First post, advice needed!

[rbrown]

Hello to all,

I'm happy to have found this site but also sad to hear about others suffering. I'm 43 years old male. I had lamenectomy/discectomy 2006. I guess it was succesful. My wife took me to emergency for severe right leg pain. The surgery happened the next morning. Apparently had massive herniation that left disc material in my spinal canal and was causing the issue. I would say compared to a lot of what I have read my problems are not as severe. Normally I have pain in both legs to some degree worse when sitting. Fast forward to present, low back pain has increased a lot since the end of 2012. More occurance of it "going out" on me. MRI and x-rays were done in April this year. Neurosurgeon said my report doesn't look that bad and asked me what I wanted to do. He said he could do a fusion but unknown if it will be better after. Things have changed big time. Muscle spasms so bad in the low back right side I can't stand, walk or get up after sitting. My primary called in Prednisone which helped almost immediately. I was able to walk and sit without too much pain. I had an appointment last week with pain management anesthesiologist and he wants to give me facet joint injections. While I was waiting on that to be approved I saw a chiropractor that is very trusted with my sister and other family members. In between seeing the PM Dr. and the Chiro the Prednisone course had finished. The day after it was gone the spasms were back to complete failure. I called Saturday and asked for more but they said no. My wife called Sunday and it was called in again and almost immediately helped a lot. The chiropractor looked at my x-rays with me and said he could clearly see the problem. He said it was facet syndrome, that the lower facet joints were out of alignment and that he could fix it no problem. He said to give him 6 weeks. In the mean time the Prednisone will run out this Sunday. I am suppose to see the chiro again Monday. If the spasms are back he wont be able to do anything with me. I have basically been in bed for nearly two months and still dont know or understand what my diagnosis is or what happened. I cry almost everyday and am extrememly frustrated, in pain, depression etc. Neurosurgeon's diagnosis is "your a young guy with a bad back". Pain management Dr. didn't say much either besides lemme give you some shots at random. I feel undiagnosed. Impossible to get better if nobody knows whats wrong. I'm sceptical about the Chiropractor but dont know what else to do?

[rbrown]

MRI Lumbar Spine without and with Gadolinium 3/30/2011:Clinical Indication: Chronic low back pain and bilateral radiculopathy; history of surgery 2006.
Findings:
There is evidenc of a prior right hemilaminotomy at L4. There is no evidence of epidural fibrosis.
The L3-L4, L4-L5 and L5-S1 intervertebral discs have diminished height and signal intensity.
There is a grade 1 anterior spondylolistheses of L5/S1 which appears to be secondary to bilateral spondylolysis. Bulging of the L5/S1 disc is present. There is no secondary spinal stenosis or impingement on the S1 nerves. The alignment abnormality is producing bilateral L5 interbertebral foraminal excroachment with possible mild impingement on the left and right L5 nerves.
Minimal disc bulges are present at L3-L4 and L4-L5 without significant excroachment on the spinal canal.
The remaining disc levels are normal. The facet joints and intervertebral foramen are normal.
The distal spinal cord and conus medullaris are normal. No intradural, vertebral marrow space or paraspinal signal abnormalities are present.
No abnormal enhancement is present on the postcontrast injection images.
Impression:
Status post right L4 hemilaminotomy.
Grade 1 anterior spondylolistheses at L5-S1 which is producing bilateral L5 intervertebral foraminal encroachment and possible left and right L5 nerve impingement. There is no central spinal stenosis or S1 nerve impingement.
Bulging discs at L3-L4 and L4-L5.
Otherwise normal MR examination of the lumbar spine.

[rbrown]

MRI of the Lumbar Spine 4/23/2013:Clinical Indication: Remote microdiscectomy in 2006. Recent redevelopment of bilateral lower extremity pain associated with numbness and paresthesia.
Siemens Espree 1.5 Tesla
Sequences: Coronal PD; sagittal T1, T2 and STIR; axial T2.
Comparison: March 30, 2011
Findings:
Redemonstrated is the grade 1 anterior displacement of L5 on S1. The lumbar vertebral body heights are maintained. Degenerative marrow changes at redemonstrated opposite the L3-L4 and L5-S1 disc spaces.
The L1-L2 and L2-L3 disc spaces remain normal.
L3-L4: Redemonstrated is the right hemilaminectomy and partial right facetectomy. The central canal remains widely decompressed. Normal neural foramina bilaterally.
L4-L5: There is mild posterior annular bulging without canal or foraminal stenosis.
L5-S-1: The bilateral pars interarticularis detects are redemonstrated. There is stable mild posterior annualar bulging. There reminas mild to moderate narrowing of both neural foramina.
Normal conus medullaris. Normal paravertebral soft tissues.
Conclusion:
1. Overall, no significant change from the March 2011 exam.
2. Stable post-operative changes at the L3-L4 level without residual or recurrent canal or neural foraminal stenosis.
3. Stable degenerative disc bulging at L4-L5.
4. Stable grade 1 isthmic spondylolisthesis of L5 on S1 with stable mild to moderate bilateral neural foraminal narrowing.

