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Worsening back pain; already had surgery. What's next?

BrihtwulfBBrihtwulf Posts: 69
edited 06/11/2012 - 8:30 AM in Chronic Pain
I've been a bit at my wit's end trying to figure out what to do about my severe and chronic lower back pain. I conjunction with my shoulders and right knee (which are less severe in terms of the pain), it's almost unbearable at times and while I appreciate the thoroughness of doctors, time drags on for me. Anyway, let me share with you the results of my most recent MRI, and a little history of that location.

First, I had a discectomy in March '08 in my L5-S1 joint. It was a large (roughly 1 inch) rupture, which resulted in spinal stenosis and I began to develop cauda equina syndrome. After the surgery, my right heel and entire outside of my right foot are numb. The pain subsided to mild levels after my recovery, and remained that way for about 6 months.

Now, at the 1 year+ point, the pain is back around the moderate-severe level, and making me quite miserable when it's bad. I've also had 2 surgeries on my left shoulder in the last 4 months to remove inflammatory tissue and part of the bone in my AC joint, which was causing pinching and a lot of pain. My right shoulder is headed that way, but for the moment it's tolerable.

During my first shoulder surgery, a crystalline fluid was found, but pathology did not test the material to determine WHAT KIND of crystals they were. No idea why. Calcium levels, rheumatoid factor, cell counts, sed rate, have all come back normal. I am positive however for the HLA-B27 antigen.

Now, my most recent MRI. This was a pelvic MRI, though it also included the L5-S1 region. It was ordered by my rheumatologist under suspicion that I may have ankylosing spondylitis. That was not the case, however. Here is the information on the report. Perhaps someone can help me make sense of what I should be expecting, or what all this might mean for me:

STIR coronal images do show moderate spondolytic changes of the L5-S1 disc space where there is some discogenic degenerative changes and edema in the adjacent endplates at L5-S1. There appears to be a Schmorl node involving the inferior endplate of L5 with some surrounding bone marrow edema on the STIR coronal images.

The sacrum itself otherwise has normal bone marrow signal and the SI joints are not fused and have normal signal characteristics as do the visualized segment of the iliac bones. Axial images show that the sacral canal has normal caliber. There is a central disc protrusion at the L5-S1 disc space level which may represent a small focal confined central disc herniation as well. The presacral fat has normal signal with no evidence of fluid or soft tissue mass surrounding the sacrum.

1. Moderate spondolytic changes of the L5-S1 disc space level. There may be a central confined disc herniation at L5-S1 with no spinal stenosis. There is some mild narrowing of both neural foramina at L5-S1 due to degenerative changes.
2. Schmorl node deformity involving the inferior endplate of L5 with some surrounding bone marrow edema.
3. Normal MRI Exam of the sacrum and both SI joints.

My general physical info:
Male - Caucasian
30 years old
200 lbs.

Any insight would be greatly be appreciated. I heard mention about seeing a "pain clinic", but also not sure if I will need to go back to my neurosurgeon...



  • Hello JJ -

    I had an L5/S1 fusion back in 1991, because of a spondylolisthesis of L5...thanks to it being split in half through a work related injury. What "spondolytic changes" means is that the vertebrae is pushed forward to one degree or another and therefor is out of place. This can cause the disc space to narrow, cause the disc to bulge and leave you prone to all sorts of nerve impingement possibilities.

    After reading your history, I definitely would recommend seeing a Pain Mgmt. Doc...and a good one will steer you in the right direction, prescribe appropriate meds and over-see you course of treatment.

    There may be a fusion of the L5/S1 vertebrae in store for you down the road, but give any and all recommended non-invasive therapies an honest try because once you have the surgery done...you're then dealing with a whole new set of issues (beginning with a 6 month recuperation period).

    Take care and best wishes to ya -

  • sorry that you are in so much pain ..my advice .go to your doctor and sort some stronger pain killers out .have you tried the acticare unit? its a high end TENS and external spinal cord stimulator well worth a try with so much pain.i have one and use it every day {dont confuse with cheap TENS the acticare is a different animal!} see www.acticare .com
    as for pain centres i have had bad experiences so i carnt recommend them i have a very good doctor and he is in control of my pain medication ..the other thing i have found that helps is swimming .it is also helping me loose some weight! .i know how bad pain is and i have been in a similar position to you its only recently that i have been able to leave my home .as the pain was so bad ..dont beat yourself up because you carnt don the stuff that you used to be for you got ill..and you are young so give yourself time to recover before you have any more surgery..i have just been diagnosed with facet joint hypertrophy and the surgeons wanted to do a fusion but i have refused because my doctor and others dont think that it would help me ..so think on regarding more surgery ..some surgeons think that they can operate there way out of pain ..with out much concern for the poor patient when thing's go wrong..i hope that things get better for you and feel free to contact me anytime tony.beer1@googlemail.com
  • I'll have to do a search on those TENS and mention it to my doctor at today's appointment. I'm not really familiar with how they work. Will something like that help with the pain that shoots down the back of my legs as well (mostly my right leg)? Swimming would be a good option, but it's still fairly cold most of the time here in Michigan, and the pool season doesn't really start until after memorial day. (I used to be a swimming pool builder before I blew out an already troubled back).

    Maybe I could/should get a membership to a gym with an indoor pool?

    Does insurance usually cover things like a TENS system or swim therapy? Maybe I could bring up the swimming option to my doctor as well and see if I can request that form of physical therapy. Normal phys. therapy is more painful than helpful. I can hardly do the home exercises without feeling too much pain.

    Thanks again for the help guys. This will give me lots of things to bring up with my doctor this afternoon!

  • Well, my appointment today with my family doctor got things going in the right direction I think. I'll be going in to start some swim therapy tomorrow at the physical therapy center. I also got a referral to an internal pain specialist, though I probably won't be able to get in until next week. It seems that way with specialists (sometimes a lot worse).

    For the pain in the meantime my family doctor gave me another prescription for 5/500 Vicodin to try to help before my appointment with the specialist. She tries to prescribe as little with narcotics as possible. It's a hard balance to find between understanding the doctor's standpoint on that and having it feel like someone has a pair of vice-grips on your spine and a foot kicking your butt.

    So, I'll see what this new specialist has to say, and I'll bring up the TENS system. There are really 2 things I want to avoid if at all possible. First and foremost being surgery as a last resort. And secondly I would like to keep large needles far away from my spine. I've heard mixed feedback about spinal injections, and needles creep me out to begin with!

    If anyone has further input before my appointment next week, I'd be glad to hear it!

  • the indoor pool idea is a good one {that's what i do } over here in the uk not many people have there own pools and even fewer have a heated indoor one ..so there are many gyms with a nice pool .TENS works by using a small electrical charge to block pain signals .the acticare goes one better and its the only one that you can use on your spine it has a special function that blocks pain signals going to your brain .it is a uk invention and had been proven to work ..i would give it a go if you can .i use mine every day i sometimes sleep with it on too.i hope things get sorted soon for you .good luck jj
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