Hello, and my introduction =(

[pittpete]

Hey all, Im a 37 year old male whos been dealing with lower back troubles since 1994.
I initially injured my back carrying a 24' ladder and slipping on the ice.
I was 24 and it was the first time I ever had back pain. Pain was only in lower back, with no leg pain.Pain gradually got worse and right leg pain started till eventually it was 24 hours a day unrelenting.After an MRI confirmed a large HNP w/fragment right sided crushing the L5 nerve. I had a microdicectomy w/laminectomy in 1995 and all went well. In 2000 I started having major lower back pains with some leg pain/numbness and was sent for another MRI.
MRI confirmed small right sided HNP both L4-5 and at L5-S1 with slight bulge at L3-4.Minimal scarring at L4-5 from discectomy.Went for physical therapy with traction and the results were well.
Well since 2000 there are times where my back goes out, I cant stand straight and Im out of work for a week or two. Seemed to be the norm.In beginning of 2007 I heard about DRX9000,got another MRI and MRI showed, no herniation at L4-5,HNP right sided at L5-S1 with some S1 nerve root displacement,disk bulge at L3-4,DDD and spondylosis L3-S1.DRX after 12 sessions did nothing for me except lighten my wallet.Which brings me to Dec of 2007.
I was pushing some snow(not lifting),came in laid on the couch and when I got up,BOOM cant stand straight.Nice, just in time for Xmas.Lower back was in total spasm and while laying in bed a few nights later I tried stretching a little and extended my back trying do a self adjustment.Wasnt a smart thing to do and my back hurt worse the next morning.A few days later I started getting pain down my right leg, but it wasnt the same as it was when before I had my surgery.Hurt so bad I was limping and could barely walk.Leg pain started 3 weeks from today and it is improving daily but Im still limping slightly with dull pain behind my right knee,outside my foot and just under my buttock.Also some cold tinglies in the outside of my right foot.Back pain is not too bad.All dermatones point to L5-S1 and the S-1 nerve root which is probably why it doesnt feel the same as when it was compressing L4-5 pre-surgery.
I see a good chiro 1x a week,use ice,moist heat,light stretching and lower back/abdominal exercises and use my TENS unit intermittently and inversion table.
2 Aleve per day has dulled the pain, but Im at a crossroads on what to do next.
Should I be patient and see if the leg pain goes away totally or schedule an appointment with a good neuro/ortho surgeon?
I could handle the nagging back pain, but the sciatica just scares the crap out of me.
Thanks

[B13s]

I wouldn't say that you need to schedule appointment with surgeon especially if you pain is improving , but I would suggest to get another MRI if this is not a problem for you.

[mmglobal]

pittpete... welcome...

Your decision depends on many factors. What's missing from the discussion above is what your discs look like. If they don't look too bad and you are experiencing improvement, it behooves you to wait and see. However, if you have a configuration that will surely fail.... sometimes sooner is better than later, because you preserve the health of the surrounding structures... facets, ligaments, etc. Leaving them for extended periods in a severely collapsed config may eliminate options that you have today.

Discover your options, make informed decisions.

Good luck!

Mark

[pittpete]

Thanks for quick reply.

When you say "what do your discs look like", is a discogram the only way to actually find out or will MRI tell?

I dont think getting another MRI will be a problem w/ insurance carrier

[Poncho]

Originally Posted by pittpete

Thanks for quick reply.

When you say "what do your discs look like", is a discogram the only way to actually find out or will MRI tell?

I dont think getting another MRI will be a problem w/ insurance carrier

Actually, both should give information on the structural integrity of the spine. Both inside and out. The discogram will give even more information related to the tears of the walls of the disc (leakage) and which disc(s) are causing your pain.

If you go to have a discogram - feel free to ask Mark and others in your local area as to which docs have a good reputation performing discograms. Experience counts a lot!

The more information you can get the better.

Take care,
Poncho

[mmglobal]

pittpete.... it's a subjective view of the disc. I'm fine-tuning my theories about waiting for surgery, or even trying minimally invasive surgeries based on recent experiences with clients (and my wife.)

If you have a new disc protrusion and good disc height that may likely heal, both conservative treatment or minimally invasive discectomy may be the best bet. However, if you have a long circumferential tear and bulging across the entire posterior aspect of the disc and moderate to severe collapse, the idea of waiting or having MISS hoping to salvage the disc.... one must balance the increased risk incurred with not fixing the system, AND the reduced chance of success of the less invasive options.

My point is that the further you are down the degenerative cascade, the less likely you are to have success in salvaging the disc AND the more likely you are to damage future options because of ongoing and increasing abuse of other other elements of your spine. Not only can you give up options, but even if you retain the options, the chance of success may be reduced.

Mark

[B13s]

But again - if minimally invasive options do not help - what are the other choices really ? ADR or fusion ? None of them can guarantee you anything and chances that they will worsen situation unfortunately are quite high.

[dshobbies]

Pittpete,

Welcome to the forum. We are a bunch of people with usually serious back and neck problems. Most of us have had or want information on ADRs. You've already had one surgery but still have problems. You should know that in many cases, and disco/lami promotes DDD at adjacent segments which sounds like your situation. The success rate of those same future surgeries dimishes drastically, down to 5% with the third. However, ADR's may be overkill.

You should definitely get opinions from doctors based on a new MRI. Those that do not perform ADR surgery are less likely to recommend it but those that do may not feel it justified for your specific circumstances.

Also I'm not a fan of decompression machines. Your inversion table does the same thing. Instead of your chiro, you might want to look into physical therapy. Unfortunately, without a current MRI you don't know the condition of your back. That would be my starting place, followed with consults. You want to arm yourself with as much info as you can. Ask questions. Get yourself informed. If you tell us where you live, maybe we can give you some Dr. recommendations.

Good luck to you, Dale

[pittpete]

Hey guys, thanks
1 of my MRI's from 2000 says small posterior radial tear in the annulus at L4-5(surgery) and L5-S1
Most recent from April of 2007 says nothing about tears in either of the discs, just the HNP at L5-S1
The problem is, I think I overreact every time I have an episode of extreme back pain. It always gets back to tolerable levels,which my wife often reminds me.
I tend to harp on it and get depressed and she says "Pete, it always gets better and this time it will also".
Thing is, it seems to take longer to heal now.

As far as physical therapy, I dont want to sound like a know it all, but Id rather do my own routine then have someone treat me like another number on the chart.
I do my own stretching and exercises,use my stationary bike,eliptical machine,walk on the treadmill and use the inversion table.
While Im sure there are some very good and caring physical therapists out there, but I'm the only one that knows my body and having had to deal with this problem for 13 years now I tend to be very in tune with it.

Good news is my massage therapist(deep tissue massage) after my massage was able to stretch my right hammy at 90 degrees without any back or leg pain,I felt like jumping up and down in excitement.
The chiropractor I use is a good man and a friend.He is very good with his hands and doesnt push treatments on me.
He is also good at filling out paperwork when I miss a few days at work here and there.
I think Im going to ask my chiro to order a new MRI beginning of Feb and let this last episode calm down.Just in case I scheduled an appointment with Dr James Yue of Yale in Connecticut
BTW I'm from NY area so it wont be too long of a ride.Problem is earliest appt I could get was April 2nd.
Patientce unfortunately is not 1 of my virtues, and like you guys have said its better to not rush into anything if the discs structual integrity is not too bad.
Thanks and keep suggestions opinions coming, I look forward to hearing from everyone.
Pete