[jsewell]

Hi Randy,
I actually live in Duarte, almost in Monrovia now. Still neighbors. I am no good at interpreting MRi's that is for sure . but in reading yours what i want to say first is i have had some MRI's that have stated mild changes which hurt like you know what. So i don't believe everything that is stated is correct regarding pain. I had a right hip MRi that stated no arthritis. My hip surgeon did arthroscopic surgery looking for a simple tear and found my whole hip was arthritic on both weight bearing surfaces. Next step total hip replacement.
So in reading yours it sounds to me like the L5-S1 is impinging on nerves for sure and could certainly be the cause of your problems.
I know you have been to a few different health professionals. But have you had a second opinion with a spine surgeon? That would be my first step. "And quickly.
I have had 9 spine surgeries in the last 5 years and most with the same surgeon. I trust him, but i just cancelled the surgery which was planned this summer after getting a second opinion. The second opinion doc made so much sense regarding my problem with walking and even standing. My whole spine is very out of sagittal alignment. I can't stand up anywhere near straight and it is getting worse . So a total reconstructive surgery is now planned with this surgeon that i just saw on Monday.
I am ok when i am sitting up in bed and that is where i have spent the whole day. Standing and walking i am all hunched over and it gets more painful the more i do it. My spine no longer has the normal curves it needs.
Good luck in getting to another doc soon.
Judy

[rbrown]

Any recommendations for a 2nd opinion? I'm in Monrovia, Los Angeles County. I have United Health Care HMO and am in the Healthcare Partners network. We are thinking about switching to PPO if needed!

[Maria]

Hi and Welcome
I agree w/Judy re MRIs sometimes stating things in a manner that would appear nothing much should be bothering one or not so much and the reality is quite different in terms of pain. I also suggest seeing a good spine surgeon.

If your spine situation isn't Workers Comp and you have an HMO you are pretty limited in who you can see w/o paying cash. I'd definitely switch to a PPO if able to. The only thing is you will still be limited to surgeons within a network and if you go out of network you'll pay probably at least a 40% of the costs.

Can you find out what spine surgeons would be in a PPO plan that you might be able to obtain and then see if you can switch to that plan? Or would you want to pay cash for consultations while you're in an HMO?

Do you want to see a Neurosurgeon or an Orthopedic Surgeon or both for opinions?

My last spine surgery consults were in 2006 and I saw Rick De La Marter (sp) in Santa Monica, John Regan (think he was at Cedars) and Frank Coufal in San Diego.

The first two surgeons mentioned are orthopedic spine surgeons and the last one is a Neurosurgeon. I decided not to have more spine surgery (had 2 discectomies back in '89 and 92).

Good luck and keep us posted! Maria

[rbrown]

Originally Posted by Maria

Hi and Welcome
I agree w/Judy re MRIs sometimes stating things in a manner that would appear nothing much should be bothering one or not so much and the reality is quite different in terms of pain. I also suggest seeing a good spine surgeon.

If your spine situation isn't Workers Comp and you have an HMO you are pretty limited in who you can see w/o paying cash. I'd definitely switch to a PPO if able to. The only thing is you will still be limited to surgeons within a network and if you go out of network you'll pay probably at least a 40% of the costs.

Can you find out what spine surgeons would be in a PPO plan that you might be able to obtain and then see if you can switch to that plan? Or would you want to pay cash for consultations while you're in an HMO?

Do you want to see a Neurosurgeon or an Orthopedic Surgeon or both for opinions?

My last spine surgery consults were in 2006 and I saw Rick De La Marter (sp) in Santa Monica, John Regan (think he was at Cedars) and Frank Coufal in San Diego.

The first two surgeons mentioned are orthopedic spine surgeons and the last one is a Neurosurgeon. I decided not to have more spine surgery (had 2 discectomies back in '89 and 92).

Good luck and keep us posted! Maria

These are some of the questions I dont know the answers for. Should I see a Neurosurgeon or an Ortho Surgeon. Ive already seen Neurosurgeon Dr. Ross in Pasadena he performed the procedures I had done in 2006. He basically said only I know how much pain im in and he could do a fusion if I choose to have surgery. I wasnt in much pain when I saw him 2 months ago. He didnt offer or suggest any other test, or even give a diagnosis besides "your a young guy with a bad back". I have almost no leg pain besides a slight feeling in my left calf. When I'm off the Prednisone my low right back goes into full lock up spasms which is very painful if I move. If I'm lying down not moving, no pain. I had an appointment with Dr Seltzer at Pasadena Rehabilitation. He is the medical director there. He is an anesthesiologist. I am approved for lumbar facet medial block injections. Does it make sense to have these if I'm not having leg pain? Just really felt like it was take a number and heard me out as fast as possible with no feeling or wanting to get to the bottom of the pain and why.

