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  • Discodan
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    Post count: 5

    Hi there. Was hoping someone could throw some light on my back situ and maybe give some advice.

    Background- I’m a 35 yr old male. I had been dealing with a back issue for 7+yrs before I had surgery. It started back when i was around 27/28 and had returned to running in an attempt to get fitter to get back playing football. I was in fairly good shape at the time but I noticed some discomfort/tightness in lower back after every run. I got physio a few times and rested up while doing core exercises in the gym but after a couple more attempts it had gotten worse. An mri a short time later showed a small bulge but the advice was to do core exercise which I did. I just got on with things and forgot about running.I cycled and walked to keep fit. The flare ups became more regular and couple of years later I ended up leaving my job as I felt spending 3+hrs a day in a car was making things worse. A flare up would be when my left buttock would tighten up really tight and I would get a dull pain down the left leg which left it hard to walk more than 200m. The physio would dry needle my glute and I would be back ok again until the next time.It was gradually getting worse and I noticed by late 2018 that doing a 7km walk was causing some discomfort and i found myself taking a pain killer before a walk to stay ahead of the pain. I was reducing my walking and I felt that it was now really getting worse almost by the month and I had to do something.

    So I went to see a consultant and had an mri. He showed me where there was a small herniation at l5s1.I also noticed the disc was very thin. He booked me in for an injection which had no effect, infact I thought I was slightly worse after.

    Surgery was the next option and I decided to go with it. He informed me after surgery that it was worse than he was expecting. He performed a posterior decompression of spinal cord/nerve root, by laminectomy, foraminotomy, facetectomy and/or discectomy, unilateral, 1. He said that had I not elected to go for it that it would have only been a matter of time before I was going to need it.

    So now almost 7months out and I’m not progressing the way I hoped. Surgery was easy, I had no pain whatsoever although i was drugged up with targin amd lyrica. I just had to be careful for the first few days while I was getting stronger, and I was improving every day until around the 3 wk mark when I was starting to feel a little discomfort but more annoying was the numb tingling feeling I had on the left side of my lower back wrapping around my side. This only became noticeable after about 800m of walking. I reduced my walks to about 4x 600m walks a day. I found walking any more and the pain would increase.

    At the 1month follow up the surgeon was happy enough and said it was normal for some pain to return and to have unusual sensations aswell. He gave me a script for more lyrica should I need it and said to walk as much as I can and come back at 3month mark. Over the next 2 months I had started to improve and I was increasing my walks and reducing lyrica and pain was subsiding. A wk before my 3month follow up I was off lyrica and only using panadol if needed, I was also up to walking a 5km walk once a day aswell as 2 or 3 5-6min walks. I was growing in confidence aswell and probably walking a bit faster. Then 1 wk before my 3month follow up i started to feel some pain again and I had to cut the walking right back down to a few very short walks again. I’ve noticed also that any day I do too much walking, along with feeling extra sore the next couple of days I would also have a really tight left calf muscle.?

    So I informed consultant at 3month follow up and he asked how bad the pain was and could i walk through it. I said i only start to feel some pain now at 800m and it isnt bad but gets worse and the problem with walking through it is trying to sleep that night aswell as feeling worse the next day. I said also that I had been using the onset of pain as a guide to my limits and that was how I was building up my walking distance trying to go a little further every other day if I felt up to it. He said to go back on lyrica until you feel you can come off it while also trying to build the walking back up and see if you improve and come back at 6month mark.
    I did that and after a month I started to improve again but like before when I had built up to about one 5km walk along with 2 or 3 5-6min walks the same thing happened. So I rested up for a week just doing very short walks and I decided to come off the lyrica over a 2 wk period which I did and I’m now taking nothing. While taking no meds I can walk about the house and sit down pretty much pain free but I start to feel some discomfort after walking 1km. My 6mth follow up was supposed to be 3wks ago but for some reason had to be put back until early December. I have since rang them to get me another mri before I see him.

    The past 10days has been great though. I had a flu and had to go to my GP and he put me on a steroid aswell as anti biotic.
    The steroid not only gave me a boost of energy but it has relieved my back symptoms a lot. Yesterday I did 2x 2.5km walks and i was active most of the day aswell without hardly any pain. I’m off the steroid 4days now and it’s still working seemingly. I know it will prob wear off soon though.

    Any advice?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    I’ve summarized your history and symptoms here. “A flare up would be when my left buttock would tighten up really tight and I would get a dull pain down the left leg which left it hard to walk more than 200m….He booked me in for an injection which had no effect, infact I thought I was slightly worse after….small herniation at l5s1.I also noticed the disc was very thin….performed a posterior decompression of …nerve root…3 wk mark when I was starting to feel a little discomfort but more annoying was the numb tingling feeling I had on the left side of my lower back ….. This only became noticeable after about 800m of walking”.

    By the interpretation of your complaints, you might have both isolated disc resorption (IDR) and foraminal stenosis. Doing the previous decompression surgery can remove compression from the nerve root but may eventually aggravate lower back pain due to IDR and aggravate foraminal stenosis. All-in-all, however, it sounds like you are functioning reasonably well so I don’t think you have to jump into further back surgery.

    See
    https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/ and
    https://neckandback.com/conditions/lumbar-foraminal-stenosis-collapse/

    Dr. Corenman

    Discodan
    Participant
    Post count: 5

    Thank you for your quick response and after reading both the IDR and Stenosis links you sent it’s seems to tie in with my symptoms and the mri imaging I saw of my l5s1 disc.

    I suppose I’m also wondering what your thoughts are regarding the chances of my current symptoms improving given I’m now at 7months post op?? I’ve read that in some cases where a nerve has been compressed a long time (7yrs in my case) it can take much longer for the nerve to settle down. But I have interpreted that if I have IDR as a result of my surgery then the root cause of my symptoms now may not be from my decompressed nerve..

    If my symptoms do not improve over the next few months, is there any other treatment other than surgery that can help my situation? I’ve noticed the oral steroid I took for my flu helped, does this mean a steroid injection may help? I suppose my end goal here is to get back working at maybe 75% capacity and being able to walk/cycle a good distance.

    When you say not to jump into another surgery, are you saying that maybe I should be happy with where I am and settle for that? Maybe that is the way to go and I may have to get my head around that. I suppose I just love being active but I am aware that there are people in much worse situations than me.
    I won’t be jumping into another surgery and if it’s suggested as an option to me Id definitely be getting a second opinion.

    Thank you again for your response, it’s hard to get a response let alone and informed opinion on any other forum.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    You can try an epidural steroid injection to calm down the nerve root and patiently see if you can slowly increase your capacity for exercise. When it’s time for further surgery is not easily definable. I like William Potter Stuart’s comment when he was asked to define pornography. He said “I can’t define it but I know it when I see it”.

    Dr. Corenman

    Discodan
    Participant
    Post count: 5

    Seems pretty sound advice. I’ve been able to build up my exercise twice already before the flare up/setbacks so I’m still hopeful that I can do it again more patiently and steadily.
    Im booked in for MRI and follow up on 9th/Dec so I will know more then.

    Thank you again for getting back to me.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Please keep in touch with the Forum for further developments.

    Dr. Corenman

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