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  • v322512
    Member
    Post count: 10

    I fell on to concrete in June of last year. My back hasn’t been the same since. I was miss diagnosed with an SI Joint problem. I went thru SI Joint injections nerve ablations PT with no success. Finally an MRI was done and the results are in. 2 Lower budging disk L5 S1, Narrowing of the spinal canal, and joint arthritis on top of that…. The next step the doctor wants to do is more injections Epidural steroid. I am in tremendous amounts of pain and I am on narcotics. Am I wasting my time here? I just want to get better.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Most likely, you had preexisting but asymptomatic degenerative disc disease prior to your fall. Most of us do. The fall most likely caused further tears and possibly some annular wall failure (see website) that brought on the pain.

    The sacroiliac joint is commonly blamed for pain generation but in reality, the sacroiliac joint causes less than 1% of the pain that seems to originates from that joint. Most of the time, the pain is caused by the L4-5 or L5-S1 disc and it seems to be the cause in your case.

    The question is “where is your pain”? If it is in the sacroiliac joint and buttocks and not in the central part of your lower back, this may be nerve root related pain. If the pain is in the center of your lower back, it may be disc related pain. This makes a difference if you eventually consider a surgical repair.

    Right now, you want relief. In general, a good rehabilitative program using pilates through a physical therapist or chiropractic care would be in order. Medications such as NSAIDs can be helpful. Epidural steroid injections can be useful to reduce nociceptor (pain nerve) sensitivity. If this injection is a prelude to seeking surgical care, it should be more specific such as a selective nerve root block (see website).

    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.
    v322512
    Member
    Post count: 10

    Your website is very helpful as I move forward with this particular adventure……. In all seriousness, when you posed the question “where is your pain” It is hard for me to pin point it. The pain is constant much worse as I sit. Completely unbearable when I get home at night and lay down and try to move my legs. What should I be paying attention to and what does it mean as related to what surgical procedure is appropriate?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    If the pain is centered in your SI joint and buttocks (unilateral pain), it is more likely from nerve root irritation. If the pain is centered in the small of your back, the pain more likely originates from the actual discs of the back. Sitting pain is more likely from nerve root origin as a general rule.

    If there is nerve compression and unilateral pain, the surgical procedure is a microdecompression. If the pain is central, the procedure is more likely to be a fusion if necessary.

    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.
    v322512
    Member
    Post count: 10

    I have had a micro discetomy and sir i feel like im back at square one. I am still in so much pain on my left side. My ortho did a post op mri and doesn’t know why i hurt. when i lay in bed lift my left leg to move the covers it feels like im ripping my spine out. I need ideas help something Im in agony. pain killers aren’t the answer i have a problem that needs a fix. Any thoughts are so greatly appreciated.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    You are now in the category of “failed back surgery syndrome”. Please see that section under conditions- lumbar spine to understand the potential problems that can be encountered.

    Let us start with the workup. Did you have a selective nerve root block (SNRB) to identify that the level operated on is the level that is causing the pain (see section under selective nerve root block)? If not- how was the level identified as the pain generator?

    Has your pain changed in quality, location or intensity after surgery? Was there a dural leak during surgery? What does the new report from the post-operative MRI say? Did the surgeon have a new SNRB performed after surgery?

    It sounds like you currently have a “hot” (inflamed) nerve root. Did your doctor give you any oral steroids or consider membrane stabilizers (Lyrica or Neurontin- USA named drugs) for your current pain while you are being worked up?

    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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