[jsewell]

Randy we had car issues here today and i was out and on the phone and missed calling you. it is 10 now and i feel it is too late. i will try harder tomorrow.
I see DrSeltzer as my pain management doctor. My spine surgeon, in Pasadena, DrWilliam Costigan has done all my injections. Is DrSeltzer not giving you anything for pain or were you ok when you saw him. I am currently on morphine. I would get myself to a spine surgeon and ask for a diagnosis . hopefully we will talk tomorrow
judy

[rbrown]

Originally Posted by jsewell

Randy we had car issues here today and i was out and on the phone and missed calling you. it is 10 now and i feel it is too late. i will try harder tomorrow.
I see DrSeltzer as my pain management doctor. My spine surgeon, in Pasadena, DrWilliam Costigan has done all my injections. Is DrSeltzer not giving you anything for pain or were you ok when you saw him. I am currently on morphine. I would get myself to a spine surgeon and ask for a diagnosis . hopefully we will talk tomorrow
judy

I wasnt in pain when I saw Dr Seltzer. He did prescribe Norco 10/325 in case. After the first cycle of Prednisone was gone and the spasms started I used the Norco I think three times and didnt feel it did anything. Hopefully we will talk tomorrow. I'll be free after the Chiropractor after 1:00pm.

[Maria]

I think if you could get in to see one of the very reputable spine surgeons that might do both ADR and fusion that would be a worthwhile endeavor. I highly recommend seeing Dr. Frank Coufal in San Diego. He's a neurosurgeon and does both ADR and fusion.

Another thing I'd do is to talk to Mark Mintzer (mmglobal) here. In fact I highly recommend this as well if you've not already contacted him.

I was first offered Norco when I started with PM back in 2001 and it helped with the pain but the coverage wasn't long enough and it made me feel very sick when it was starting to wear off and very sleepy when it was working. Next move was MS Contin and epidural steroid injections which both helped me greatly with my pain. I continued to get ESIs for 10 years as they helped so much.

Now for really bad spasms that pretty much either stop me in my tracks or limit me greatly I've been getting a 60mg IM injection of Toradol. It can be given as 90mg as well and can be a cocktail with some steroidal material mixed in if that works better for some inflammation.

Good luck with your future endeavors. Long ago my back used to lock up horrendously and I'd be bedridden for weeks .. that's a really bummer place to be tho then again so is much of what happens with serious spine issues.

If I were in your position and not in an emergent need of spine surgery I'd get some effective pain management going on meanwhile seeking some super reputable opinions even if you have to pay cash for consultations. Esp. if your MRI is recent that means that at least you're walking in to consultations with some updated diagnostics.

[rbrown]

Thanks Maria and Judy for the replies and info. Maria do you have any referral for a spine specialist closer in this area San Gabriel Valley?

[Maria]

I've seen Dr. Rick Delamarter in Santa Monica and Dr. John Regan at Cedars? Both are orthopedic spine surgeons. I liked Dr.Regan tho Judy actually had surgery with him and some serious probs so perhaps you'd want to talk to her. Again I do recommend talking to Mark because he does Spine patient advocacy and actually works with spine surgeons so he would have a much better idea of who you might want to see. Good luck!

[rbrown]

Originally Posted by Maria

I've seen Dr. Rick Delamarter in Santa Monica and Dr. John Regan at Cedars? Both are orthopedic spine surgeons. I liked Dr.Regan tho Judy actually had surgery with him and some serious probs so perhaps you'd want to talk to her. Again I do recommend talking to Mark because he does Spine patient advocacy and actually works with spine surgeons so he would have a much better idea of who you might want to see. Good luck!

I sent him a PM hopefully will hear back from him. Having even this amount of contact with others having back issues is somehow helpful. I have my wife and my family prays a lot for me but its something special to have contact with people that have experienced this terrible thing. I look forward to more info and hope that I can contribute somehow through my problems. I did see the Chiropractor today. My pain was very low and he said he got some good movement on me today. He is very confident that he will have me in "good" shape in 6 weeks. Ive never been under the care of Chiro before and am trying to work through my previously closed mind about them. I'm trying to keep the best mental attitude possible and asking God for strength. I took the last of the Prednisone yesterday so tomorrow will be a really big deal for me at least mentally. I feel like I'm ready to turn the corner on this bought, been pretty rough for a few months this time around.

[Maria]

No doubt you may feel some aggravation w/o the prednisone as it's such a powerful anti-inflammatory drug though I hope your pain if present is minimal. I don't know if you're having just the flare up type of pain from disc material leaking on nerves and muscle spasms etc or if you also have facet pain or other pain generators involved.

Hopefully if you speak with Mark you can get a better grip of what might be going on and maybe who it would be worth your while to consult with. Trying to get your HMO to authorize any outside spine consults will probably be futile and even getting in to see someone in the network that you may want to see will likely take time. I dislike HMOs very much for their management of things like back pain although some do have good Pain Management services and some very good doctors. Unfortunately it's the insurance co. themselves that restrict so much of what a really good doctor would or could do. At least this is my opinion.

