From the information given I would say that you have suffered what is sometimes called a chronic soft tissue injures to the lumber spine. ,which could have been present before the back surgery. The surgery could aggravate and bring about more symptoms from this pre-existing problem.

It would seem that you would be best with a referral to a Pain Specialist or a physiatrist for further evaluation and long-term treatment.

Good luck!

Hello Jgieseke,

Welcome to this forum!!!

Regarding laser spine surgery vs traditional spine surgery I would direct you to the "Laser Spine Surgery" thread. Its like a book at this point, but well worth a read in my opinion. As you will note there are differences of experiences and thoughts of/for each. Spine surgery as you are well aware of is not simple.

May I ask were in WV you live? You can respond by PM if you so wish.

I would highly recommend that you search out the very best spinal surgeon/neurosurgeon who you can find in WV.

I'll look forward to your reply.

RichT

I have been in contact with LSI and have even sent them a copy of my MRI they sent me a diagnosis and told me I have just about every known back problem there is:
I have formatted this letter to detail the following: what we found on your MRI report, which procedure Dr. Perry has recommended, and a description of the procedure

One of our Board Certified physicians has reviewed your films/report and has noted the following abnormalities:

 Degenerative Disc Disease @ L2/L3, L3/L4, L4/L5, L5/S1

 Bulge/Herniation @ L2/L3, L3/L4, L4/L5, L5/S1

 Spinal Stenosis @ L4/L5

 Foraminal Narrowing @ L3/L4, L4/L5, L5/S1

 Facet Disease @ L4/L5, L5/S1



After noting these findings, Dr. Perry has recommended a laminotomy/foraminotomy, a percutaneous discectomy, and facet thermal ablation at level L4/L5. Your exact surgical recommendation will be determined after a full physical evaluation with our surgeons.

A Foraminotomy is a medical operation used to relieve pressure on nerves that are being compressed by the intervertebral foramen, the space in the vertebra where a nerve root exits the spinal canal. The term foraminotomy is derived from the Latin words foramen (hole, opening, aperture) and –otomy (act of cutting, incision). A foraminotomy is performed to relieve the symptoms of nerve root compression in cases where the foramen is being compressed by bone, disc, scar tissue, or excessive ligament development and results in a pinched nerve.

See what I mean

Hello Jgieseke,

Thanks much for sharing.

That sounds almost identical to what I received from LSI about my back about a year ago.

Makes one wonder!!

Take that DX with a ton of salt. As RichT said, it seems to be the typical DX that most people if not all get from them.
Once you are there they will push to have all of these areas treated and I would hate to think what the cost will be for you to pay.


"Degenerative Disc Disease @ L2/L3, L3/L4, L4/L5, L5/S1 Bulge/Herniation @ L2/L3, L3/L4, L4/L5, L5/S1"

The spine of a 51 year old usually shows some of both of this and the only time it becomes a concern is if there are symptoms to go along with the MRI findings.

That is also the same with spinal stenosis and facet disease.

The only time any of these findings mean anything is when a good qualified spinal surgeon takes a look at the MRI images as a part of the pieces to diagnose a patient and then proceeds to match those images to the symptoms that the patient exhibits.

Just because all of this shows on MRI images doesn't mean that they are a problem. They only become a problem that needs to be dealt with if the patient exhibits symptoms that match the MRI image.

I would suggest, as RichT did, to find a well qualified spinal specialist close to your home or as close as you can and proceed from there.
As a matter of fact I would get get several opinions from several different spinal specialists.

The reason I suggest that is that, from experience, some spinal specialists are set in one way of treatment, they tell you, that you need a fusion for almost everything, vs starting with conservative treatment and then move from there.

There are many new procedures that are being used now, especially with sports medicine orthopedic surgeons who specialize in spines only.
They use laminotomies instead of a full laminectomy to do decomressions and they always make sure that the lateral recess is decompressed as well. Not doing that is the biggest cause of failed spinal surgery for decompression.
They also do what is called 'minimally invasive fusions" when needed.

What you really need to do to is get some opinions on what is wrong with your spine and what the best treatment will be.
You do not need a "one size fits all" DX that seems to always come out of the laser spine facilities.

Good luck

Fran

Thanks for the advice and I can tell you that you were right about the cost they want 30,000.00$ before they even see you,I am going to check with a Pain Management Specialist tomorrow

I would also seek the opinions of several spine surgeons in your area. The best way to deal with spinal issues is with the combined opinions of several spine specialists as well as pain management doctors.

Good luck and keep us posted.

Fran

Hello Jgieseke,

I TOTALLY agree with Fran!!!

RichT

I'm doing the research as we speak

It sounds like a one size fits all solution, since LSI gave me a similar response!
C

I decided to give Pain Management a try and had my first set of shots today.I seriously feel better already.I have to go back in three weeks for second series of injections but I think it's still better than having my back laid open again. I will keep you updated on my progress, or if you have any questions feel free to ask.

Hello Jgleseke,

"had my first set of shots today" - Jgeseke, how many shots did you have?

Why a second series of injections if the first are working?

I'm getting very concerned that your PM doc is giving you way to many injections.

The rule of thumb for most doctors is a max of three injections containing a corticosteroid within a given year.

