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  • Lrae
    Member
    Post count: 4

    Hi Dr. Corenman, I have a central, large herniation in T-10. I am a paramedic and originally hurt my lumbar area in Sept last year. Several bulging disks and possibly 1 tear. Severe sciatic pain, burning, and pain in the leg and calf. I had therapy and 3 ESI shots total 9 steroid shots and 2 oral steroids. I went back to work and was lifting the legs of the cot w/o a patient, they stuck and I had instant pain in the URQ of my abdomen, along with severe leg pain/back pain. I had an MRI and it showed a central herniation at T-10. I was told by the ER, to see a specialist immediately and not to bend, twist, lift, cough, sneeze, or bare down. I saw an Orthopeadic/spine doc and they said the same thing.. they wanted to do more steroids and more scans.. I saw a Neuro/ortho doc and he said steroids, therapy, and pretty much the same thing.. I have been off work since April 28, (which is driving me crazy), I refused the steroid, because the other shots did not work or worked temporarily. I started therapy with terrible results. Increased back and leg pain, but worse when I bend or lift even slight objects, my SNS kicks in and I break out in a sweat, have pain over my gallbladder, and central back pain. I know the surgery is very invasive and would cause additional problems, but IDK what to do. When I do nothing it causes problems, (like my feet/ankles turning purple)and when I live life normal, I only last a little bit and then I have to lay down. I checked into the minimally invasive alternatives, but like you said, they have mixed reviews..also a problem, I live in Arkansas.. I guess my question is, since the herniation is on my spinal cord, what would you recommend? I am familiar with spinal surgery, I have a cervical fusion C-4 to C-6. My husband has had 3 lumbar surgeries. the third was due to 2 failed, the disk pieces and hardened so much they cut his nerve in his leg. Please help. No one will tell me what I should do or options. The therapist threw her hands up in frustration, the WC have no idea, my case manager has no advice.. sigh.. thank you for this forum, I hope you can help.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    You have symptoms from both the lower lumbar spine and the lower thoracic spine. The T10-11 herniation will cause belly pain on the side of the herniation (the T10 nerve radiates to the umbilicus) and local pain in the lower thoracic spine. If there is cord compression, the symptoms will be imbalance in the legs and possible blower/bladder involvement.

    The lower lumbar spine can cause lower back pain as well as leg pain so I assume you have herniations at that location as well.

    The treatment of thoracic disc herniation is generally conservative unless there is cord compression causing cord dysfunction. That means steroid injections, therapy, medications and time. The reason for that is that surgery to correct this condition is quite involved normally requiring a fusion and not uncommonly requiring an anterior approach (through the chest cavity).

    I don’t want to disappoint you but maybe the physical requirements of patient extrication and lifting might cause more problems than it is worth continuing the job of being a paramedic. You might be able to continue if you rehabilitate well. With a 2 level fusion in your neck, probable multi-level lumbar disc disease and now a thoracic herniation, your spine is not cooperating with you. Could you find a position as a supervisor or other less taxing opportunities?

    Dr. Corenman

    Lrae
    Member
    Post count: 4

    Thank you for getting back to me. My MRI of the lumbar show no herniation’s, just some spinal stenosis, possible tear w/o protrusion, and dry facets.

    I’m very familiar with the traditional surgery and do not want that. I am experiencing bowel changes, but the sphincter works fine. At the moment I’m not even on light duty. I have a home gym and pool, but when I walked on the treadmill, I had needles and pins followed by itching across my back and abdomen, going down the legs. Lifting even something small triggers pain in the abdomen and profuse sweating.

    I have almost come to terms with not being on an ambulance, and I am a certified teacher, but I’m also a woman, and there are no women in a supervisor position of education. Although, I teach in the hospital. I know it doesn’t make sense.

    I suppose what i really would like to know is, am I making it worse when I get the pain? or is that just a fact of life? Do you ever see any good things about the minimally invasive procedures such as endoscopy? accurascope? or should I just deal with it, until I can’t walk anymore.

    thank you for your opinion.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Spinal stenosis is unusual for someone as young as you but not unheard of. Do you have congenital stenosis (naturally narrowed canal) or is it the typical degenerative stenosis?

    In general, you are not causing damage as long as there are no significant findings of weakness or long tract signs from the physical examination.

    Endoscopic procedures for “discectomy” in the thoracic spine have a reasonable success rate for the nerve compression but are not as simple as in the lumbar spine. Local pain from the disc tear is not addressed with this procedure if that is a major complaint.

    These herniations are normally not progressive so it is unlikely you are going to have increasing inability to walk.

    Dr. Corenman

    Lrae
    Member
    Post count: 4

    I’m not really sure of what kind of stenosis. I didn’t have any major problems before Sept. Would exercising that causes burning and lightning pain down the leg be detrimental? or the symptoms of the pins and needles, do you think that is just a “side effect” of exercise and ultimately, the exercise is beneficial?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    I cannot comment without a complete history, physical examination and review of the images. The symptoms you describe could be related to stenosis or the many other disorders.

    Dr. Corenman

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