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Chronic Low Back Pain - Disc Issues - Please Help

gfdwarfggfdwarf Posts: 7
edited 06/11/2012 - 7:58 AM in Lower Back Pain
Hello-
My name is Dan and I am a 47 year old male, father of four kkids (ages 20, 15, 5 and 2). I live in the Twin Cities of Minnesota. If you are willing to read my story and offer any opinions or help understanding what I am up against, I would greatly appreciate this kindness. I desperately want to return to being an active, healthy father and husband. Any help or opinions would be greatly appreciated.

I am at a tipping point of frustration with my back challenge and though I realize that relative to the situations that many of you suffer with I am probably fortunate, I still need to find a solution that will enable me to get my life back to some sense of normalcy.

I have had what I considered a "bad back" for about 5 years or more. This was traditionally chracterized by events when my back would "go out" and I would be laid up for 5 days or a week and it would gradually get better and I'd be symptom free afterward. The pain was always in the same spot, around L4-L5, just to the right of my spine. This would happen about once every few months, maybe 3-4 times per year. I understand now that much of this pain was likely muscular in nature.

Last January, that all changed when I took a hard fall from a height of about five feet (slipped on ice off our front steps) and landed with my full weight on concrete (I am 6' 4" and 270 pounds) directly on my lower back. After an excruciating period of a few minutes when I thought I had been paralyzed by the fall, I was able to crawl back into my house with my wife and son's help. I endured for a couple days, but visited the ER two days later and had xrays and finally an MRI in April of 2011. I had a tremendous bruise and a lump the size of a baseball just to the left of my spin in my lower back (even now, 11 months later it seems still the size of a golf ball).

The April 2011 MRI showed two bulging disks (L3/L4 and L4/L5). The report read:

L3-L4: Mild disc bulge. No central or foraminal stenosis.

L4-L5: Degenerative disc disease with disc dehydration. Broad-based disc bulge lateralizes to the right where there is a right foraminal annular fissure. Moderate right foraminal stenosis with nerve root contact but no definite compression. Left neural foramen is patent. No central stenosis.

I visited an orthopedic surgeon (on referral from my family doc) and he basically told me that a simple discectomy, or disc shave was not possible since my bulge was foraminal. He said that my only option would be fusion and he felt that based on our discussion, I was not ready for that at the time. And I agreed. I had heard many horror stories about fusion and I was only 3.5 months post injury and felt that I would get better. He suggested a PT regimine and I attended regular PT sessions for six weeks this past summer, under a doctor's supervision, working to strengthen my core. I have continued the strengthening exercises with use of a Roman chair at home, as they instructed me, at least up until the last week or two. I also had one cortisone injection that had limited effect.

During this time I did a fair amount of work using my back. We had two major storms in our area and we lost many trees and I did a lot of wood cutting and cleaning up over many weeks. This work caused me a lot of pain and soreness, but I basically just worked through it, iced my back after the work and used pain medications (Vicodin, Percoset, muscle relaxers) at least 5 days out of every week. I had periods of less pain and at time went a week or ten days without pain meds, but the problem always came back.

During this period my pain was characterized by a burning pain and soreness that permeated my entire lower back centering around my spine and the injured area. The spot where I fell, the primary impact area, is just to the left of L4/L5 is still sensitive to any physical pressure and as I mentioned before, still feels like a lump when I lie on my back on a hard surface. And it hurts as well, almost all the time. If I sit in a chair (as I do for work) for more than an hour or two, I am ready to climb the walls with discomfort and pain. I would also get right leg sciatica - numbness, aching, pain, tingling, etc., but this has come and gone and frankly is not my biggest concern in terms of tolerating the pain. My pain on a scale of 1-10 was typically in the 3-5 range (I consider myself to have a reasonably high tolerance to pain - I am not a complainer typically).