So wishing you the best. We do understand here believe me. Maria

[rbrown]

Saw the Chiro again today. Electro stim therapy, cold laser treatment. Adjustment wasnt much today cause I was pretty stiff and guarded. Havent had any bad spasms or pain this week except for a few little grabs today. I still have not heard from Mark. I have no idea what happened or is happening with my back. My Primary Dr is on vacation this week. I did request a referral to Dr. Costigan and a request for a weight bearing MRI. They said either my Primary has to request the MRI or the specialist. I dont know what will be approved if anything till my Dr is back. These last few months have really been terrible and confusing. I thought for sure surgury was imminent or at least facet injections. Is it possible that what ever was happening has resolved itself for now?? Will I ever know what the cause was/is?

[Maria]

Hold your last few thoughts there and do a wait and see if you're feeling better. I'd like to say things can resolve themselves and I think for some people they actually might. That wasn't my case although I went thru years of having flare ups and then periods in between without probs. When the flareups became more frequent and closer together or the period inbetween was indistinguishable then I had my first spine surgery.

Keep a positive outlook even though the spine stuff is driving you crazy because the good thing is you are at the point where you can get more information and there are options. While it may not seem like a good place to be believe me it is (at least in the spinal problem journey).

Keep us updated please if you're so inclined. Hope you'll find a really good spine doc to consult with! Maria

[rbrown]

Mark called me and we were able to chat a bit. I mailed him copies of my MRI and Xrays. Maybe he will see something and have some ideas of what might be going on. It seems that a discogram might be a logical test but who knows if I'll find someone that does them through our HMO. I'm still having the low back spasms on and off. Less than before but still there. I'm trying to stay out of bed as much as I can during the day, I'm sick of laying here! Last couple days ive been on my feet, sitting for short periods and streching and excercising to the extent I can. I havent been having much leg pain and am wondering if I just tore or stretched a muscle/muscles or ligament or tendon or something in my low back. Maybe someone can comment if its "normal" that a disk or nerve issue is causing the muscle spasms or is it more likely that its just a muscle issue? I know the spine doesnt follow a given set of rules but I'm hoping that its a muscle problem that will heal sooner than later. I dont want another surgery and cant find a Dr that cares to find the problem. I'm still seing the Chiropractor but the last couple visits he didnt really get any adjustments done cause my pain and back are guarding to much for him to get any movement. I am getting electronic stim and cold lazer therapy there so I assume that is better to have than not.

[Maria]

Can often happen when spine is guarding or protecting itself. Torn ligaments, tendons, muscles take a long time to heal. Maybe a strain.

Disc material leaking out on a nerve (as in bulging disc) can create muscle spasms and usually does..

Try getting an injection of Toradol 60mg IM (Nsaid) if no known allergy to medication and no probs with kidneys. This often helps with muscle spasms pretty quickly and can break up a cycle that might take weeks to otherwise alleviate.

I had electric stim therapy and cold laser and did well with it though that was long ago and took many sessions.

[rbrown]

Originally Posted by Maria

Can often happen when spine is guarding or protecting itself. Torn ligaments, tendons, muscles take a long time to heal. Maybe a strain.

Disc material leaking out on a nerve (as in bulging disc) can create muscle spasms and usually does..

Try getting an injection of Toradol 60mg IM (Nsaid) if no known allergy to medication and no probs with kidneys. This often helps with muscle spasms pretty quickly and can break up a cycle that might take weeks to otherwise alleviate.

I had electric stim therapy and cold laser and did well with it though that was long ago and took many sessions.

Does a bulged disc necessarily mean leaking disc material? If a disc is leaking will it stop leaking at some point? Would the Toradol injection still help even after ive been on two cycles of Prednisone? Can my primary Dr give me the Toradol or does that have to be a specialist?

[Maria]

Good reference is ChiroGeek's Home Page
You can get answer to many of your questions there.
Bulging discs when actively flared up are usually leaking some disc material. I have had flare ups for years with regard to leaking disc material from disc bulge. This is even after a discectomy at L4 and L5S1. Meaning the discs rebulged after surgery. I have not had fusion surgery or ADR. I think with either of these surgeries the complete disc is removed. While in theory this should mean no more pain from disc it doesn't mean there won't be pain from other sources.
I have had 2 spine surgeries and had 10 years worth of Epidural steroid injections and have taken a low dose opioid pain medicine now 1x/day for 12 years and Toradol injections help greatly to alleviate muscle spasms for me. it helped many people I know with back pain from spasms and most recently my ex has had an acute bout of back pain with spasms so I told him to go to Urgent Care and get an injection of Toradol and it helped him immediately. He still has some discomfort but he couldn't move at all hardly for the pain until he got the shot.
My primary care doc can give this injection, urgent care doctor, ER doctor, Pain Management doctor, etc. It is a Non steroidal anti-inflammatory medication. It may not be given if one is taking oral Nsaids on a daily basis, or one has an allergy to the medication or has problem with his or her kidney function.

[rbrown]

Maria?
Would it still make sense for the Toradol if two cycles of Prednisone havent taken the spasms away completely?

[Maria]

I imagine it might help although I'm not sure what your pain generators are and maybe the bulging disc or spasms isn't creating your current problem? Really I cannot say. If it were me I'd approach your primary care doctor about getting a Toradol injection (or whoever prescribed the steroids). It can't hurt to ask and even if one doctor turns down the notion then approach another.

