I know - two extremes, right?

I am 28 years old, about 6'3" 190 pounds, in great physical shape except for a number of back problems, mostly hereditary:

-Disc bulges at L3/L4, and large herniations at L4/L5 and L5/S1
-Multiple level degenerative disc disease at L4/L5 and L5/S1
-Severe foraminal stenosis, left and right sides
-Mild instability/spondylolisthesis

I had a laminectomy/discectomy/decompression 3 months ago, but the unfortunately I have a recurrent herniation at the L4/L5 level. I have been to a few different orthopedic surgeons/neurosurgeons and the common thread seems to be a fusion recommendation, and that physical therapy wouldn't be of much use. Additionally, they are saying that another discectomy would be a poor choice given the structure of my spine and the recurring herniation, which would likely happen again.

My insurance company seems to favor physical therapy, but I really don't want to waste a year of my life (+ money) on something that I'm told will not help and could possibly worsen issues.

Has anyone been in a similar situation before?

EDIT: Thought I should include the imaging studies done to confirm the above conditions - x-rays, an MRI, a myelogram/CT (which gave me nauseating headaches lasting over a week, had to have a blood patch), and an EMG.

Thanks to anyone who provides any feedback.

-Brian
Did you find this post helpful?
|

replied April 4th, 2012
Experienced User
I would personally give physical therapy a bit of a try. If I experienced no help after a month or so I might then do surgery. You can never go back once you have the surgery.

Of course this all depends on your pain level and how you are able to function now. If you can only lie in bed now then surgery is probably the way to go.

I am in a similar situation although I am almost 50. Had the discecomy/laminectomy in 2000. Took me 11 years for my herniation to recur. Now I am getting the ability to function in a limited capacity with periodic epidurals.

My doctor is stressing keeping my strength and flexibility to keep from having a fusion. With my multiple bulged discs he says I am likely to rupture the next level up if I get fused.
|
Did you find this post helpful?

replied April 4th, 2012
I appreciate the reply!

I am not really able to function in society. I am not able to go to work. Commuting to the doctor takes a lot out of me (my wife has to take off of work to drive me). Getting into and out of a car is horrible. But, I am able to, so it's not like I am bed-ridden, so I'm not sure what to do.

I'm told my conditions are severe. I just had surgery 3 months ago and I already have re-herniations. I'm not sure how physical therapy can help all of my conditions. What kind of exercises put herniations back in the proper place? Are there even exercises that heal degenerative discs or widen the narrowed spaces compressing the nerves? I want to say that I am open to physical therapy but I can't fathom how any stretch/exercise can help these matters.

It's really frustrating/depressing having a condition like this, because everywhere you turn the primary concern seems to be money. You go to a doctor and they are concerned about: 1) can I get sued, and 2) how much money could I make off this patient? You contact insurance and they think: 1) what is the cheapest option possible? You ask a surgeon "can physical therapy help?" and they say "no." You ask a physical therapist the same question and the answer is "yes." Hard to trust anyone. Would be nice if someone somewhere put the patient first.

Sorry for venting!
|
Did you find this post helpful?

replied April 4th, 2012
Experienced User
No , it is good to make an informed reasonable decision. The consequences will be with you the rest of your life.

I went to a chiropractor and he was quite a bit of help. Not that he did a lot to reduce my pain, but he showed me some stretching and exercises that help. When I told him I scheduled an epidural he said he thought that was my best course now.

Have you had an epidural? I remember the first one after my re rupture. I went from laying on the couch or floor to being back to limited work.

I assume you take pain meds now? The level you need to just live without wanting to end it all will tell you somewhat the course for you.

PT won't work for everyone. I have talked to people that swear by it and swear about it. The same about surgery , epidurals, and chiropractors.

I hope to avoid the surgery. You never know when they might come up with an amazing new method of helping us.

