Hi NavyDave,

So sorry you are in the pain you are in with little pain relief with your meds.

You asked if you where missing anything and want to try everything you can to relieve your pain.

Having the experience of 2 spine surgeries, the first in June 2006 because of spinal stenosis in the L4/L5/S1 and the second in June 2008 as the result of an accident, I can offer you some experienced information, as well as experience from others I know and just plain research.

First off, you mention a ruptured disc at the L4/L5/S1 and a service injury 15 years ago with your spine that you recovered from.
You said you didn't have surgery with the first disc injury because the odds where against you and you did recover over a period of months.

Let me assure you that spinal surgery today for ruptured/herniated disc is far more precise than it was 15 years ago and the results are very good today.

Second, most herniated/ruptured discs will heal on their own with the proper treatment, proper treatment being the key words here.

Assuming that you have had an MRI very recently that confirms the diagnosis of a ruptured disc at the L4/L5/S1, you do need to see a spine surgeon that specializes in spines only, either an orthopedic surgeon who specializes in spines or a neurosurgeon who specializes in spines only.

You did mention in one place in your post seeing a neurologist and in another a neurosurgeon and pain management. A neurologist is not the kind of doctor you want to see as they are not able to or trained in treating spine patients. Neurosurgeons are and orthopedic surgeons are that have specialized in spines.

You say that the percocet is helping, reducing your pain level from an 11 to a 9. In my opinion that is very poor pain relief, but percocet is a narcotic and narcotics will not help to relieve nerve pain.
I am surprised that the doctors have not prescribed any meds to help ease the nerve pain that I would expect you are having from a ruptured disc. Something like Neurontin or Lyrica.

The treatment for a ruptured/herniated disc is a course of PT to strengthen the core muscles over an 8-10 week period and time. If needed, epidural steroid injecitions, administered by a pain management doctor under floroscopy can also be done to ease the pain as well.

Most herniated/ruptured discs will heal this way. If after several weeks of PT the symptoms don't ease, then a return to the spine surgeon for cosultation on surgery is then done.

Also a course of either steroids on a decreasing dosage in what is called a Medrol pack can be prescribed as well as starting on nerve pain medication such as Neurontin or lyrica.

As for pain relief from using a chiropractor, I would not suggest going to one. I have known far to many people who have suffered more injuries and increased injury to herniated/ruptured discs from spinal adjustments from chiropractors, including my next door neighbor.
He had a herniated/ruptured disc and against his spine surgeons advise tried a chiropractor for pain relief. Within 3 days, he was on the OR table from severe damage to the disc, caused by the chiropractor.

The inversion table is really just a gimmick to spend money on for pain relief. It may or may not relieve some pain, but it can cause further rupture of the disc and increase the likely hood of surgery over being able to heal the rupture on it's own.

Prolotherapy is specifically for tenodn and ligament injury, not for a ruptured disc. I don't understand how it is possible to heal the disc or even relieve any pain.
The disc material is coming out of the disc and it is causing the irritation of the nerve and causing your pain.

An article in the NY Times in 2007 quotes a specialist in the field Dr. Donna Alderman "Dr. Alderman cautions that prolotherapy is appropriate only for patients with musculoskeletal pain who do not have underlying conditions that would interfere with healing and who are willing to receive painful injections in an effort to recover."

You have underlying conditions, i.e. the ruptured disc, and you don't have musculosketal pain, your pain is coming from the disc and nerves and weakened core muscles from not using them correctly because of the pain.

Acupuncture may be able to relieve a bit of the pain, but it will not be able to heal the underlying medical problem that you have. That needs the proper medical care from a spine surgeon.

Don't get me wrong, I'm a strong advocate for acupuncture and using it when the condition warrants. I've used it myself to help the healing of severe tendon problems in both of my arms, but it was under the care of my arm orthopedic surgeon and physical therapist and used in conjunction with other treatments as well. It worked wonders for me and helped me to regain the use of both of my arms, quite a few years ago.

IMHO, you need to forget about the the chiropractor, the prolotherapy, inversion table and shelve the acupuncture for the time being.

Get evaluated as fast as possible by a spinal surgeon, you said you where waiting for an appointment with the neurosurgeon and pain management doctor. No doubt they will send you for PT, an MRI if it is more than 4 months old (usually, they want an MRI that is recent and consider 4-6 months old as not valuable information as too many things can change in that period of time), and maybe an ESI to ease your pain.

The best course of treatment is to start with the standard conservative treatments and then move from there, if necessary.