Oh yes, do make sure your doctor is using a fluoroscope to help him/her guide the needle and medication to precisely the correct location.

This series of shots sounds to me like a hit or miss attempt by your doctor. THAT is not how such injections should be given.

RichT

Usually spinal epidural injections are given in a series of 2 or 3 injections over a 9 week period of time.
Each "series" is really one injection of steroid and one injection of lidocaine or whatever numbing anesthetic the doctor is using. Therefore it is called a "series.

Each injection is done with about a 3 week interval in between each one.

The immediate relief of pain is from the numbing anesthetic used as it take about 2-3 days for the full affect of the steroid to kick in.

If the first injection provides partial relief, then a second 'series" of injections will be done in about 3 weeks and usually the doctor will attempt a slightly different location but very close to the first attempted area to relieve the pain.

If total relief is not obtained with the 2nd "series" of injections, a third may be attempted in the area that provided better relif.

If a second injection provided total relief, then the 3rd injection is held off and saved for a later time, as most doctors will only give 3 steroid spinal injections over a period of 12 months.

If there is no relief with the first injection after a weeks time, accept for the initial numbing injection, then usually a second "series" of injections may or may not be attempted and they doctor would attempt to locate the steroid in a different location to help alleviate the pain.

That's the procedure that my Pain Management doctor uses and the only way I have ever heard of it done.

I have no knowledge of only giving one injection for the pain and then waiting till it wears off to have another one, like you have Rich.

I mentioned it once to my PM doc and he never heard of doing it that way either.

I guess if it works, Rich, I wouldn't worry about it being different than what other doctors use. It may be that he uses a larger dose of the Kenalog at one time than other docs do, or you are just lucky that all you need is one to get you through for many months.

I say the "if it ain't broke, don't fix" holds for how you have your injections done. Be glad that they work and you can still go without surgery.

Fran

Hello Fran,

Interesting the difference in techniques. I'm glad I only have to deal with ONE injection every 4 months or so. It was my understanding that my PM inserted the needle but once. No guessing with my PM doc as to where the Kenalog needs to go, this guy is SUPERB. Of course, he studies the MRIs well and uses a fluoroscope to help him guide the needle to exactly the spot it needs to go.

The first time I had an epidural by a PA it was painful. She was moving that needle all over. Would have kicked her if I could have. With my PM doc, he is so smooth there is but a very small "pinch" of pain that only lasts a second.

Now you have me curious. I'll ask him about the actual details next time I have an epidural. I know I get lidocaine to numb the pain as the needle is inserted and then once the needle is exactly where it is to go the Kenalog is added.

RichT

It seems to be working for me Thank God I feel somewhat normal again and from what I have learned a series of shots to get you started is SOP.I will do some more checking though.Thanks for your thoughts

Hello Jgieseke,

That's GREAT!!!! I hope they continue to work for you.

Well, it wasn't SOP for me. LOL It has been one shot about every 4 months. Everyone responds differently.

RichT

My eyes are still popping out of my head that you had a PA do an ESI on you. I've never ever heard of a PA doing them.

Even a search on the net, I could only find MD's, anesthesiologists, and radiologists do them.

All I could find was PA's doing trigger point injections into joints like the hip, knee, shoulder etc. Which is what I have had from my spine doc's office. PA give steroid injection into my knee and my hip.

My PM doc has no PA's with him, he does all the ESI, nerve blocks himself and they are done in the OR Facility downstairs from the Ortho office that he is part of and I go to.

The OR facility is a registered outpatient hospital facility with the state of MA and is accredited by the State, hospital board etc.

Never in a million years would I let a PA near me to do an ESI or put any needle into my spine. The risk of injury to the spine is very great and to hear that the PA had to move the needle around to several locations to get it correct is even more scary to me than the thought of just a PA doing it.

I'm thinking that you are one lucky man to have had nothing go wrong with that injection.

Fran

That's fantastic that the first ESI is really helping you. Hope it continues for you.

Had they worked for me, I would have held off on surgery the first time. But the first ESI worked for only 24 hours, the lidocaine wore off and the steroid didn't help. I tried a second which did the same and the 3rd made the pain worse.

In the end the surgery was done as an emergency because i lost bladder control.

Oh, yes, as far as I know and have heard and seen, a series of ESI is SOP.

Fran

Hi jgieseke
Funny.. you and I have exactly the same diagnosis from LSI! I have "cut & pasted" my MRI diagnosis from LSI's email below:
• MRI Findings For (my name)
• Degenerative Disc Disease
o [L1/L2] w/S [L2/L3] w/S [L3/L4] w/S [L5/S1]
• Bulge/Herniation
o [L2/L3] [L3/L4] [L4/L5] H [L5/S1]
• Spinal Stenosis
o [L4/L5]
• Facet Disease
o [L4/L5]
It seems that LSI have a template that they send to everyone who send them their MRI report. I would be very careful about this place as they have a very high number of complaints found on the internet and various blogs. Also, their charges are very high ($20-30K!). I have lower back pain since '92 and have tried Acupuncture, Chiropractice, PT, Epidural injection etc and nothing worked. I am scheduled to go to MicroSpine in DeFuniak Springs, FL in Sept 09. I will post my experience with them after my procedure. They accept my insurance and will cost me only my deductible and co-pay.
Good luck.