Think about what you want to be able to do. Talk with your family about it. Hopefully your wife understands. Not all spouses do.
|
Did you find this post helpful?

replied April 4th, 2012
Steve,

No, I haven't had an epidural. Out of 2 orthopedic surgeons and 1 neurosurgeon, none of them even mentioned an epidural. They seem intent on a two level fusion. Insurance is only approving physical therapy, despite the fact that all 3 doctors say it would be useless.

Yes, I am on pain meds. For a month or so I was on Oxycodone, but I started feeling like pure death in the mornings, which I'm guessing was a form of withdrawal, so I asked the doc to scale it back to something less toxic, and so now I am on Hydrocodone, which has the effect of about a glass of water. Oh well, better than a horrible addiction I suppose.

I'm with you, I would prefer to avoid surgery, but I absolutely loathe the thought of wasting so much time and money on physical therapy. I've heard that fusions take a lot of scrutiny but actually help countless people. My dad had one twenty years ago and his back has held up all these years.

What exactly does an epidural do? Why would any doctor not try this first ahead of invasive surgery?
|
Did you find this post helpful?

replied April 4th, 2012
Experienced User
The epidural is an injection of steroids near the rupture. It is supposed to shrink the protrusion and pressure on the nerve is reduced. These are usually given by an anesthesiologist. I had 3 undirected epidurals prior to my first surgery and they seemed to have minimal effect. The ones I had last year are directed and they seem to do more good.

I would ask both my orthopedist and insurance about it. They cost me about $1000 after insurance but my insurance isn't real great. My orthopedist referred me to the anesthesiologist.

Because they helped me there is no guarantee they will help you, but I can't see any harm in asking.

I take 7.5 mg hydrocodone. After the epidurals I would take 1 or 2 a day, somedays none. I had the last epi in Sept and the last month I noticed I had gone to at least 2 a day and even 4 some days. One problem with narcotics is your body will build a tolerance to them, requiring higher doses the longer you take them. I did take oxy and had a similar experience to yours.

What do you do for a living? Do you think you will be able to return to it or do you have other options?
|
Did you find this post helpful?

replied April 7th, 2012
Active User, very eHealthy
Quote:
'm told my conditions are severe. I just had surgery 3 months ago and I already have re-herniations

Surgery can clean up the damage that is done but does not FIX the CAUSE. As you are re-herniating your discs, the cause of your problem is not being addressed.
Until you do, you cannot heal as the muscle imbalances will keep pulling the discs apart. Even if you have a fusion, the muscles will still be pulling your back apart.

Quote:
'm not sure how physical therapy can help all of my conditions. What kind of exercises put herniations back in the proper place?

The exercises which fix your muscles imbalances. Muscles attach to bones and when the bones are out of place, you will ALWAYS find the muscles aren't working right either.
Actually exercises are BETTER when you have a lot of problems as you are fixing the whole thing (shoulders and hips too) vs. one small area as with surgery.

Quote:
Are there even exercises that heal degenerative discs or widen the narrowed spaces compressing the nerves? I want to say that I am open to physical therapy but I can't fathom how any stretch/exercise can help these matters

Discs are ligaments. These ligaments attach to the bones (vertebrae in you back) and hold them in place. Ligaments are called "passive tissue" because you cannot work them directly like you can a muscle. Ligaments are not under your voluntary control. But you CAN control the muscles and given time the ligaments will heal if you get the muscles working properly.
Either decompression or stretching your hip flexor (psoas) muscle will allow the disc to rehydrate and open up the narrowed spaces. As proof of this, people will gain and average of 1/4 to 1" in height after regular decompression.

Quote:
I would prefer to avoid surgery, but I absolutely loathe the thought of wasting so much time and money on physical therapy.

So the crux of your post is why do P/T when a fusion is so much easier? It would be interesting to chat with you in 20 years post-op and see if the fusion turned out to be the right choice.
|
Did you find this post helpful?

replied April 11th, 2012
I appreciate your feedback. Very informative info regarding PT, thank you.

