micpMemberAugust 20, 2011 at 5:43 pmPost count: 1
Hi Dr. Corenman,
I am a female, 45 yro, now 50 lbs. overweight (was slighty overweight prior to injury)
I incurred a work-related injury lifting (twisting at waist) a heavy patient some time ago (2.5 years ago). I had a annular tear and herniation of L5-S1. After conservative treatment, I returned to work for 6 months and had second injury to L4-L5 (herniation). I had conservative treatment, including 3 epidurals, high dose NSAID daily. I was doing well with the NSAIDS until I developed a gastric ulcer, 2d to NSAIDS) I was not able to tolerate pain meds. due to the adverse side effects (nausea, dizziness,hypotension, and disassociate mental state).
I was formerly a very active person and enjoyed my occupation very much. A friend had an L-5-S1 fusion due to spondylythesis and has returned to being a firefighter/Paramedic. His successful return to work inspired me to hope to return to work (same occupation).
My spinal surgeon gave me poor odds of returning due to the two disk injuries. He suggested a fusion and a synthetic disk.
As long as I am not active (walking, driving); the pain is tolerable. But this is not living! Only existing. Activity increases pain up to an 8/10, and radiates to buttock, thigh. Pain mostly across lower back and right hip. Herniation was on the right.
The other concern is driving: Pain increases with driving and I feel as though there is crepitus when I get out of the car-I feel relief of the pain and pressure upon standing. I had a diskogram, and now the area of L3-4 is uncomfortable-they injected dye in this disk, as well.
So, my question is: am I unrealistic in hoping to return to work as a Paramedic and my formerly very active life?
Thank you for any response and thank you for your website, it is very informative.Donald Corenman, MD, DCModeratorAugust 21, 2011 at 1:40 amPost count: 8431
You are a 45 year old female paramedic with a degenerative disc at L5-S1 and a herniated disc at L4-L5. You were OK on NSAIDs but developed an ulcer. You just had a discogram from L3-S1. You are incapacitated from your prior active lifestyle and are now sedentary.
First some questions. Was the discogram blinded (you were not told what level was being tested)? What was the result of the discogram at L3-4? Was this disc intact and non-painful, intact and painful or degenerative and painful/ not painful? When you developed an ulcer on NSAIDs, did you then try Celebrex? This NSAID is supposedly more gastric tolerant. Have you tried a membrane stabilizer (Lyrica, Neurontin)? I assume you have gone through a thorough rehabilitation program.
Now for some answers. Unfortunately, you have a genetic predilection for disc tears. With two degenerative discs, you could have a fusion of both levels (depending upon the results of the discogram) but returning to the job of paramedic involves some risks you may not want to take.
A fusion of the two lowest lumbar vertebra does stress the ones above and with a genetic risk of further tears, you might become a “zipper” patient. This is a patient that feels great after a two level fusion, goes back to their high stress occupation and and then every year to two, tears a disc above and requires a fusion of that level.
A one level fusion is compatible with heavy work or athletic endeavors as your friend has demonstrated but a two level fusion is in the grey area. I do have patients who have successfully returned to heavy employment with a two level fusion but these patients do understand that the risk is higher to L3-4 secondary to stress concentration and genetics. A proper rehab program would be helpful after surgery with training in ergonomics to prevent stresses that could tear the disc above .
I am not a fan of an artificial disc in the lower back as of yet (see section on lumbar artificial disc on the website). These lumbar discs still need to be perfected. I do think there is a place for cervical artificial discs but that is another matter.
Good luck with whatever treatment you choose!
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