What is not a good idea, is to try and self treat your medical problems with your spine. That can and will create further damage to your spine, and that is something you do not want to do.

Good luck and keep us posed on how things go.

Fran

Fran,
First, thank you for sharing your experience, and taking the time to make a very helpful post.

Yes, 15 years ago, I elected not to have sugery, and I'm glad I didn't have it then. I am adverse to surgery as my Father had a fusion at age 62 or so, and although he says it's good; his mobility is poor. I'm of course much younger, and I've always been active and healthy; I'd prefer to avoid surgery if at all possible. Mainly because I want to eventually get back in shape ( I enjoy being fit and feeling healthy and well)

If I said I was seeing a "neurologist" I may have been mistaken; I have a consult to the Neurosurgery clinic, and the pain management clinic at the Veterans Administration Hospital; so I believe they are sending me to a Neuro-Surgeon.

I don't plan to see a Chiropractor again for my current condition; I generally have good posture & mechanics, and I don't think I'm out of alignment... besides; I don't want to cause any more trauma to the area.

I only have one more Acupuncture treatment on this series; I have a trip to go on which requires me to sit in an airplane seat for several hours; and I wanted to reduce swelling as much as possible before the trip.

I did not mention in my original post that my Osteopath (my doctor is a DO) originally prescribed me flexoryl (sp?) and Ibuprofin. After two weeks, I returned with no relief (actually getting worse) and she prescribed a cycle of prednisone (7 day cycle) along with Norco (Hydrocodone 7.5 / 325 acetaminophen) - the Prednisone had no affect other than making me a bit tweaky; so the thought was the disc injury was not made worse by a ton of inflammation. At that point; because my original injury is service connected (occurred while I was in the Navy); I decided to get back into the VA system. Otherwise, I have to pay out of pocket for all my treatment as my private health insurance excludes my "prior exisiting condition" relating to my back injury.

My MRI is fresh; dated September 4.

I may cancel that prolotherapy appointment; I'm really just reaching at straws looking for hope.

I will also talk to my Dr's re: the medications; I'll look into Lyrica, & Neurotoin... I just heard yesterday from a friend with a similar injury that Lyrica was helpful to her. I know there are problems w/ addiction w/ the narcotics; but it hasn't been an issue for me in the past. When I'm done w/ the pain, I'm done w/ the drugs.

I've just been in so much pain these last few months; that I'm really willing to try anything; including an inversion table.

I didn't buy an expensive inversion rack; it's $200. if it helps, great. If not, I'll sell the piece of crap on craigslist. I just have to try it; and after reading so many consumer customer reviews who claim to have received relief from Sciatica pain via using an inversion table; I figure what the heck. Really, I can't get much worse here. (well I guess I could become paralyzed; but that's not much worse than where I am for the last several months)

Thanks again; and if anyone has had positive experiences w/ Inversion in regard to a L4/L5/S1 rupture w/ Sciatica, I'd certainly appreciate the feedback!

Navy Dave

I'm going to edit for brevity; here's the meat:

"At L3-4 and L4-5, there is mild disc dessication, without significant disc bulge or gross focal disc herniation. The spinal canal and neural foramina appear adequately patent. There is, however, some mild right L3-4 neural foramina disc bulging; with a possible right far lateral annular tear.

At L5-S1, there is moderate degenerative disc disease; with disc dessication and disc space narrowing as well as discogenic endplate changes. There is a a right posterior paracentral disc herniation; measuring approximately 8mm, signifcantly indenting the right ventral aspect of the thecal sac, and impinging the traversing right S1 nerve root. There is some hypertrophic facet arthropathy at this level, and mild bilateral neural foraminal disc bulging, causing mild bilateral L5-S1 neural foraminal stenosis.

No other significant disc bulge or gross focal disc herniation. Mild degenerative disc disease is noted at L3-4, and L4-5 and ther emay be a right far lateral annular tear along the L3-4 disc margin, with mild buldgin into the inferior recess of the right L3-4 neural foramen, but there is no evidence to suggest significant neural foraminal stenosis.

##end report##
From what I get; the big problem is L5-S1 nerve compression. Any additional insight appreciated.
Navy Dave

Hi Navy Dave,

I'm not a doctor nor the best person to answer questions about MRI's, but it does sound like the L5/S1 area is where at least some of your pain is coming from. There is compression of the nerve and narrowing of the foramin, i.e. stenosis.

There are several other areas that are of question, but I'm not one to interpret the MRI.

