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My Dr. said LESI's would not help me since I have 2 discs/annular tears and leaks. Why?

blackberrybunnybblackberrybunny Posts: 157
edited 06/11/2012 - 8:43 AM in Lower Back Pain
I'm just trying to understand. I have much to learn and you guys seem so much more advanced than me.

My Neurologist, my pain mgmt dr. did the discogram, cinfirmed 2 leaking discs and said I needed fusion surgery. Before we did the discogram though, he gave me a LESI, my first EVER-- and it did not help. It hurt me more. Why?

Where exactly does this ESI injection go? And if I have annualar tears and leaks, why wouldn't an esi help? Can someonee help me understand what's going on in the body when and where the ESI is being administered?

ANd when I sit down initially and it makes me have sharp stabbing pain that make me jump and cry, what IS that? Is that the discs being pushed down upon and the gel sqiushing out, or what? I've asked my dr. just these questions, but I cannot understand him. My legs, thighs in the front, get numb and ache if I stand too long, like cooking or doing dishes.


  • I was reading your history and see the mention of a museum. I swear, walking in a museum is just about the most painful thing a spiney can do. I was "working" (it's volunteer work) as a docent at an art museum when I developed my problems. As much as I loved my time there, I could not stand the pain of standing or walking.

    Now to attempt to answer your questions...an esi is a steroid injection and it can go just about anywhere the doctor decides to put it. Generally speaking, if you have a bulging disc at L4-5, the doctor will use fluoroscopy and guide the needle to a spot adjacent to the area that is bulging. Or if you are having nerve pain that is probably coming from the L5 nerve root as a result of that bulging disc, the needle will be placed tight up to that nerve root. The steroid then bathes that immediate area, with the hope that it will cause any inflammation to go down. This will hopefully allow the nerve to stop being irritated and stop sending out pain signals! In the case of the herniated disc, the hope again would be that inflammation would go down, allowing the area to settle down enough that the patient can proceed with physical therapy and give the disc enough time to heal on its own. This is a very simplistic explanation of a couple situations where injections are used.

    An annular tear is based on the concept of a leaking disc. The material from the center of the disc is able to leak out, which can fall on enervated tissue or the nerve root itself. The ESI does not really help the annular tear, because, first, it does not reach that part of the disc, as doctors do not inject into the disc during this type of procedure. The tear is surrounded by the rest of the disc material. The steroid material cannot heal the tear in the disc...so the fluid continues to leak out and cause irritation.

    The pain you feel in your legs probably stems from a spinal nerve that is either being irritated or compressed. Each spinal nerve relates to an area of skin called a dermatome that run like bands around the body. When the nerve in the spine is compressed, it can cause pain to radiate out to that area. If you're interested, run a search for "dermatome map" and you can see where the pain can run from a compressed L4 or L5 nerve.

    When you sit, it may be that the disc is getting thinner and the weight of the vertebral bone pressing down again causes that spinal nerve to get pinched.

    If you want to learn more, there are excellent articles and videos on this website, written by medical professionals.

    Here is a video of the ESI procedure:


    I encourage you to learn as much as you can about your particular back problems, spinal anatomy and some of these procedures. It will make communicating with your doctor more satisfactory!

    I hope I answered some of your questions.

  • I don't know why he'd say that or if it's true, but here's some good info:



    It was my understanding that the reason that leaking disks hurt so much is that the fluid in the disks in highly irritating to the surrounding nerves. But I don't know why an ESI wouldn't help unless it has to do with where the leak is.

    ESI goes in the epidural space, there's a good video here: http://www.spine-health.com/video/epidural-steroid-injections-back-pain-and-leg-pain-video.

    But remember that fusions also don't have a 100% success rate, so weigh all of your options carefully!

  • Thank you so much Swennie! Your answer made a lot of sense to me and I'm going to look up this dermatome map and read all I can.

    They keep telling me the only thing for me is a multi level fusion, but ugh!!
  • It's always a good idea to get more than one opinion when dealing with something that might involve surgery. Different doctors have different approaches. Some recommend doing "more" than others, etc.

    Often when there is more than one segment of the spine involved, doctors will suggest fusion to avoid any potential for instability. Instability can cause its own problems, so they try to avoid creating a situation that might cause it....You'd be trading one problem for another...or, that's the fear.

    I believe there are a couple new procedures to deal with annular tears that are less invasive than fusion...but they are probably only being done in a few places around the country at the moment. If I can find a link I'll send it to you.
  • Thank you, Gwennie, you're great! I appreciate any info you have. I'm trying to learn all I can....

    I have gotten a 2nd, opinion and this surgeon says to wait, I am only 41 (almost 42 now) and he says I am too young, to wait.... so I wait. And hurt. :-)


    I guess the back is a very tricky thing. I never thought I'd end up with a problem like this! But I'm working on TRYING to lose some weight, although we went to our family reunion and I ended up bringing home an entire key lime pie no one ate (I bought 2 to take), so anybody up for some pie? I've got plenty to share!!

    Getting this weight off will surely help though, don't you think? Ohhh, that pie is delicious and devilish at the same time....:::SIGH::::

    Have a great day.
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