04-2011, 04:17 PM
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Harrison Harrison is offline
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Hey SB,

Do you have any way of knowing if your spine was in excellent health before any of your car accidents? It sounds like it was. Also, getting six years of relief from the rhizo is impressive. Do you recall the details of that procedure?
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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  #6  
Old 09-05-2011, 11:24 PM
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MeggieLynn MeggieLynn is offline
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Initially I thought maybe some additional muscular issue, but after reading things again I'm thinking more in line with posterior facet joint syndrome pain. You did get really good relief from that rhizotomy years ago. Maybe they're acting up again.
__________________
*C4-5 and C5-6 Mild & moderate posterior broad-based disc bulges w/small posterior end plate osteophytes, mild spinal canal stenosis.
*C6-7 Broad-based posterior disc bulge w/small focal posterior central protrusion mildly indenting the anterior thecal sac, no canal or neural foraminal stenosis.
*SI Joint issues, Fibromyalgia, Chronic Myofascial Pain, Neurogenic Thoracic Outlet Syndrome
*Tx's-PT, 2 ESI's Interlaminar & transforaminal, 2 SI Joint steroid injections, Failed LBB for SI Joint
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  #7  
Old 09-07-2011, 12:48 AM
Spine Journey Spine Journey is offline
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Unhappy

I don't recall having any spine issues prior to the original MVA in the 90"s. What i see in the Dr notes from the rhizo was a one level procedure @ L5/S1. My back pain is dull achy and always there. For the past 3 wks I have given my body a rest and haven't been active or working at all. Walking 30 - 45mins causes the leg pain to increase to a pain level of 8+. The back pain is dull achy and always there, but since I've been resting it's low, but increases with activity, and I'm not doing anything these days. I'm certainly not living. I'm very apprehensive about the ADR because I’m not certain that my leg pain is caused by DDD at L5/S1. I'm told leg pain is a symptom, but my pain does not travel down the back of my legs, it's the outer thigh portion, and my thigh muscles feel achy and sore. So, I'm not certain if I actually have enough nerve damage to notice relief from an ADR because it does not always handicap me, just sometimes. But those sometimes are excruciating. I recall when I had the sciatic pain the hovered over my buttock, that was a sharp, stabbing pain that would not allow me to sit for more than 1 hr-. This leg pain is different.

Also I see dialogue re: the Charite (sp?) vs Pro Disc; the keeled vs the cleated. How do I determine which is the best for me? My Dr is Dr Blumenthal @ TBI and I noticed a Board Member or Advisor with ADRS.org. I know there is a possible financial gain for TBI/Dr Blumenthal and Pro Disc's parent company. Dr B recommended the Pro Disc and never mentioned other options--Hmmm. Also, I see several great comments about Dr Zigler @ TBI, but I don't see any comments about Dr Blumenthal. Dr B appears to be very experienced based on my online research. Do you have any comments regarding his outcomes w/ Pro Disc L?

I'm exhausted and conflicted.
__________________
‘03 Lumbar: DDD L5/S1, 3m bulge narrowing foramen, protrusion mldly descending S1 nerve, annular tear,L3 & L4 w/ mild facet arthropathy. ‘04 Rhizotomy w/99% pain relief till ‘10.
’07 Neck pain: desiccation c3-7,mild spondylosis, c4-5 bulge, bone spurs.
‘08 c3-7 cervical plasma disk decompression left w/ chronic neck pain.
‘10 Lumbar pain retnd worse. DDD L5/S1, sm disc protru, annular tears, L4-5 mild facet,L5/S1-Injections min relief.
Dec 2011 Prodisc L/5 S/1 Dr. Blumenthal
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  #8  
Old 09-07-2011, 01:33 AM
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laid up doc laid up doc is offline
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SJ - the Charite' is not being manufactured anymore... some docs still have some, others don't and/or have switched to the Prodisc b/c it's the only one being made and FDA approved. supposedly it's being replaced by the In-Motion disc, but i haven't found much on it searching the net.

i have a few questions that might guide your analysis of your symptoms:
1. did the steroid injections resolve all/most of your symptoms?
2. were they epidural or facet injections?
3. do you have a lot of pain w/ sitting/coughing? those 2 things are fairly specific for discogenic pain. facet pain is usually more constant, worse w/ lumbar spine extension (leaning back).
4. if you had facet changes in '03, they probably are at least as bad now. did they comment on your facets in your more recent MRI?

as i usually mention... i am a doc but not a spine doc... but being a fellow spine pain sufferer, i have done a lot of reading on my own and have had discogenic and (briefly) facet pain (my brief facet pain was while i was in an LS brace after biacuplasty - pain doc said it was from being locked in extension. no mri evidence of facet dz, pain completely resolved when i took out the larger/more restrictive/harder part of the brace).

my completely nonscientific review of post-op outcomes makes me think that SOME people who had unsatisfactory outcomes had/have another pain generator. you will see that Harrison often pipes in and asks about pain generators - i think this is why. if you have problems beyond 1 disc and have an ADR at 1 level - whether it is the wrong level or not enough levels - then replacing 1 level isn't the right solution.

you may have to be very persistent to get your doc to outline where they think your various sx are coming from. from my experience, having pain and trying to carve out a normal existence (ie work on your feet for 10 hrs) causes all kinds of leg muscle soreness, b/c of gait changes. you may have to see a pain specialist in addition to your surgeon to take another look at your workup and symptoms before committing to a plan.

also, make sure you review your MRI with your surgeon and/or pain doc. radiologists vary widely in what they call, and they do not have the benefit of having the patient in front of them.
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US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #9  
Old 09-07-2011, 11:24 AM
Spine Journey Spine Journey is offline
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Hello Doc, thank you for your guidance. I'm heading to a Dr appt now, but will answer your questions when I return. This is also great guidance, and may lead me to some answers. In addition, ML thank you for your similar suggestions. I'll post replies for all to see incase some else has similar questions.

