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  • pec5002
    Participant
    Post count: 33

    Hi Dr Corenman-

    I have been quietly reading your boards for weekse. I initially hurt my back in December of 16 and got so bad I had a micro D in April 17, my pain was 8 at its worst and only on the left side before the Micro D.

    I felt 100% for a week until I re herniated a week later coughing. Still felt 75% but my surgeon said if i got another Micro-D I could probably get to 90% better and able to be much more active again. I went with the second mico d in April of this year, never had any relief but didnt feel worse either. 2 weeks later I had an episode one day where I came home from a walk and started to get pain down both my legs and spasming in both legs which I never had before, MRI confirmed a 2nd herniation. Since then there have been ups and down more up than downs, but the biggest thing is I cannot sleep on either side without a really annoying feeling down both legs/hips which seems to be getting worse not better but it could also be my mattress softening up

    Biggest things I cant do are lie on my sides OR bend over obviously, back is OK if my head is low enough. Also prior to the surgery my pain was mostly on my left side now it is down both.

    Here is what I tried so far and results

    1) 3 Epidural injections- first 2 took the edge off,3rd did nothing

    2) facet Injection- nothing

    3) Physical Therapy- mostly focused on my priformins, made better during and after but then had more sciatica after which progessivly got worse every time- stopped after 3 sessions

    3)Ozone Therapy- Into the disc and into the surrounding muscles- 4 weeks ago with no results

    5) Did some light swimming, free style/crawl made it neither worse or better

    4) SI Joint Injection today- they dont think this is the problem but worth a show

    5)Inquired about PRP/Prolotherapy/Stem Cells but was told I am not a good candidate for it as I dont show symptoms of having facet injections and really my paid is do to pressure on the nerves

    What I have planned to try next is acupuncture which I will start tomorrow

    I wanted to see if any of you had any other options? Here is what else I am considering

    1) Physical Therapy Again with a highly regarded physical therapist maybe going very very very easy

    2)Foam Rolling or possible a thera gun to loosen muscles as opposed to stretching

    3) a third micro d- going endoscopic this time with a laser to seal the annulus (i know you arent a fan of 3 times)

    4) a fusion or Artificial Disc but fully noted my insurance wont cover a disc so need to look into that more

    5) another option?

    6) do nothing and hope gets better on own

    Thanks for the help in advance knowing how bad it is, which is maybe a 3.5/4 but also very limiting in my life, should I consider another surgery or just be glad this is only as bad as it is.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    After a third herniation (second recurrent herniation), you need a TLIF fusion to remove the herniation and fuse the disc space to prevent further herniations and permanent nerve injury. Artificial discs have no place in this problem in my opinion. All of the other treatments, either proposed or completed will not help other than the epidurals which have already run their course. The pain is most likely from the compression of the nerve roots with a small possibility that you have chronic radiculopathy (permanent injury from three separate compressive episodes).

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    pec5002
    Participant
    Post count: 33

    Thanks Dr. If this is severely limiting my life and I have very healthy discs above, if I do the fusion how much greater strain will I put on the rest of the back. One surgeon said there a 10% chance I will re herniate another disc and the other said there is a 25% chance I will not only not herniate but do it in the first 5 years.

    I am thinking about coming out to you all as well.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    The numbers for adjacent segment disease that needs surgical attention is 2.5%/year. That is, in 10 years, you have a 25% chance of problems above. I will state that I think the chances of having problems above if your do nothing to the current problem level now is not small either. I don’t believe a good study of degenerative changes above a very degenerative level have been looked at well.

    Nonetheless, with three herniations at one level, the chance of a fourth is very high and can be catastrophic if it occurs as the root can develop permanent damage. I do not endorse artificial discs in the lumbar spine while I do in the cervical spine.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    pec5002
    Participant
    Post count: 33

    Thanks Dr I appreciate your help here I can’t even put into words how helpful you are and I will be calling your line.

    So at the age of 31- would you recommend s fusion now over waiting as I am in some pain which is limiting my life due to the fact that the other discs will have trouble regardless? Or is it better to wait until I get older and see what happens and possibly this will fix itself?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8656

    If you are going to get another surgery due to continued nerve root compression, you need a fusion in my opinion. If however, you can get by without a surgery (as long as you have no motor weakness), then you can deal with the symptoms you have now and hopefully, these symptoms will improve over time. The presence of modor weakness from root compression dictates a fusion.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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