What I can tell you though, is that the reading of your MRI is an opinion of the radiologist that read it, just his/her opinion.
Another radiologist may have a very different interpretation of the MRI, as can a spine surgeon, as long as the spine surgeon can read an MRI.
Not all spine surgeons can read MRIs.

A good spinal surgeon will look at the MRI pics him/herself and then attempt to match your symptoms to the MRI pics that he/she sees.

Just because the disc bulge is mild or there doesn't appear to be significant stenosis doesn't mean that the bulge isn't causing a problem for you specifically, but it wouldn't in someone else.

We are all individuals and we respond to pain and spinal changes differently. What would be no problem to one person, can be a disaster of pain and function to someone else.

That is why a good spine surgeon will use the MRI pics as only a part of the diagnostic tool in determining a patient's diagnosis. The real key is the patient's symptoms and how they line up with the MRI as well as an exam to add to the information.

Ins. appears to be ruling the lives of people today. that pre existing coverage is something that should be illegal.
I guess we should really be grateful that they cover anything, because if you think about it, a human being is really a pre-existing condition to start with. We all have a pre-existing condition, our bodies. How that body ages is out of our control. Some are pre conditioned to have certain problems and others are not. Some are at higher risk for certain things than others. Only time shows who is going to develop them and who is not. but the pre existing condition to do so is there from time of conception.
But they get away with the pre-existing condition once it develops and not until then.

Good idea to talk to your doc about the Neurontin or the lyrica. Both can help a great deal, but it takes time for the meds to build up in your body to have the desired affect and it takes time to reach the correct dose.
Neurontin is started out slowly and the dosage is increased. I'm not familiar with how the dosing is done on Lyrica, but neurontin was a life saver for me till surgery.

They both can have the affect of making you very tired to start with and sort of loopey, but your body will get used to it in a few days and you will be fine.

Good luck and keep us posted on how you are doing and what the doctor says.

Fran

Navy Dave,

How are you doing now? Did you have any surgery? Are you back on your feet now?

Fran

Just wanted to throw my 2 cents worth in here. Found out I had annular tears and bulges at L4 and L5 last year. I've had chronic pain for years, but having a high pain tolerance, thought it was just some arthritis or something in my back. I've led a very active life including years of Kung Fu and remodeling houses. Got MUCH worse though while pregnant with my son so after I had him I decided to find out what the problem was and get some steroid shots or something. An MRI and discogram later, got my very surprising prognosis. The doc at the pain clinic said one of the discs was "trashed" (his words) and started me on a round of procedures that was supposed to keep me from having surgery, since that wasn't an option with a baby at home to care for. After my 6th visit there - and in more pain that I was when I first went - I got disgusted and looked into other options. Read about Spinal Decompression and decided it was worth a shot, and the only other thing I could try that was non-surgical. I was skeptical, but figured I didn't have much to lose after all I'd gone through at the pain clinic. Long story short, after the 4th (of 20 overall) treatment, I was sleeping all night with no pain, for the first time in over 10 years. It's been about 5 months since I completed all the treatments and I feel about 90% better. I believe I would feel completely well if it weren't for having to chase around a very active, VERY big 1 year old. Still go back to the chiropractor where I got the treatments for little "fixes" now and then when I feel I've thrown something out of whack back there and it always seems to do the trick. Just wanted to let you know there are other options besides surgery that actually DO work.

Thank you for that last post. I have been getting conflicting opinions from 3 different professionals. I had L4-5 bulging 1.5 yrs ago and thought I had healed. Recently went to a new chiropractor who specializes in "Cox" technique for disc problems. All was going good for relief of the ongoing "slight" lower back pain that I haven't been able to shake until 2 weeks ago. I sneezed. And it was all over. A whole new level of pain. And immobility. I was referred to a naturopathic Dr. for injections, (not steroids or epidural). Got some relief. Then went ASAP for a current MRI, which now shows extreme bulge at L4-5. The naturopathic Dr. told me I must look into surgery. The chiropractor and the acupuncturist (sp?), both said NO!. I am now confused as all the advise is foreign to me. The internet has a lot of good and bad info on surgery, which just leaves me more in question. I want to make clear that the "Cox" method is not your average chiropractor adjustment. If anyone knows about it, please comment. The naturopathic says "stay away", he suggested a decrompression similar to the X-0900 table (unsure of exact label), that lays you flat, stratches you and puts you back. The last posting from "Lifeisreallygood" gave me some hope. I have no insurance, self-employed, and can not afford surgery anyway. If anyone has had similar or would like to comment please do.
C