Steroids are very potent anti-inflammatory meds but I don't like to use unless in an epidural steroid injection. I try to avoid taking them orally and preferably at all.

[jsewell]

Randy i am glad you sent your materials to MARK , he is the best.
About the bulging discs, i have had some that were bulging and they did not show any signs of leaking when i had the discography. so it is hard to say. Prednisone is a very strong anti inflammatory , you just have to really be careful not to take too much as it can shut down your adrenal glands from making cortisol as they haven't needed to when on prednisone. That is a nightmare i have experienced. you don' t want to go there. i am surprised someone gave you 2 doses so close together.
you said the chiro had not had any luck helping much the last few times. I am sorry about that.
I really don't have any advice at this point. Just hope your week goes well.
judy

[rbrown]

I plan to follow up with some sort of second opinion with a Orthopedic specialist (spine). I'm asking for another MRI since my back got so much worse since the scan I had in April. Everything feels really weird and confusing. I'm not having terrible pain as of now but have to be super careful
or I will have a spasm. Cant lift or do much but can walk more and stretch some and excercise a little. My wife still has to help me dry off my feet and lower legs after the shower. I saw the Chiro again today. He tried again to get some adjustments out of my low back but it didnt move. It hurt and I was much worse after the visit for all of today and tonight.

I dont know how or if to follow up with pain management (Dr. Seltzer). He wanted to give me facet nerve block injections but I'm not having leg pain or even the intense painful spasms. Hopefully Mark will have some advice for my next logical step along with the other help you guys are giving (Maria, Judy) thanks!

[Maria]

I'd say if you need your wife's help to dry off your feet then you definitely should be seeing a spine specialist in terms of a consult.

I would think a doctor would order some muscle relaxers for you to take when you start to get really tight or painful and see whether that helps ease off the spasms. That's usually first line medicine along with Nsaids that a regular Primary Care doctor would prescribe or maybe an Ortho.

I've never been to a chiropractor in my whole history of back probs. I did go to Osteopathic doctors (D.O.) because they can do manipulations and are actual physicians so therefore can prescribe as well.

With regard to your PM doctor he should adjust whatever he's considering doing based on what you tell him your symptoms are now. If he persists in the same treatment for symptoms you no longer have then you might want to consider going to someone else. Injections are where the $ is at with PM however if you are seeing an HMO PM that's probably not the case.

I still think that when you are in spasms if you got a shot of Toradol which is so benign compared to many other things that can be suggested that would help a great deal to at least break up the cycle. It's ever so much more effective than the oral medication Toradol (non steroidal anitinflammatory medication).

Also I do recommend reading that website of Chirogeek's because that is incredibly informative and even looking at your old MRI report you can read about what you have on that and what Chirogeek has written and maybe you will see where some of your symptoms may be coming from and/or things might make a bit more sense to you. I will admit that the beginning of the spine journey can be very confusing because one wonders what on earth is going on and what it could possibly be or what do these symptoms mean and it's all very scary. Educating yourself as best you are able will help you to ask better questions when you do see the doctors and to get better answers out of them and possibly ones you will better understand. I always write my questions down before going in to see my Ortho, I write down what he replies and I ask for a copy of my MRI or xrays or any tests I have done. I like to get a copy of his notes as well but being that my case was WC (Worker's Comp) that doesn't usually happen. If I am referred to a specialist or 2nd opinion surgeon tho I do always ask for a copy of his notes/recommendation.

Good luck with your continuing spinal journey. Sounds like you have to do a lot of guarding or protecting your movements for fear of setting off painful spasms or that you are still pretty locked up.

[jsewell]

Randy i am sorry the chiro is having a hard time with your back. I saw DrCostigan yesterday and he said i have been his most difficult case and he is now presenting my case to the next meeting of the USC spine surgeons to get an opinion on which type of surgery will help me with my hunched over posture which is progressive. I thought i was all set in my decision to have a certain type of surgery at Cedars, but he put a wrench in that and now i have so much more i do not understand . I guess i am lucky that he really does care deeply as my insurance pays him almost nothing as he is out of network. He said not to worry about my bill , he is only doing this to help me . So if you do get to see him, please do tell him i sent you. He can be rushed and i think if you mention my name it will be a better appointment., I think when i first met him ,well the second time, i kind of felt rushed and asked him to have a seat as i was not done with my questions, (in a nice way of course) and now i always get more than enough time, he also at this point knows pretty much about my whole life!! So it is still confusing and i have been dealing with back pain for over 10 years.
Mayvbe i would go back to DrSeltzer and fill him in on how you feel and as Maria said take a list of questions, or just a list of your symptoms and things you need help with so he hopefully will let you have some time.
Judy

[rbrown]

Maria;
I have flexeril but it only makes me a little tired and as far as I can tell doesnt stop the spasms. I requested a referral for a second opinion from an Ortho spine specialist but hurry up and wait I guess. The way things have been going I have a bad attitude and assume the next spine Dr wont care either. Ive spent many hours now ready on Chirogeeks site. Very educational but again I'm totally confused about my current state. I am very guarded and stiff/locked up. Almost no pain at all unless the spasms grab. I figure its got to get a lot worse very soon.