About two months ago (sometime in September 2011) something changed considerably and the pain described above was joined by a much more significant electrical impulse sort of pain that would come at varying times (often associated with lifting or shifting my right leg). There have been days where I feel it only 3-4 times in a day (my best days) and times where it is essentially bad the whole day (like the last three consecutive days). These jolts of pain seem to be in the very center and core of my spine, right around what I think is L4-L5. They are excruciating and each time I feel them I let out a yelp (I cannot help it). The pain subsides reasonably quickly, as I adjust my position, but some lower grade pain lingers. But they are so bad that they make me want to take extreme caution when moving at all and basically restrict me from doing much at all (lifting kids, driving, going outside, etc.). Basically I fear moving too much and experiencing the pain again.
My family doc ordered another MRI to see if something had changed considerably and I had that last Friday (11/18/11). The results, to my surprise, were not a lot different from the April results:
L3-L4: Mild disc bulge. No stenosis.

L4-L5: Degenerative disc disease with mild loss of disc space height and disc bulge. Right central annular fissure. Moderate right foraminal stenosis as a result of a foraminal disc bulge or protrusion
with nerve root contact but no definite compression. Left neural foramen is patent. No central stenosis.

I am scheduled to revisit the same ortho surgeon that I saw in May on December 8th. I have had the problem longer and have grown less patient with it and also less hopeful that it will heal. I also want to ask whether the fact that my L4/L5 fissure is now described as "right central annular" (vs. last time being " right foraminal annular") would make me a candidate for a simple disc shave (discectomy), which I have heard great things about, in terms of success rates. The stenosis is still foraminal, so I fear he will say the same thing, with fusion being my only option.
Is that likely?

I am also scheduled to go see another orthopedic surgeon on December 22nd - this is a doc that was highly recommended to me by a good friend who has had back problems far more significant than mine.

I find myself hoping for a surgical solution, as after 10 months of suffering with this and seeing no improvement (in fact it has gotten worse), I am very tired of the problem. I am tired of pain meds too. I am continually having to explain to my kids why I can't do the things I want to do and I have now spent a year of my life avoiding by necessity activities that are core to my life (active dad, outdoorsman, tennis, skiing, etc.). Though I try to keep my outlook positive, this pain cycle wears on me and I find myself less patient, more down that usual and not the person I want to be. I am ready for a solution. But fusion still scares the heck out of me!
Among my questions are:

1. Is the change I noted in the MRI results significant? i.e. should I be hopeful that a disc procedure may be more possible now?

2. Is it true that a foraminal bulge is not operable (from a simple disc shave/discectomy standpoint)? My family doc seemed to not understand why this would be the case and questioned that opinion.

3. Are the MRIs I have had sufficient to diagnose the issue?

4. I worry about use of pain meds long term. I have been told by a couple docs that as long as you are using them to combat pain, you are OK. I try to do without them when I am able, but for two months now I have never skipped more than a day. I do not take them all day, usually just late afternoon and evening, to help with sleeping.

5. Is the electrical impulse pain I described indicative of the fissure/bulge? Or could it have another explanation?

6. I fusion really as bad as I am imagining it? Should I open my mind to it? I am not willing to live the remainder of my life like I have this past ten months.

Again, thank you all so much for your kindness. Finding this site has given me hope that I am not alone in this struggle. I feel blessed for my problem being limited to what I have. I am not feeling sorry for myself, just anxious to find relief and a long term solution that hopefully helps me regain my lifestyle to a reasonable degree.

Kind regards,
Dan
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Comments

  • Welcome to Spine-Health. You'll find a lot of information throughout this site with articles and videos and the members of the forum are very supportive, kind and knowledgeable.

    With that said, there is no way for any of us to answer most of your questions. There are questions that only a good spine surgeon or specialist can answer. I wish we could help you more in some area, but we're not doctors and everyone is so different - even if I had the same MRI readings as yours, my outcome may be totally different than yours.

    Pain meds: Your doc is right - if you use pain meds to combat pain, then you may become dependent on them, but not addicted. Those are two totally different things. Many of us here are dependent on pain medications, muscle relaxants and nerve medications just to get us through the day. They allow us to function as normal as possible, but never take away the pain totally. They just reduce the pain to a manageable level.

    Fusion surgery: I've had two, one 3-lvl cervical and one 1-lvl lumbar at L4/5. The decision to have the fusions, well the cervical was an immediate need so there was really no decision to make as I was at the point of being paralyzed if something happened such as a fall or car accident.

    As for the lumbar fusion, it came down to quality of life. I couldn't stand or walk for more than a few minutes, had severe back and hip pain and pain radiating down the back of both legs. After finding that the problem was not disc-related, it was facet and stenosis, there was not an option of microdiscectomy, only fusion and decompression.

