[Awiltfeuer]

#6470

Below I have my 2nd MRI Report. I have gone through 2 physical therapy sessions that have lasted 5 weeks 3 times a week. I have had 4 epidural steroid injections. Neither have helped. Have had 2 Medial branch blocks done on angles 2 shots at each level in the l4-l5 and l5-s1. They did give me relief but only for 6 hours. I have had a ct scan. Have had an EMG test done which was normal. I am currently on cymbalta and flexeral. I had tried oxycodone and hydrocodone which have helped but the pain management doesn’t want me to be on them. I had tried Tramado l which I had side effects that I did not like because my serotonin level was too high. I have seen the neurosurgeon about 4 times, PCP about 5 times, and Pain physician 6 times. I have bought a inversion table and use it. I have tried multiple types of bengay, ice hot, ibuprofen, Tylenol, etc. which doesn’t help much. I go in next week to talk to the Pain Management doctor on a procedure call radio-frequency block. I am only 23 years old and have missed to many days of work and have let my house become a mess, my relationship with my girlfriend has become a mess. I struggle with pain on a daily bases and it gets worse as the day goes on. I feel like non of the doctors have helped me and I am at this point 100% sure I want to get surgery if nothing changes. My question is how come my doctor does not want to prescribe me what has worked in the past? And second question is am I warranted for back surgery? Third question is there anything else that I can do to help the pain? And forth question is what does my MRI report mean?

CLINICAL HISTORY:
Lumbar disc herniation.

COMPARISON:
MRI of the lumbar spine performed 03/21/2012 at UPMC McKeesport.

TECHNIQUE:
Multiplanar multiphase magnetic resonance imaging lumbar spine was
performed without contrast including the following sequences:
Sagittal STIR, T2 and T1, axial T1 and T2.

FINDINGS:
The lumbar spine alignment is anatomic. The vertebral body heights
are maintained throughout. There is no evidence of an epidural mass
or collection. The conus and cauda equina are unremarkable with the
conus ending at the lower end plate of L1. The prevertebral and
paraspinal soft tissues are unremarkable.

T12-L1 through L2-L3: No significant central canal or neural
foraminal narrowing is present.

L3-L4: The central spinal canal is mildly congenitally small due to
short pedicles resulting in mild canal narrowing.

L4-L5: Central spinal canal is congenitally small. There is a focal
central disc protrusion indenting the ventral aspect of the thecal
sac resulting in mild spinal canal narrowing. However, the lateral
recesses and neural foramen remain patent.

L5-S1: The central spinal canal is congenitally small. There is a
mild diffuse disc bulge resulting in no significant central canal or
neural foraminal narrowing.

My signature below is attestation that I have interpreted this/these
examination(s) and agree with the findings as noted above.

Impression
IMPRESSION:
1. L4-L5: Congenital spinal stenosis. Focal central disc protrusion
resulting in mild central canal stenosis.

[Awiltfeuer]

#6471

Back issues since 2012-01-02

[Awiltfeuer]

#6472

I do also have leg and but pain that come and go along with weakness but that is not the issue it is the back pain that is constant

[Donald Corenman, MD, DC]

#6476

Please see the section under “Conditions”; “How to describe symptoms” to understand how to describe what is causing the pain. That way, I will have a better understanding of what symptoms you have and how it is affecting your life.

The reason that most physicians do not want back pain patients on chronic narcotic usage is the affect of “Tachyphylaxis”. Narcotics attach to pain receptors to block pain signals. When the body is subjected to chronic narcotic usage, the body up-regulates these receptors. That is, the body build more receptors.

The more receptors you build, the more narcotic you need to take to block these receptors. The more narcotic you take, the more receptors you build. This is like a dog chasing his tail where he will never catch it!

Eventually, the increased narcotic usage can start to depress the breathing reflex. Patients eventually go through withdrawals, even when on the narcotics. You can see that narcotics are not a very good way to treat chronic pain over the long term.

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.

[Awiltfeuer]

#6477

Dear DR.,

The Quality of the pain is moderate and never goes away.
Pain is sharp, aching in my back which is constant its at the hips to mid back feels like and expands out from the spine. Leg feels like im being shocked every once in a while in diffrent parts of my right leg that range from the hips to the toes. Every once in a blue moon I will get a very bad elctrtical pain thats in my right hip and that ussually makes me fall to the ground imediatley because of the intensity of the pain.
Yes back does feel better for a couple minutes when i stand up. But sitting it feels the worst and then laying down doesnt feel much better.
Pain Percentage is probly 90% of back and 10% leg
on pain scale its probly a 6 or 7 just because its so annoying.
There is a little bit of weakness in my right leg.
I always catch myself automatically walking on the exterior of my foot instead of the whole bottom.
Ive had back pain in the past probly about 6 years ago for like 3 weeks then it went away that was from a bike accedent. Then I had back pain 2 years ago and that lasted about three weeks that was due to lifting a fridge up into a truck. And this year I got into a dirt bike accedent thats when the pain had started.
Laying down is probly the prolong most comfortable along with ICE :)
Sitting down for more that 10-15 minuters makes more back pain and standing for more than 5-10 minutes makes more back pain.
I walk every day for about 15 minutes periodically through out the day and night.
Back does hurt more when bending and it feels more stiff.
The pain has not gone away since 01/02/2012

Pain has changed my life completly I dont do alot of stuff around the house and when i do it has been put off for extended amounts of time. I lay down constantly after work and periodically walk outside for a little bit. but for the most of the time i am laying down. I have given up fishing biking lifting s exual life gaming working overtime vacations.
Before I used to work 70 80 hours in 7 days now im lucky to get 40 in seven days and most weeks I dont I use my vacations.

I am a EIT/Survey Technician/Cadd Technician
I no longer go out in the field for my job and im constantly getting up and moving and streching. I had my company get a new chair for me. I use ice at work.

Let me know if you need any other info.

Thanks,
Alan

[Donald Corenman, MD, DC]

#6478

If you had good relief for six hours after your facet blocks, than this is a good diagnostic response and your next move you should consider would be dorsal facet rhizotomies.

This procedure is performed where a needle is introduced into the back at the point the small sensory nerve enters the facet capsule. The tip of the needle then cauterizes this nerve. Chances are about 75% that this will reduce your back pain based upon the results of the block.

If this procedure is not effective, your symptoms are somewhat consistent with degenerative disc disease but occasionally stenosis can also cause your symptoms. If you consider surgery, a simple decompression of the L4-5 level might be the next step. The recovery is relatively easy and you do not burn any bridges if eventually a fusion might be required.

If the rhizotomies are not effective, consultation with an experienced spine surgeon is the next step.

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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