Judy;
I'm still seeing the Chiropractor. I told him today I didnt want him to do any attempts at the stronger type manipulations. He agreed and used the activator thingy on me today. I also saw my physical therapist yesterday and he gave me some core exercises I can do without spasms. They are for coordination and stamina not strength which he said is more important for now. I'd bet if I make another appointment with Dr Seltzer maybe for the toradol inj Maria suggested for the spasms, I'd bet I wouldnt be having any spasms that day!

Man I am really sick of this.....I dont know if these spasms are muscle related or if its disk or nerve issue. Sure seems like I'd be having leg or butt pain or symptoms to some degree if it was disk or nerve related. If not then what?? Ive been exercising, stretching, walking as much as I can........what gives!

[Maria]

Go see if you can get a shot of Toradol as long as you have no kidney probs or are allergic to it. It should unlock spasms or break up cycle.

You definitely have some disc stuff going on at least per your MRI you showed here. Whether those discs are your pain generators or not I don't know but they could be. There could be others as well. You may need more diagnostics to know what is really a pain source to you.

Orthopedic doctors here in CA order discograms to try to determine which disc is the pain generating one. Neurosurgeons use myelograms for a pre surgical type of diagnostic beyond an MRI or CT scan.

Understand being wary of doctors and thinking they probably don't care. I think that's how modern medicine can be to a larger degree than ever in the past. At least here in the US. That being said not every doctor is like this and many are very good and even excellent. It's finding the good guy or gal that will work best for you and your needs that you can afford to go re insurance and such.

[rbrown]

Originally Posted by Maria

Go see if you can get a shot of Toradol as long as you have no kidney probs or are allergic to it. It should unlock spasms or break up cycle.

You definitely have some disc stuff going on at least per your MRI you showed here. Whether those discs are your pain generators or not I don't know but they could be. There could be others as well. You may need more diagnostics to know what is really a pain source to you.

Orthopedic doctors here in CA order discograms to try to determine which disc is the pain generating one. Neurosurgeons use myelograms for a pre surgical type of diagnostic beyond an MRI or CT scan.

Understand being wary of doctors and thinking they probably don't care. I think that's how modern medicine can be to a larger degree than ever in the past. At least here in the US. That being said not every doctor is like this and many are very good and even excellent. It's finding the good guy or gal that will work best for you and your needs that you can afford to go re insurance and such.

How do I ask my primary for a Toradol shot? Do I say I "heard" it could stop the spasms or read it etc??

[jsewell]

I would just say i heard it has helped many people with spine problems. If he says no, you would be better off asking DrSeltzer as he should be able to give you a reason why. i hope. sorry i missed your call/text earlier, i left my phone in the kitchen and although it is a little house i never heard it.
Judy

[Maria]

you can tell whoever that a few people with back problems said they got that for spasms and it helped almost immediately. I've told you and I could refer you to another website where almost everyone there with a back prob gets a shot of Toradol now and again for spasms.

My husband's back was bothering him really badly last week for the first time in 15 years and he could hardly move. I told him to go to Urgent care and ask for a shot of Toradol which he did and he got it and it worked right away for him. He felt much better and could move more freely and then he got a script for a muscle relaxer to take every 8 hours for 2 days (Sat and Sun since he wasn't working) which helped him quite a bit. Some people have to take the muscle relaxers every 4-6 hours or however prescribed but regularly for about a week in order to break up a really bad cycle though usually the Toradol works well for most people even with really messed up spines like mine.

I was RN, Family Nurse Practitioner so while I'm not a physician I did see patients in ambulatory care as an NP and some of my recommendations come partly from this yet mostly from my own spine patient experience of the last 30 years.

The doctor may offer oral Toradol but I think the shot is much more effective as do most people I know that have had it. Like yourself many of the oral muscle relaxers haven't worked that well for me but then again I didn't like taking them regularly because the biggest effect they seemed to have on me was making me super tired. I have never felt this way with a Toradol injection and usually I feel immediate relief and can keep on functioning.

Asking for a Toradol injection isn't like going in and asking for shot of Morphine or Dilaudid or strong narcotic medicine. Most doctors are Ok with a patient asking for this although some patients medical history may be a reason that it wouldn't be given. One must have good kidney function to get this medicine and the biggest risk with overuse either oral or otherwise with it is kidney damage. It may help to state you've tried Flexeril and that hasn't helped you much (although there are many oral muscle relaxers to try).

Good luck.

[rbrown]

Maria?
If the spasms are being caused by a disc or nerve issue will the Toradol still help? I realize this is difficult to answer. But if it is disc or nerve related and the Toradol helps is it likely that the spasms will just return once the Toradol wears off?

[Maria]

Basically anything you use medicinally is just to break up a cycle of spasms or cover up the pain depending on type of medication.

