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In need of advice

lela497llela497 Posts: 17
edited 06/11/2012 - 8:50 AM in Lower Back Pain
For the last 6 months I have been through chiro, PT , Cortisone, Epidural and lots of pain meds.

I have had 2 MRI's with the following results:

L5 S1 herniated

L1 L2 L3 L4 either bulging or pertruded and also one of these is herniated per the last MRI not sure which one yet but the dr feels that is the cause of my pain.

My pain has been burning, numbness up my spine, into my buttocks and ALOT of pain in both of my dimples in my low back. NEVER DOWN MY LEGS.

The MRI shows no nerve pinching.

Across my low back sometimes feels like I got hit with a baseball bat. None of the treatments have helped with any of my pain. Although the pain meds do give me about 80% less pain I can not do anything while taking these as they give me all kinds of side effects.

My dr said that he wants to do a discography to be positive of which disc is causing the pain. He gave me 2 options after that which are:

1. Fushion surgery 2. Live with it

I have had alot of stress since than trying to determine what is best for me to do. Most of what I read here is about leg pain which I have never had so I am concerned with what is right for me.

Any advice is very much appreciated as I am almost in tears here. I don't know what to do.


  • Hi lela497, welcome to Spine-health. I'm sorry you are in pain and worrying. I don't know if you are aware of this, but stress can really add to our pain levels. You are here with a group of folks, most of who are either going through the same or pretty similiar pain situation(s) as yourself. In other words, you are not alone and you can find the much needed support to help you understand your situation ..or at the very least, help you as you work your way through it all. There is a lot of information on your symptoms and though it might not ease your pain, finding answers and understanding can help a lot on the way to getting there.

    Understanding our pain and symptoms can often help us alleviate our fears and minimize our stress.

  • Hi and >:D< welcome to the Board. >:D< Once the discogram is done you should get a second opinion. Spine surgery isd not something to jump into, although in most cases surgery is successful. But as with any operation, there are risks, and there's something else to consider as well: physical therapy, which in a lot of cases is also successful. Do think about that before deciding on surgery (although I'm not a doctor, but PT is usually tried first). In my case, in early December I was advised to undergo a fusion, largely b/c of what at the time was severe scoliosis (I also had three herniated disks, the worst of which was at L4-5, and spondylolisthesis at the same level). I opted for PT instead, and boy oh boy, my pain has greatly improved and the curvature is better, which means no fusion for me (sorry, doc!). Best wishes and keep us posted.
  • Welcome and I also am sorry for your pain. As one that has gone through 2 fusions now, on the levels you are talking about, I can tell you after the discogram, get at least another opinion. Depending on the level the problem is at, you can have several different tpes of approaches to fusion. Some more invasive than others, Most insurance co will make you try PT and other things before fusion, unless it is something that will not help. I went with an Ortho at a Spine Clinic the last time, and had it minimally invasive surgery on L2-3-4. It was alot easier than the 1st one that was a PLIF of L 4-5 and S1. Good Luck, Discograms are not as bad as some make them out to be. I have had 3, and they really can pinpoint the problem. I am finally feeling good after 5 years of dealing with trying to figure it out! PM me with any questions, I will be happy to help in any way...
  • If not, I suggest finding one. He/she will probably be able to offer you some less invasive options. Right now, my pain doc and I are talking about my having a spinal cord stimulator installed, which is an outpatient procedure, and much less risky than surgery. The stimulator is supposed to replace the pain signals to the brain with electrical signals, and apparently it works well for many people. There is also a pain pump that can be surgically installed, which delivers medicine directly to the spinal cord, and which also seems much less risky than open back surgery.

    I had a fusion in 2008, and for me, it was a mistake. From what I've read, people should only have a fusion if a nerve is impinged, which doesn't seem to be the case for you. My advice is to consider all other options first.

