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Considering options

I am 53 year old and had developed back pain. I developed simultaneously developed depression and I had not considered surgical treatment as I was told that Xray and CT scan were not showing any major disc bulge. Now after eight months the report from an MRI is L3 and L4 left paracentral disc protrusion with associalted left moderate neural foraminal stenosis and L5=s1 there is broad based disc protrusion with associated bilateral moderated foraminal stenosis.I am in severe back pain and cannot stand for long. What are my options ? Should I try some conservative management before going to a spinal surgeon ?


  • Most great spine surgeons will not operate until conservative treatments have failed. That doesn't mean you can't go and see one, I find spine surgeons sometimes have the best connections to the best conservative treatments. If you aren't sure you want to go that route just yet, then talk with your primary care doctor. I'm sure even he/she could get you started with a few different options. I hope you are able to find a treatment that works for you and give you relief soon. Welcome!
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • PaulPPaul Posts: 730
    edited 04/29/2013 - 4:36 PM
    If you are not experiencing loss of bladder control (called cauda equina syndrome) then you have room and time to consider your options.
    They usually like to exhaust conservative treatments before surgery. Traction is a fair start. Meds can be helpful too.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
  • Once I was diagnosed, and once I finally decided on which surgeon I wanted to work with, he had me do other things before surgery.

    Despite the fact that they are called "surgeons" - and especially because insurance companies want to make sure that due diligence is done first, they often don't jump to a surgical conclusion unless it really is the only option.

    It gave me time to see three surgeons - immediately rule out one, then another and decide on what was ultimately the right choice. It was a three year timeframe between initially scoping things out and my surgery - mostly because I had a lot of projects to complete and I was not in pain. I had/have tingling in my left hand and I just didn't want it to get any worse because of my fragile neck.

    And, since it sometimes takes time to get in for appointments, it might be good to start establishing all of that.

    Let us know what happens.
    10/26/2012 ACDF C3/4 C4/5 surgery
    No pain; no pain meds - thank goodness!
    04/01/2013 - 5 months + 1 week - FUSED
    Doing some physical therapy for even better range of motion
  • I had micro micro discectomy 17 hrs ago due to severe stenosis. Been in pain for 2 months finally could not stand it anymore went on fmla. Upped my meds to 60 mg moriphine 2x a day oxycodone hydrocodone xanax! Oh ibrupropin. Nothing took away this awful pain I can't describe this like my whole left leg was getting stabbed. And I had children and this was just as bad. Woke up this morning had ambulance come get me from home to the hospital told them that I needed surgery they said lets give you a pain shot it did not work. So they finally transferred me to another hospital where I had emergency surgery and right now I'm 100%%% out of leg pain this is unbelievable!!! No pain after all this time suffering I get to go home tomorrow cause I'm having insision pain only. Lol makes me laugh considering what I've been suffering from now I can't handle this stinging lol
    I'm so glad this saved my well being was starting togo insane and career
  • lotiallotia Posts: 3
    edited 04/29/2013 - 9:42 PM

    Thanks for your responses. Conservative therapy is the way to go probably. But I have more to add to history. I have left work on account of depression and back pain. I have had lack of motivation to seek help for both conditions. I have cannot take antiinflammatory medication as I developed pain in stomach and was admitted to emergency last month and had gastroscopy to find an ulcer in my hiatus hernia. This has responded though over the last few months on taking Nexium. So my illness is complicated by a number of factors. Currently I remain bed ridden most of the time. Be it depression or the back pain aggravation on prolonged standing. I cannot excercise because of the back pain. Seeking conservative treatment may be a bit hard. About the report it said that there is disc degeneration as well. The MRI also said that i had loss of lumbar lordosis on account of muscle spasm. All this is complicating my case. I appreciate your time for answering my queries
  • Degenerative Disc are a part of life, especially for women... most women have it, that isn't to say it's not painful, but it isn't an immediate concern.... what is an immediate concern is your mental health. I can not encourage you enough to get on the phone with your primary care doctor TODAY and seek treatment for the depression. I am not a doctor, but I wouldn't be surprised for him/her to suggest an antidepressant... there are lots of them out there so surely there is one safe for all of your conditions. If you are currently on an antidepressant, then it clearly isn't working and you need to have a higher dose or change all together. If you are already seeing a therapist/psychiatrist you need to call them today and let them know the treatment is not working. Spine issues are complicated for everyone, and we on this forum understand that. For most of us its not just physical but emotional as well. My 2 cents, and this isn't a medical opinion, just my observations about myself and people I know and even people on this forum... we often think fixing our physical spine problem will solve our emotional issues, but I find it is much more prudent to get emotional issues under control as best as possible so you can go into treatments like physical therapy or even surgery with a positive attitude and frame of mind. Please get the depression seen about ASAP. We are here to encourage you, not judge you. Also please go ahead and make your appointment with a spine surgeon. I don't think you will need surgery, at least not immediately, but he can really help you find the right treatment for your back. Most of us on this forum have Complex spinal and medical histories... Spine Surgeons are actually Spine Specialist and are able to work around all our conditions. Keep us posted... try to stay positive, I know its hard being so young and bed ridden. Glad you found us.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • Thanks AllMetal, will go ahead with your advise
  • LizLiz Posts: 7,832
    I am sure that you will find your time on Spine-Health very rewarding. This site is a powerful and integrated system that is dynamic and continues to grow.
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    If you have any questions or need assistance, you can use the Private Message facility to contact any one of the Moderators on my team:
    dilauro , tamtam or liz

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Just for insurance purposes you may want to find out if your insurance will even cover surgery before conservative treatments have been exhausted. I'd already completely exhausted my conservative options by the time I was scheduled for surgery so it wasn't a problem but before approving the procedure my insurance company did ask for records proving that nothing conservative had worked.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • Braddy123Braddy123 Posts: 9
    edited 05/02/2013 - 11:07 PM
    It would be better for you to consult an orthopedic surgeon and dont as there are many therapies such asprp injections ,bone marrow transplant procedure,trigger point injections have evolved to heal you up.
  • When I first injured my back I went to Physiotherapy and she taught me exercise in the warm water pool and I wore a floatation belt in the water and although pain free in the water the minute I stepped out it's like a ton of weights on my back but at least it may be an option once you see your Family Dr. and an Orthopedic Surgeon.

    Do you have any numbness or tingling in your legs because of the stenosis? I had to see a Neurologist because of the numbness and weakness in my legs and foot and get an EMG (nerve test) with the Neurologist then see the Orthpedic Surgeon even though I only have minor stenosis it's good to see a Orthopedic Surgeon or two for their opinion well it was in my case anyway.

    My Dr. had me take flexion/extension positional x-rays to check for the stability to my spine since I have stenosis as well.

    Keeping a pain journal may be helpful also to show your Dr. your symptoms so he may order these tests and referrals. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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