    The choice whether to have surgery is a very personal one, but I can tell you that I'm very glad I had the lumbar fusion. It's a long recovery and the first few weeks are fairly tough, but around the 6-month mark I started feeling better and just after a year felt pretty good. However, there's always a risk of adjacent disc problems with fusion, and now, with my job that requires some heavy lifting and bending at times, I'm experiencing mechanical pain. That's where the discs above and below my fusion are doing double duty since my L4/5 no longer moves and creates a radiating pain, so I'm still on pain meds.

    But I don't feel that fusion surgery is as horrible as many people say. It can be a life-saver for many, myself included. Even though I still have some pain and am still limited, I can golf sometimes, can work a full-time job and still enjoy life.

    No, you aren't alone in your struggle with spine issues and you've found a wonderful place to share stories, receive support, hear other people's experiences and just vent if you need to. We're all here for each other because many times our spouses or significant others simply don't want to hear about the problems any more, or just don't want to hear about them every day. But we will. There is always someone here that will listen and give advice when they can.

    Take care Dan. I'm sorry I couldn't help you more, there are things only your doctor can tell you or that you have to decide, but I thought I'd share my experience with you so you know that fusion surgery is not a death sentence, in fact can be quite the opposite.

    Cathie
  • For your kind and thoughtful response! I realize that these questions may not have black and white answers and that the support network here cannot offer medical opinions. I am looking for exactly what you provided. Just other experiences that may be similar and more than anything for hope.

    My spouse is compassionate and helpful, but I must admit I have grown tired of answering the question "how's your back?", as though one day I will miraculously say "better". I feel the answer is never positive and trying to categorize levels of "bad" can be frustrating, probably for both sides of the conversation. I am by nature not one who like to complain or feel sorry for myself, but there are times when it overwhelms me a bit and I think that shows to those closest to me. And it is a harsh reality when you realize that the pain is taking from you a very important part of who you are - your personality and ability to be joyful.

    As far as the pain meds, over the last six months I have tried like heck some days to do without them and I think I put my body and spirit through a lot more stress as a result. I do not enjoy the "dumbing" action, nor the hangover effect following their use. But while they are working, they are a tremendous blessing and I can actually be myself sometimes while under their influence. And for that I am thankful. One day a week ago I was climbing the walls, trying to go without my meds for a full day and finally was so strained by about 9pm that I took a couple percoset and what a blessing, to be able to relax just a bit and concentrate on something other than tilerated pain. Then I felt foolish for denying myself so long and subjecting my family to the results. You just read and hear so much about them becoming a problem that is causes you to be overly sensitive to using on a regular basis perhaps.

    This is primarily a reflection of me being "new" to this chronic pain. I think I am starting to grow more comfortable with them being a long term part of my life.

    Thank you for sharing your story Cathie, I wish you the very best and am very happy to hear you enjoy so many pleasures in life after your procedures.

    Happy Thanksgiving to all!

    And thanks for listening and caring.
  • Hi again Dan. That's good that you're feeling better about taking your medications. So many times we hear stories like yours, where someone doesn't want to take meds for fear of getting addicted only to suffer more than necessary. It does affect more than just you - it's hard on family and friends when you're in so much pain. If you have the meds, use them to try and live as normal a life as you can.

    One thing about meds is that we try hard to stay ahead of the pain because once the pain gets too bad it's very hard to get back under control, as you've found out.

    I'm glad I was able to help, even if in just some small way. If you decide to get surgery, although this doesn't really help, the anticipation is usually worse than the surgery itself. Basically, you get to the hospital, you go to sleep then wake up in your room. Sounds simple, doesn't it? But that's what it's like. As for recovery, it's best to measure your improvement in weeks, not days, as it's a long recovery, like I said. But you'll feel yourself improving. I remember the day that I realized that the pain I was having was from having surgery, not the pain I had pre-op anymore. That was a good day and made me feel like I would get through it.

    One thing about being new to chronic pain is that you go through so many emotions and have so many questions. That's why we're here, to help you through it as much as we can.

    Happy Thanksgiving to you and I hope you have a less-pain day and enjoy your family and some good food.

    Cathie
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