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    Post Edited by Moderator haglandc
  • I'm sorry I could not be more helpful, but we are patients too and not Drs or radiologists. We are not even permitted to try to decipher your MRIs for you. Only you know what is best for you, and like you said, "I am concerned with what is right for me."

    We care and offer opinions and advise (or is it advice, I always get those two mixed up), but anything more well..we just don't do that, but we do try.
  • Howdy, and Welcome to Spine Health!!

    Aside from us being patients and not doctors, here is something else to think about. You can have a guy with no symptoms, and yet have a very scary/nasty MRI, and then you can have another guy with minor things, and writhing in pain! The MRI's, CT's, Discograms and such are tools to create a completed puzzle for your doctor along with his exam of you, and where you are at.

    Things like "moderate and severe" on reports tend to get us wound up, sometimes for no reason at all. I'm one of those that on one of my fusions, the MRI hernia looked rather small, but I lost strength, intense pain etc. They went in, and it was bigger than the MRI showed.

    That he is sending you to test your disk(s) to see if it or they are the pain generators shows you aren't being dropped or ignored, he's trying to get a full picture for proper treatment. Hopefully after the discogram your doctor and you will have a better picture of what is going on.

    Have you undergone NVC/EMG studies yet to check the status of your nerves? I know my surgeon sent me for them prior to finishing his decision as to whether PT, shots, meds or surgery was warranted. All are tools he needs to help you best. I wish we could give more answers, but can only go on our experiences. Please try not to stress without all the answers. Here is a support *HUG* for you. We are here, and understand the unknowns feelings. Okay?

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thank you all so much for all the feedback it means alot to get tips and pointers from deiffent levels.
    I have had in the last 6 months:

    1. Two nerve tests
    2. Two MRI's
    3. Chiropractic care
    4. Physical therapy
    5. 3 epidural injections

    Tried Lidoderm back patches,Tramadol, Naproxen, Prednisone, Orphenadrine, Nucynta, Oxycodone, Cyclobenzaprine, Ibuprofen.

    Finally settled with Hydroconden and Diclofenac all though they give me some relief, the side effects don't go away. I get dizziness, drowsiness, nausea, itching and blurred vision.
    The dr I am seeing now is my second opinion dr. The first dr wanted to burn my nerves all together without any other testing.

    The pain I have is constant and gets worse with movement.

    I am waiting on my copy of the last MRI/report to see which of the L1, 2 and 3 is torn/herniated. The dr told me when I was in his office but I can't remember since I was overwhelmed with what decisions I will need to make next.

    I just hope the discography is the last procedure I need to go through before making a decision on surgery.

    I have done alot of reading on the fushion and still not sure if that is what is best for me. I will discuss it in detail with my dr at my follow up visit.

    Thank you all again!
  • Ok got the MRI results that show and tear in the L5 S1 disc.

    Does anyone have experience with this?
    Does anyone have an opinion about how well this can be treated with just meds?

    Thank you
  • I have two things similar to you - my pain is primarily in the back (I DO have a little pain that radiates down the leg, but the pain that cripples me is axial pain - it's all in the back); and I also have a tear.

    My tear is at L4-L5, and I also have a bulge at that level. This disc also used to be herniated, but after a year or two, the herniation dried up or got sucked back in or something. (This is NOT unusual - but not many people realise that herniations can resolve spontaneously, and paradoxically, the bigger the herniation, the more likely it will, and the bigger the amount of herniation that is resorbed).

    ANYWAY - NOT A DOCTOR - THIS IS ALL JUST WHAT I "THINK" I've learned after 3 1/2 years of severe, intractible, disabling pain. I can't work or do much other than the basics - despite the damage to my disc being described as "mild". I originally hurt my back on a roller coaster ride. You say "For 6 months" - what happened? Did you just wake up in pain? Had you had pain before?

