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  • kevin
    Member
    Post count: 4

    Hi i was hoping you maybe able to offer me some advice-

    Background information is that ihave had back pain on and off for the last few years , normally it would last for a few days and then go away and i wouldd be ok again for a few months until it happens again. it would happen all of a sudden eg by sneezing or just moving the wrong way.
    unfortuneately for the past year its been constant pain, i think this is from when my disc actually hermiated. i have outlined the findings of my mri below, i dont have leg pain so iam just wondering would you think surgery is the best solution to my problem. i have tried physio,acupuncture, chiro etc but no luck

    Mri findings
    at l5-s1 there is a large focal right posterolateral disc protrusion displacing the left s1 nerve root and narrowing the right l5-s1 disc lateral foramen

    at l2-3 l3-4 and l4-5 there are moderate sized broad based chiefly central posterior protrusions . there is posterior disc bulging at l1-2

    no bone destruction is shown.-
    considerable chronic degenerative changes at all lumbar levels- minor degenerative changes in corresponding lumbar facet joints
    Also what do you think of non surgical;any advice appreciated as i really dont know what to do-

    also what do you think of non surgical spinal decompression? could it work for me? do you have any faith in it?
    thanks in advance for taking the time to respond

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Lower back pain can be caused by degenerative disc disease (most common cause), degenerative facet disease (about 5-10% of the time) and even a disc herniation or spinal stenosis (narrowing of the spinal canal) but these are not as common causes. The pain from degenerative disc disease can originate from the annulus (see degenerative disc disease on the website) or from the bony endplates of the vertebra (isolated disc resorption). Even though a disc herniation does not commonly cause back pain (it normally causes leg pain by nerve compression), it can stretch the annulus enough to create back pain.

    Does the pain occur with standing, bending and lifting or does it occur with sitting? Standing/ lifting pain is generally more associated with degenerative disc disease and sitting is associated more commonly with the herniation. Is the pain in the center of the back or is it more to one side (the sacroiliac joint)? Central pain is generally associated with degenerative disc disease and pain to the side can be associated with either the disc or the herniation.

    Your MRI notes multilevel degenerative changes in the lumbar spine. If your pain originates from the disc, any of the levels can generate pain but normally the bottom two levels (L4-5 and L5-S1) are more commonly pain generators.

    The “spinal decompression” machine is essentially spinal traction with a fancy name. I have no typical objection to it except for the cost and the number of visits normally “required” to sign up to gain access to the machine. The only two conditions I think are contraindicated are a spondylolysthesis or instability of the lumbar spine (see website for more details). Will it work- not very likely but there is still a chance of it being effective.

    I am a big fan of Pilates for spinal rehabilitation. You would need a physical therapist or chiropractor who is well trained in Pilates rehabitiation.

    Only if noting else is effective and you cannot tolerate the pain is surgery an option. You would need a surgical workup to determine if you are a candidate for surgery.

    Good Luck!

    Dr. Corenman

    kevin
    Member
    Post count: 4

    hi thanks for getting back to me so soon.

    the pain occurs when bending and also when lifting. i try to avoid lifting anything much these days. i am tsking lyrica(pregbalin ) tablets daily. these have helped me out a fair bit but i dont want to have to take them for the rest of my life. before i was prescribed then i would struggle at times to get back up off a chair if i sat down for a good while. Also it got to the stage where i would have to walk with small steps as i simply wssnt able to walk normally. occasionally when sitting i get a pain in my back also. best way i could describe it is that its like there is pressure been put down on my back , the tablets seem to have alleviated this in the main. i can also get a sharp shooting pain in to my back every now and again which lasts just for a second. its like something has touched a nerve

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Bt your report, your pain could be discogenic from degenerative disc disease. Lyrica is a membrane stabilizer and a reasonable medication if it works for you. Make sure you are on the correct dosage by asking your physician.

    Have you tried a pilates stabilization program administered by a well trained therapist? To see results, this could take at least three months. You could try using the Med-X machine which stabilizes and strengthens back muscles.

    Finally, you could get a consult with a spine surgeon to have an appropriate diagnosis made and look to see if you are a potential surgical candidate.

    Dr. Corenman

    kevin
    Member
    Post count: 4

    cheers. i have tried various exercises for my bak alright, struggling to even get into the bridge position so pilates would be hard work., never heard of the med x machine,will look it up, is it expensive..
    have been to see a couple of surgeons, one said operation wouldnt be suitable , the other said he thinks it would work, thats why i dont know what to do

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    The Med-X machine was popular in the 1980s and there are still some that should be around today. This machine is really an exerciser machine designed to strengthen the multifidi and rotator muscles of the lower back. I can be effective but not all the time.

    The surgeon who thinks he can help you- is he suggesting discograms to determine if surgery can help you? Please review discograms in the website for more information. Based upon blinded discograms, you may or may not be a candidate for surgery.

    Dr. Corenman

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