I respectfully disagree with your statement that I consider a fusion to be easier than PT. Why would anyone think that? I've heard horror stories about fusions and it scares me quite a bit. I would consider PT to be easier. For me it's just a matter of effectiveness. Prior to these debilitating back issues, I was extremely active. Ran and swam at least 3x a week, on top of household duties. To insinuate that I'm looking for an "easy out" from this condition - which I did nothing to bring on - is borderline insulting.

Anyway, I heard from my insurance company today (Cigna) and they approved a 1-level fusion but not a 2-level because they consider it "exploratory." I'm reluctant to get 1-level done because I'm told that the added pressure on the adjacent disc (which is degenerated and herniated), would just cause further issues. Anybody have any thoughts on this?
|
Did you find this post helpful?

replied April 11th, 2012
Experienced User
Brian , that is why my Drs both are telling me to try to control my pain without the fusion. Dr V told me that after fusion , many patients are back with a rupture the next level up.

Have you asked about an epidural? My last one a week ago helped me quite a bit. I find that at times My pain is so minimal that I don't notice it if I am doing something like reading or watching tv. It has also let me work harder at my stretching and strenghtening without being in agony. I can now put on my right sock without incredible pain.
|
Did you find this post helpful?
Users who thank unclesteve for this post: BrianFL 

replied April 12th, 2012
Steve - glad to hear that your recent epidural went well! Putting on your socks!? I can't even fathom doing that without passing out in pain. I have asked my doctors about an epidural shot and the common response has been "too little too late and too temporary". Also, I had to have two blood patches for a myelogram after experiencing nauseating migraines that barely allowed me to think for about two weeks, which would likely happen again with epidural injections. The docs say that oral meds are best until a more permanent solution is put in place.
|
Did you find this post helpful?

This post is being reviewed to be sure that it adheres to our Community Guidelines.
Thanks for your patience!

replied April 12th, 2012
Active User, very eHealthy
Not a statement, sentence had a question mark. No insult intended. Thanks for the clarification.

P/T ineffective? I have herniated or broad based disc bulge at L1, L3, L4, L5. All are black discs. Broken back at L1. Schmorl's nodes, bones spurs filling 1/2 the foraminal opening, severely arthritic facet joints, broken hip, bone on bone on right side @ L5. I HAD leg symptoms, foot symptoms, bladder issues. Couldn't sit 5 minutes or even get out of bed in the morning without immediate foot symptoms. Couldn't stand up for more than 20-30 minutes.

Dr's recommended epidurals, facet joint injections, and then 3 level fusion or ADR. Nothing left of my back to do lesser surgery on. I told them I wanted to heal my injury, not cover it up with meds.

Best of luck!
|
Did you find this post helpful?

replied April 12th, 2012
Active User, very eHealthy
Quote:
I respectfully disagree with your statement that I consider a fusion to be easier than PT.

I did not make a statement. I asked a question and ended it with a question mark. No insult intended. Thanks for the clarification.

I make a point of NOT responding to "surgery threads" but your title "Physical Therapy vs. Fusion" got me confused. Sorry to interfere.

Good Luck!!!
|
Did you find this post helpful?

replied April 12th, 2012
I found your question to be rhetorical, which you've validated by saying that you make it a point to stay out of "surgery threads," which this isn't. Don't be confused. The title of the thread is exactly as intended. I haven't made my decision yet. And you didn't "interfere." Honestly, your information about physical therapy was the most informative I have come across and I'm very appreciative. It's actually making me strongly consider PT. But I think your "e-tone" is intentionally ambiguous. Say what you mean to say.
|
Did you find this post helpful?

replied April 12th, 2012
Active User, very eHealthy
I can't say whether a fusion is right for you or not. As our musculoskeletal system is made to last for 125 years, IMHO in most cases, "packing it in" and getting a fusion at 28 seems premature.
I don't think typical P/T of ab work / Cobra stretch / Bird dog will fix you either.

