Viewing 6 posts - 1 through 6 (of 7 total)
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  • KLove
    Member
    Post count: 4

    Dr. Corenman,

    I have been in agony since an accident a year and a half ago that resulted in herniations at L4-L5 and L5-S1 (confirmed with an MRI). Thus far, an orthopedic surgeon recommended a discectomy and laminectomy at both levels but before making that choice I’ve decided to see a neurosurgeon. My question is that most of my pain is when sitting and standing after as little as 20 minutes the pain in back starts to become unbearable. I have very little pain radiating down my legs and even when it does radiate it’s really minor compared to the pain in my back. The back pain starts in the center of the lumbar region and begins radiating out to the point where it “locks up” and leaves me unable to rise from a seated or lying horizontal position (and thus often leaves me needing assistance just to use the restroom). I have tried spinal decompressions, been prescribed narcotic pain medications, and even had 2 injections with no relief. I’m on the verge of even losing my home since I’ve been unable to work since the accident.

    My question is that I keep reading on the internet that a discectomy does not help relieve much back pain and is mostly used to relieve radiculopathy. Is this true? If so, what other options exist for the back pain? This is very disabling and depressing, and being unable to work, I may end up homeless should nothing regarding my situation change, but I also don’t want to risk surgery purely for the minor leg pain.

    Any suggestions would be greatly appreciated. I cannot even get in to see the neurosurgeon for 3 more months.

    Sincerely,

    Kelly

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You are correct in your research. Lower back pain (that centers in the back) is typically generated by disc or facet pain and not by a disc herniation that compresses the nerve root. Now there are some exceptions to that rule.

    If the pain is not just central back pain but does refer to one side, especially if it radiates to the SI joint (the area on one side in the pelvis), then the origin is more likely to be nerve pain. This would give a better prognosis if you underwent a simple microdiscectomy.

    Even central back pain can be improved about 50% of the time with a microdiscectomy. The reason why that procedure is not highly regarded is that the satisfaction rate is only 50%.

    You could consider facet blocks of L4-S1 (see website for description). The facets generally don’t generate as much lower back pain as the disc, but the treatment of facet pain more likely than not does not require surgery. I think it is worth looking into the facets in your situation.

    Dr. Corenman

    KLove
    Member
    Post count: 4

    Dr. Corenman,

    I received one epidural and one facet injection a few months after the accident (the accident was in June 2011, injections in November 2011). I definitely did something when I bent and twisted that felt like lightning shooting up and down my spine that put me in instant pain. I’m hesitant to risk surgery from everything I have read. The lack of extreme leg pain makes me think the disc isn’t the culprit. All I know is that I cannot tolerate this pain any longer and I’m working with very limited funds. Would facet pain linger so long, a year and a half later? I also have an annular tear, stenosis and severe degenerative disc disease but was not in disabling pain until the accident where I had lift a heavy box.

    Thanks again!

    ~Kelly

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You report stenosis of the spinal canal. This might change the potential pain generator. Do you have pain in your back or sacroiliac/pelvis region with standing and walking that is relieved by sitting down or bending forward? If that is the case, the pain might be generated by the canal narrowing.

    If not, does the pain tend to be central pain or pain that more favors one side than the other?

    The lack of extreme leg pain has nothing to do with letting the disc “off the hook” as the cause of the pain. Disc hernations that compress the nerve root cause buttocks and leg pain. Disc tears (annular tears) and degenerative disc changes cause central lower back pain.

    Dr. Corenman

    KLove
    Member
    Post count: 4

    Dr. Corenman,

    The pain is definitely not relieved with sitting. The pain is constant and the best position for me is lying horizontally on my side. Upon sitting or standing, within about 20 minutes the pain starts in the central part of my lower back (along the lumbar spine) and then spreads across my lower back. Sitting on a hard surface, such as a wooden chair, makes it extremely worse. Even sitting or standing with support the pain starts and after some time gets excruciating and “locks up” to the point that I become immobile. If I am forced to sit or stand on a hard surface for an extended period of time the pain usually also renders me useless for a day or two after said event. The central pain seems to radiate horizontally across my lower back. It doesn’t seem to really prefer one side but it does seem to be slightly worse on the left side (note: my left leg is shorter than my right leg).

    When I bend forward, I have pain when I am moving forward until I get to the point where my hands touch the floor and then my lower back feels better. I also experience pain when bending backwards. Movement from side to side is more uncomfortable instead of painful. I also have quite a lot of muscle spasms in my lower back. I’ve been on copious amounts of different types of narcotics that have done nothing. Ice and heat, as well as massage, only have a minimal, temporary effect. What actually feels the best is when I have someone push hard on my lower back moving their hands from a superior to inferior position, but the pain returns as soon as they stop pushing on it.

    Often, especially in the morning, I can only get out of bed with the assistance of using my hands to pull myself up along the wall and the same thing occurs when I sit or stand too long and then end up limping and having to use a cane. I feel the ortho didn’t spend much time evaluating me and so, after asking many medical professionals, have been referred to the top neurosurgeon in the area but my appointment isn’t for 3 months!

    Thanks for all of your assistance. You are truly a great physician that takes personal time to respond to questions.

    ~k

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Your pain is not related to stenosis but more likely than not related to the tears in your disc walls (annular tears). If you are a candidate for surgery, there are two choices for surgery. A microdiscectomy has about a 50% chance of reasonable relief of your lower back pain. A 50% success rate is not high. This lower success rate however is balanced by the minimal nature of the microdisc surgery. It is a small surgery and generally easy to recover from.

    The typical surgery for lower back pain relief is a fusion. This is a much bigger surgery than the microdiscectomy surgery and takes about four times as long to recover from. Nonetheless, this surgery is the gold standard for relief of lower back pain. You would need a work-up to determine if you are a candidate for this surgery.

    If you choose the microdiscectomy and do not get the relief that you expect, you have not burned any bridges and can still be a candidate for a fusion procedure.

    Both neurosurgeons and spine surgeons can perform either procedure. With that long wait, you might look for another surgeon to get a quicker opinion.

    Dr. Corenman

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