Sometimes covering up something can be a good thing. As an example I got Epidural steroid injections over a 10 year period because they greatly helped to masque the pain I had from a leaking bulging disc at L5 and L4.

In that period of time the L5 area had an autofusion of the facets which has greatly alleviated pain I used to have at that level and gave me a semblance of stabilization at that level.

I avoided having a fusion surgery at L5 and in fact I avoided having a 3 level global fusion (thanks to ESIs being helpful) and I didn't have a proposed L4 ADR and L5 fusion.

Now whether I would have been better off with the ADR and fusion done I don't know I only know that I am quite certain I am better off NOT having had the 3 level global fusion.

Currently I get Toradol shots when my L4 is acting up and locks my back up ro my cervical spine acts up and my neck locks up badly. It helps very much. For me it's likely the involved disc has leaked a bit of toxic material on the nerve and aggravated things so the muscles start doing their protective guarding action (or spasms).

Toradol is not going cure you by any means but it may give you a break. I'm only suggesting it because back when I used to have horrendous spasms I spent weeks in bed hardly moving because that's what it took to get over the muscle spasms. Now I can get a shot of Toradol and pretty much be back in action right away.

What works for me may not work for you but many people I know get Toradol injections for their back spasms and it helps. If you want to wait until you see a specialist and find out exactly what is going on with your back as best one can tell you I understand that however if you want to get some relief from severe spasms in the interim a Toradol injection can likely help with that although your clinical picture will not be changed whatever that is and the only way you'd know if it would help you is if you get an injection.

I cannot say 100% that it will help you but it's surely worth a try and only then will you know if it helps you.

[rbrown]

Well I haven't had any spasms yesterday or today as of now. I'm being very careful with my movements, always tighten the abs before I move. Doing my PT exercises and walking some. My low back starts to ache pretty fast when I'm upright sitting or standing. I obviously still dont know if this "episode" (4-6 months varying degrees) is muscle or spine related. I hope its muscle and starts to get better with rest and PT. Rest is always ironic because the more I rest the more the muscles atrophy which makes it hard to do PT without my back getting sore and possibly back to spasms. If it is disc or nerve related I suppose it could still "resolve" itself but who knows how long that might take if ever. I'm still waiting on a referral for a second opinion to see a spine specialist.

[Maria]

Sometimes I have a few months without any probs sometimes up to about 6 months re debilitating spasms.

[rbrown]

Found out today the referral I requested for Ortho spine specialist was denied and instead was given a referral to another Nuero surgeon. (Dr. Gregory Withers in Arcadia) who is 66 years young. Not that age is an issue but unlikely that he is doing minimally invasive surgeries or any of the more modern techniques. My primary did say Toradol shot was no problem and I can come in to get it.

[Maria]

Good re the T-shot and re the referral my Orthopedic Spine Surgeon is in his 60's and is doing ADR surgery too. I don't think he was into it as early as some of the younger guys but he got into it because it's been around a while now and is FDA approved. Sometimes some of the older guys pick up the newer techniques as well to stay competitive or may have a younger partner that is doing that type of surgery.

Even with HMOs you have the right to ask for a 2nd surgical opinion. Some will tell you that you do not but that isn't true. If there is no one in the HMO that is within a reasonable distance to you than you can request to see someone of your choice that is and go thru the process of trying to get that authorized. What I don't like about HMOs is that whomever works for them is pretty much ruled by HMO system in terms of how to proceed. I mean almost strictly by logarithm (sp). I'm not saying there aren't good surgeons in some HMOs but they are so bound by procedure according to how the HMO dictates they proceed.

Anyway everything now goes thru Peer Review or Utilization Review or something that takes decisions almost out of the surgeon's hands re insurance companies. It can be a real uphill battle in some circumstances to get a surgery authorized and in others not. I guess we'll see how things go for you and I do hope you will find this referral informative and helpful. Please excuse my HMO bashing. I guess you can tell I'm not a fan of managed care but I do not mean to rain on your parade.

Don't ever let the HMO talk you into seeing someone that is in the same office as a 2nd surgical opinion because you want an unbiased 2nd surgical opinion and that comes from someone that is not in the same office or practice.

[jsewell]

Sorry you are stuck with someone that is older and may not know new techniques, but it can' t hurt to go see him. glad the shot is no problem. i think i would try the shot and get this doctors opinion. You do need to know what is going on and any spine surgeon should be much more help than a primary doc.
judy

[rbrown]

Maria;
My HMO is United Healthcare, I'm currently in the Healthcare Partners network. There isnt an Orthopedic spine surgeon or specialist in the entire network. Does that mean if I appeal the denial to see out of network specialist (Dr Costigan) that they might approve it since there isnt one available at all in "network"?

[Maria]

Randy,
I think you have to wait until you see the Neurosurgeon as a first consult as they've not denied you a consultation with a spine specialist they've just denied one with an orthopedic spine specialist.

After you've seen the first consult generally 2nd surgical opinions are obtained only if surgery is recommended.

I'm pretty sure when there is no specialist within the network if one is in need of a 2nd surgical opinion they can be granted an appt. with an out of network physician but when it's a "2nd opinion" only I think you have to check with membership services.