    They used to think that the disc didn't have any pain receptors, but they have found that the "skin" of the disc (which is layered), called the annulus fibrosis, is full of nerve endings. And the jelly/juice inside the disc also has chemicals that can irritate the area. It is the annulus fibrosis that "tears" - and it can tear a little bit, or all the way through. When it tears all the way through, the jelly/juice in the disc can leak out. So the tear itself can cause pain and then the jelly/juice can cause pain.

    This is called "discogenic" pain. A "discogram" detects "discogenic" pain. A discogram has two parts - the first part, they inject dye into the disc - it puts pressure on the disc, and the "theory" is that those discs which cause pain when you inject dye into them are the ones that cause you pain in your back/life. (You have damage at a number of discs, but not all those discs necessarily cause pain - the discogram sorts out which ones cause pain.) The second part of the discogram is the CT Scan - this test will show if any of the dye leaks out of the discs - which they do if the tear is all the way through. For someone who doesn't have sciatica/nerve inpingement (visible on an MRI), this is an important way for the Dr's to work out where the pain is coming from - in preparation for surgery. I won't say they're 100% accurate - but what is?

    Anyway - there's stuff here and on the internet to research about discogenic pain and discograms.

    What I've been told is that back operations work better for people who have radiating pain (in the limbs) than for those with only axial (in the back).

    Do tears heal? They can, but mine's been going strong for 3 1/2 years. Can meds fix it? I think the disc just heals itself - I guess anti-inflammatories can help - but I wouldn't think meds directly "heal" them.

    Good luck! I'd be very interested to hear the results of your discogram - if you get one. I would recommend it, if you're desperate enough to be considering surgery. You could also look at artificial discs. What I would really recommend is laying off chiropractors and PT until you work out what you have. I was too terrified to go near a chiropractor. And PT - BECAUSE IT INVOLVES MOVEMENT - ALWAYS hurt my back again - and seems to have set my hip off with pain after one set of sessions. And if you get the discogram - and they will usually only give you one if you are seriously considering surgery - get it done at a GOOD PLACE - This is a FULL-ON/INVASIVE TEST - You want it done RIGHT.

    I have only very rarely seen anyone on this forum with axial/discogenic pain - without radiating (leg) symptoms, so - I hope all goes well, and let us all know how you do.

  • Very informative Coyote. I liked how you explained all of this, and I am in agreement on the PT & chiropractor.
  • Thank you so much Coyote for taking the time to give me such great info!

    I first injuried my back in 2006 while at work (housekeeping)my L5 S1 herniated I went through PT and meds and got better to go back to work. Since than I've always had bouts of pain. I keep working out and wearing a back belt to help.
    In 2010 I was helping at work again and felt extreme pain on my left side low back. I went to sit down and ended up in so much pain I couldn't get up out of the chair.

    The MRI I just had shows the herniation and an annular tear in the same L5 S1 disc. My pain is alot of burning and constant pain in both my hips up my spine and like you said the axial area.
    I can feel the muscles knotting up. I can't even touch my low back without having pain and after it's been touched a few seconds later I get alot of burning type pain.

    I am weighing out all my options and want to learn as much as possible.

    I just read last night about what you said about the jelly stuff inside the disc. I think when I have burning it is the jelly that is leaking out.Not sure but thats what I think.

    I just want to get a break from treatments, nothing has helped except for the meds I take.

    I want to hope that it will heal on it's own.

    Thanks for the info, all my best to you
  • I guess I've spent all together too much time reading about this stuff, ha-ha!

    Lela - I understand your dilemma. When I hurt my back, I was off work for a month. I went back for four months, and then I had to stop all together. Tried a few part time gigs, but couldn't handle that either - one big problem for me is just getting to and from a place of work causes so much pain - there's nothing left for work. Work places also put me in too many difficult situations - standing in crowded elevators, sitting in rooms with too many people so I can't move about freely. Just getting caught talking to someone while I'm standing - you don't want to be rude and cut the conversation short - but I know if I stand too long, I'll go home and have to suffer all night (and sometimes for days after) because the pain has built up so much.