I'm feeling apprehension b/c I'm really not sure it's time for ADR, unless this pain is truly caused by the DDD. I do see on my mri where the L5/S1 disc is completely desicatted and he discogram was truly concordant with the pain, but MRI states: L4/L5 Bilateral Facet hypertrophy. Right foraminal disc protrusion, not contacting the existing nerve root. no significant stenosis. L5/S1 left paracentral and left foraminal disc protrusion, mildly encroaching upon the under surface of the left neural foramen. No significant central of foraminal stenosis. I don't fully understand the dept of Facet Hypertrophy yet, but will research online.

As you may be aware the discogram is an excruciating procedeure; I recall a level of concordant pain experience at L4/L5 level as well. Not as much as L5, but L4 pain was about a 7+ pain level vs at L5 I attempted to jump of the table it was SOOO bad- i was in tears and could not sit afterwards the pain was so sharpe.

At this point, I'll post further when I return (just in case someone else is in the same inquiry) regarding the type of injections administered earlier this yr.

Often I lose site of what worked and what didn't b/c of struggling with upper and lower spine pain, I do appreciate ALL of the guidance. This is truly a great community!
__________________
‘03 Lumbar: DDD L5/S1, 3m bulge narrowing foramen, protrusion mldly descending S1 nerve, annular tear,L3 & L4 w/ mild facet arthropathy. ‘04 Rhizotomy w/99% pain relief till ‘10.
’07 Neck pain: desiccation c3-7,mild spondylosis, c4-5 bulge, bone spurs.
‘08 c3-7 cervical plasma disk decompression left w/ chronic neck pain.
‘10 Lumbar pain retnd worse. DDD L5/S1, sm disc protru, annular tears, L4-5 mild facet,L5/S1-Injections min relief.
Dec 2011 Prodisc L/5 S/1 Dr. Blumenthal
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  #10  
Old 09-08-2011, 04:16 PM
Spine Journey Spine Journey is offline
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QUOTE=laid up doc;90287]SJ - i have a few questions that might guide your analysis of your symptoms:
1. did the steroid injections resolve all/most of your symptoms?
2. were they epidural or facet injections?
3. do you have a lot of pain w/sitting/coughing? those 2 things are fairly specific for discogenic pain. facet pain is usually more constant, worse w/ lumbar spine extension (leaning back).
4. if you had facet changes in '03, they probably are at least as bad now. did they comment on your facets in your more recent MRI?

Doc, to answer your above questions:

1.Nov 2010: I was having an episode of low back pain w/right side sciatic pain down the back of my right leg, with sharpe pain in the right buttock. 11/2010 MRI results: DDD L5/S1, 3.5mm left paracentral and lateral recess disc protru. L4/L5 mild disc buldging no canal or foraminal stenosis. Nov Injection: transforaminal eidural steroid injection L5/S1. left side. Got relief from the sciatic pain, but back pain remained.

Jan 2011: had another episode of severe concentrated low back pain where I could not get myself out of bed for a few days. There was not has much referred pain, it was concentrated to the low back. This time the pain was caused by breathing, coughing, sneezing... Got in to see an Ortho, b/c of my appearence at that time, he felt I may have rupture my disc since that last injection/ MRI so he ordered another MRI immediately. New MRI: L4/L5 Bilateral Facet hypertropy. Right foraminal disc protrusion, not contacting existing nerve root. No significant stenosis. L5/S1 left paracentral and left foraminal disc protrusion, mildly encroaching upon the under surface of the left neural foramen. No significant central or foraminal stenosis. Dr suggested select nerve block, procedure volume caudal deposition epidural steriod. Provided moderate relief for a few days, but had trouble bending forward. bending backwards was less pain

5/2011: Had another episode of low back concentrated pain, back of the leg pain had subsided by this time. This felt like discogenic low back pain. Procedure: Paravertebral facet block L4/L5 and volume Caudal. No relief to low back pain at all.

June 2011: leg pain started. Now leg pain is side and front of the thigh, not specifically pain in the back of my legs. All pain is side to front of thigh to the point of difficulty walking/ standing more than 1hr.

No, I do not have pain when coughing. Now, I can sit for a longer period of time before needing to stand and stretch.
According to the Lumbar Dermatomes it appears that L4-S1 can cause leg pain, I just want to make sure that my leg trigger is the DDD at L5/S1.

Thank you,
SB
__________________
‘03 Lumbar: DDD L5/S1, 3m bulge narrowing foramen, protrusion mldly descending S1 nerve, annular tear,L3 & L4 w/ mild facet arthropathy. ‘04 Rhizotomy w/99% pain relief till ‘10.
’07 Neck pain: desiccation c3-7,mild spondylosis, c4-5 bulge, bone spurs.
‘08 c3-7 cervical plasma disk decompression left w/ chronic neck pain.
‘10 Lumbar pain retnd worse. DDD L5/S1, sm disc protru, annular tears, L4-5 mild facet,L5/S1-Injections min relief.
Dec 2011 Prodisc L/5 S/1 Dr. Blumenthal
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