There are policy and procedure manuals that should have this all outlined and I don't know if you'd be fortunate enough to get a truly honest person that would send you a copy of whatever policy that would state their 2nd opinion policy however that's probably what you're going to have to look into at some point should you want a 2nd opinion that you aren't going to pay out of pocket.

I think first it would be prudent to go to the consult with the Neurosurgeon you've been given and see what this person has to say. Neurosurgeons are generally more conservative than Orthopedic surgeons from my experience however it would depend on your specific findings. Also HMOs seem to be very conservative when it comes to authorizing surgery but I think if someone's MRI screams "surgery is necessary" then surgery would be authorized .

It's just often in the case of low back problems that are painful but not creating problems like neurodefecits or something that necessitates surgery then surgery is not recommended and usually conservative care is the starting point. This means a trial of PT, first line meds like Nsaids, muscle relaxers, and possibly meds for neuropathies. If someone tries these meds and they don't work probably a referral to Pain Management is in order and there one might be offered various injections and stronger meds for pain.

I think you've been thru a trial of some of the meds so you can say what has and hasn't worked for you.

Anyway back to the point I think you'll have to see the referral you were given first before you can make an appeal because as far as the HMO is concerned they are giving you a referral to a spine specialist in Network just not an OSS.

The HMO I worked for was under the United HealthCare umbrella but I stopped working there in 2000 so most likely some things have changed with regard to policies. I doubt policies have changed drastically with regard to 2nd surgical opinions however it might just be that you are looking for a 2nd opinion vs. 2nd surgical opinion depending on what your consulting Neurosurgeon has to say.

Make sure going into the appt. you have some questions formulated and written down because you may or may not get someone that is willing to explain things to you.

[rbrown]

Maria;
This will be the second consult. I already saw Dr. Ian Ross neurosurgeon. He didnt explain my MRI results worth a crap, and basically said he can fuse my spine if I want surgery. So basically my first consult was worthless especially discouraging since he supposed to be some top tear expert. I will make an appointment for the second opinion which has been approved but I'm not very optimistic given my past experience with neurosurgeons. I will have questions ready for him but if he is like 99% of all Dr's ive seen he wont come anywhere close to answering my questions in the rushed 10 minutes they give me. Ive been through physical therapy, Chiropractic, and pain mngmnt. PM wanted me to have facet nerve blocks, but I'm not having leg symptoms at this time so I decided not to have those at this time. I want to find the pain generator or generators! I dont want to have a shot, take a pill etc..I want a Dr to do his due dilligence to find the cause.

[rbrown]

My wife and I spent about four hours with Mark on Monday at his home. We learned a lot and I actually have a lot in common with Mark as far as hobbies and past athletic interest. He will be submitting my films to Dr. Bertagnoli for his assessment. I feel very lucky to have come across this sight and to be in contact with Mark and appreciate the other members contributing to the "spine" conversations. At this time the cause of the spasms is still unknown.

Maria;
I received a Toradol injection today. I had some bad spasms come back Wednesday and Thursday. I hadnt had any today prior to the shot so I dont know if it calmed down or if the shot has helped but I havent had any spasms yet today.

[teg]

Hi Ron,

I have not been here in a while and just finished reading this thread. I also have experienced severe back spasms. I have had 3 artificial discs placed in my lumbar spine due to DDD. I never had the severe spasms pre-op, but they started about 2 years ago.

My pain management doc has done rf ablation to silence the muscle spasms. From what I understand, mechanical pain (facet joints) can cause severe muscle spasms. The facet injections that your doc would like to do may help with your back spasms. I think that the ideal combination is facet injections followed by physical therapy. PT can address more issues, like helping stretch out your back and build up your core muscles.

Good luck and I hope you find some relief soon.

Thelma

[Maria]

Hey Randy,
That was great that you and your wife got together with Mark and his wife. There's a couple full of spine knowledge, their own personal surgical experiences plus advocacy there! Congrats and hope everything works out well for you!

What Thelma writes makes sense. Maybe it's worth a try re the facet injections in terms of what your HMO offers while you're waiting. At least that might help rule out one thing or another.

Thanks for updating us and wishing you the best! Maria

[rbrown]

Originally Posted by teg

Hi Ron,

I have not been here in a while and just finished reading this thread. I also have experienced severe back spasms. I have had 3 artificial discs placed in my lumbar spine due to DDD. I never had the severe spasms pre-op, but they started about 2 years ago.

My pain management doc has done rf ablation to silence the muscle spasms. From what I understand, mechanical pain (facet joints) can cause severe muscle spasms. The facet injections that your doc would like to do may help with your back spasms. I think that the ideal combination is facet injections followed by physical therapy. PT can address more issues, like helping stretch out your back and build up your core muscles.

Good luck and I hope you find some relief soon.

Thelma

Could you pin point the origin of the spasms when you were having them? My perception of mine when they happen seem like its in the SI joint area (in between the lower back part of my hip and sacrum). Its really hard to explain other than it doesnt seem that the spasms originate in my actual back muscles.