What DID work for me was myopractic (my massage therapist used this term) to fix my posture. Chiropractors move the bones into place, myopractic uses muscles to move the bones. It's a more natural way to fix the body and without getting the muscles involved, the bones will go back out again and you need another Chiropractic adjustment.
Most posture problems are visible but subtle. 1/4" leg length difference, twisted hips, can't bend to the right as easily as the left, etc.

When you hit the right exercises, you will feel immediate relief. Like a pill but better because you are helping the problem. But ligaments doesn't actually HEAL so quickly - more like 1-3-5 years.

From your posts, I'm guessing than looking at you in profile, you body is curved forwards like the bow of a ship. This is called the "Green Light Reflex" in Thomas Hanna's book "Somatics" (highly recommended)

Maybe also when you stand relaxed, one shoulder or arm is in front of the body showing your shoulders and hips are twisted. Your Dad may have the same postural problems.... it's genetic you know.

Are you in Florida? Google "Al Meilus" and also "Structural Energetics Therapy". This is the type of work which will do you the most good.

They do muscular release - getting the muscle to let go. But you also need stretching and strengthening and no one can do that for you. Have to do that yourself.
|
Did you find this post helpful?
Users who thank myopracticworks for this post: BrianFL 

replied April 12th, 2012
Yes I am in Florida. I will look into your suggestions (Al Meilus and Structural Energetics Therapy). I owe it myself and family to try everything non-invasive first. I know my body and while I'm very fit, I am struggling to come to terms with the probability of hardware successfully staying in my spine for the rest of my life (hopefully 50+ more years). I just don't think that's natural. I want to fight it as much as I can stand it first.
|
Did you find this post helpful?

replied April 13th, 2012
Active User, very eHealthy
Those are good for someone working on you. I personally have had the best success with the Structural Energetics type massage (expensive at $100+ per session) and Neurofascial Release($250 per 1/2 hour). He told me what he found wrong as far as distortions and I did the appropriate egoscue e-cises on my own. Egoscue e-cises are 70% of what I have done (got 8 menus - it was menu #7 that really hit my dysfunctions) to get better over the past 3 years. Have to do it everyday. So that is what I would REALLY recommend as you are motivated to put in the time and effort.
You can get an idea of what Egoscue is doing by reading "The Pain Free Program" by Anthony Carey. But Egoscue's custom menu is better.
|
Did you find this post helpful?

replied April 13th, 2012
Alright, thanks again. I've made my initial consultation first thing Monday morning for PT. I'm bringing all of my written reports and imaging for their review, and I'm going to prepare a list of questions. Any specific, non-obvious questions that I should ask?
|
Did you find this post helpful?

replied April 14th, 2012
Experienced User
I would ask what they would expect to see in terms of improvement and a timeline to get back to some semblance of a normal life. I know there are no set answers but get a rough idea of where they think you can go with your recovery and how fast (or more likely how slow as this is a long process).

Good luck on your therapy. Try to keep your spirits up.
|
Did you find this post helpful?

replied April 13th, 2012
Active User, very eHealthy
I would ask them what they think is wrong and how do they plan on fixing it.

As for posture / alignment:
1) One hip higher than the other.
2) Correct front / back tilt to the pelvis.
3) Too much / too little curve to the low back.
4) Overall alignment problems.

They usually check for range of motion. The important thing is DIFFERENCES in one side vs. the other so:

5) Do they see any muscles imbalances or ROM differences?
- Tight hip flexors is a universal problem because we all sit too much.

They usually won't tell you these things unless you specifically ask because patients 1) aren't interested 2) don't know what it means anyhow 3) leads to being questioned about what they are doing. So they just give you exercises and tell you this will fix you.

They probably already have a set idea on how they do things so there isn't much point in trying to make suggestions on WHAT to do anyhow.
|
Did you find this post helpful?
Must Read
What structures make up the spine? We review basic spine anatomy here...before identifying potential causes of back pain....
Click here to learn about the most common causes of back pain, and things that increase your risk of backache. We cover lower back pain and upper back pain....
Back pain symptoms may seem obvious. But do you know when symptoms of back pain are more serious or when to see a doctor? Learn what action to take & when...