    After I stopped work, I kept thinking - Oh - I just need to rest and things will get better. But they never did. I don't know if you're working, how old you are, how disabling the pain is.

    Like I say, when the pain is primarily in the back, surgery outcomes may not be so good. What surgeons seem to be able to manage best is loss of function (motor nerves), the loss of sensation (sensory nerves) and finally pain, in that order. They look at MRI's, and they can see when the herniation is pressing on a motor or sensory nerve, but pain pathways in the spine are extremely complex and many can't be seen. But look into artificial discs, too. Talk to a few surgeons (there's no obligation to sign up - ha-ha!). If your pain is really disabling I would see about the discogram.

    Strangely, my discogram was negative. I think maybe they gave me too much sedation, or perhaps, because my disc had kind of dried up and deflated by the time I had the discogram, the nerve endings of the tear in the annulus fibrosis were inverted. But who knows. I was offered another discogram, but really - get a discogram once, and get it done right. Research has shown that discograms can cause weakness in discs - and they inject healthy looking discs as a control - I don't want to risk sending good parts of my spine after bad.

    After 3 1/2 years of this, I do, finally feel I have been greatly weakened and I've fallen down the disability rabbit hole. Statistically, the chances of me ever returning to work are about 1-2%. I won't give up, but I think if you're thinking of surgery, if you find a surgeon you trust, if your life is severely limited because of the pain, get it done sooner rather than later - because "disability" does engulf you, and it's hard to claw your way out of it after a certain time (I BELIEVE - NOT SAYING IT'S ABSOLUTELY TRUE!).

    I have so much sympathy for you Lela - and I hope I haven't put you off or depressed you - many, many people have had successful surgeries and gotten some of their life back. I told the surgeons, I don't mind limiting my activity, I can work my way around that, but like you - I feel like the medications are just killing me - stealing my soul.

    Finally - that burning pain you have - I had that a lot (and like you I believe the "jelly/juice" was leaking and causing that burning). I used to take Celebrex and Tramadol - it was a great combo, because I really felt the Celebrex working on the inflammation, and the Tramadol is a non-addictive synthetic type opiate. Unfortunately, Celebrex ended up causing me to lose my hair and cause severe skin problems, and when I stopped taking it, the Tramadol caused splittng headaches. That's when I went to Lyrica, Oxycontin and Percocet.

    Good luck with everything, and do let us know how you're doing - this is a GREAT place to come, even if it's just to complain! Sorry this is so long - I'm bored, lonely, stuck in the recliner - ha-ha!

  • I too am reading reading reading! It's funny you say stuck in the recliner because my recliner is the only place I can sit, even though I constantly have to switch from one side to the other.
    My pain is the same as yours. I can't sit or stand for long and forget about walking! I too suffer for days on end afterwards.
    I haven't worked for 6 months now. I wouldn't be a very productive worker this way. I can't drive for 2 reasons, pain pain pain and the meds I take.
    I am 44 years old and I used to be a very active person by hiking, biking, running, boating etc.... I am a photographer as a hobby boy do I miss that! It has been very depressing that I can't even walk my dogs around the block and trust me I have tried and I make it to the corner which is about half a block and the pain is bad than I am in pain for days and say to myself why oh why did I do that.
    I want to be able to learn more about natural healing and what exercises that will help not hurt. I have always continued the physical therapy I learned back in 2006. My muscles were strong around my spine but I don't think they are as strong now since I can't do the exercises.
    I am determined to figure this out and if I can avoid surgery I will.
    My doctor said he was doing the discogram to confirm that the tear is the source of my pain. I am having that done this tuesday. The discussion of what I will choose to do will come on the 22nd. Per my dr it's surgery or live with it. So the info I can get by reading and by people like yourself is of great value to me.
    I appreciate very much your responses, makes me feel like I am not alone.
    I am off to do more research, please keep in touch and I hope you are having a day filled with less pain!!!
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