Well, Screw That!

[Insequent]

I had the guided steroid injection almost 4 years ago. No issues at all since then, but I am more careful about doing potentially problematic things since then. The injection hastens reduction of inflammation, which may well have occurred anyway. Although with worsening pain, which Menzies is having (like I was), a kick start for the process can be very beneficial.

Good luck with it!

 

[ssobol]

"There's nothing wrong with you that an expensive operation won't prolong."

 

[menzies]

Just waiting to be discharged after having the injection into L5-S1.
Not the best of experiences but hopefully the outcome will be more than worth it!

 

[Datenight]

He doesn`t mention the muscle spasm which goes with it where muscles spasm to protect underlying structures, and is severely painful with certain movements.[/QUOTE]

Bruce,

I was trying not to write a book! I had the spasms and could not lie down. Could only sleep in an easy chair and that was only an hour or two at a time. As Menzies said, "Non stop pain is bloody tiring".

When they tried to do the MRI I had to do the 48 minute procedure twice because it was so painful to lie still the first time. No luck the second time either.

Menzies, I hope the injection works. If not there is hope.

Rob

 

[menzies]

When they tried to do the MRI I had to do the 48 minute procedure twice because it was so painful to lie still the first time. No luck the second time either.

Rob

I had disc erosion between C6 and C7 about 15 years ago, ended up with a
cadaver fusion.

The first try at the MRI the pain was so great from having to lay my neck flat that I literally screamed for them to let me out. I think they thought I was being claustrophobic! But it was the pain.

The second time they pumped me full of Valium and it worked!

 

[Datenight]

Sorry to go off topic but I just noticed that my last post was 571. As a Groton, CT boy born, raised and still living here, 571 is the number of the Nautilus the first nuclear powered submarine. A shout out from the Submarine Capital of the world.

Rob

 

[BruceK]

He doesn`t mention the muscle spasm which goes with it where muscles spasm to protect underlying structures, and is severely painful with certain movements.

Bruce,

I was trying not to write a book! I had the spasms and could not lie down. Could only sleep in an easy chair and that was only an hour or two at a time. As Menzies said, "Non stop pain is bloody tiring".

[/QUOTE]Rob,I get that, knew it would be there, as painful and disabling as the condition it tries to protect. I saw an ortho recently for a knee, he had back muscle spasm from some activity, I could see it strike with any minor movement.
Rob, you are a great advertisement for surgery when it is really called for.

 

[SteveK]

I can relate to all of the above, 3 injections over two years, chiro & massage over the years since.
about 2 years ago went for several chiro and massage treatments which did not last more than a couple weeks. So went searching for alternates.

OK, here is where I will lose a lot of you.
Bought an inversion table. go on it as needed for 3-5 minutes.
Bonus was it also took away the stiff neck. Sure have to go on it a couple times a week but it is paid for and continues to produce.
Your experience may vary, just throwing out what finally works for me.

 

[alormaria]

Had Sciatica problems a few years back. Chiropractor and masseuse took care of it for me. Other back problems keep re-occurring but not the Sciatica.

 

[otnot]

I've had chronic back problems all my life due to a childhood accident which broke a vertebra. I just went through a bout of Sciatica this past fall that hurt so bad I couldn't walk or stand up. I have had this happen at least 6 times and the only relief I have found is Chiropractic and ice. I'm fortunate that a lifetime friend is a chiropractor but he lives 200 miles away. This last episode I tried 2 different local chiropractors that only made it worst. Finally unable to stand the pain anymore I had my wife drive me the 200 miles to see my friend. I hobbled in to his office and walked out upright. He isn't your typical chiropractor. There is no bending and cracking of bones. It's more of a massage and adjustment at the same time. I don't know how many times I've crawled into his office and walked out.
Give him a call he's a great guy and I'm sure he would know of a chiropractor in your part of the country that practices his technique.
Alaska Chiropractic Arts
Fred
(907) 563-3839
Tell him Jim from Kasilof sent you. I know what your going through and I feel your pain. Surgery isn't the answer.

 

[The Brockerts]

Nothing that 8 screws, and 2 -10 inches and 1-3 inch titanium rod can't take care of.


The Brockerts

 

[IfItsWorthDoing]

FWIW I'm an anaesthesiologist, not a surgeon or radiologist, but that looks to me like it's at the L4/L5 disk level not L5/S1, so notwithstanding you got imaged at the Mayo clinic I would ask them to just double-check the images and reports (CT or plain X-ray and MRI should also tally on this). In the meantime, unloading your spine should help, so cut down on being upright and look for some monkey bars to suspend yourself from for a while. Physio advice will be crucial, and probably start on Gabapentin or Pregabalin but be mindful that that will impair your balance/sleep/memory/judgment in the beginning! It all might heal without any need for surgery if you are lucky ...

 

[Potomac boater]

Disc

I don’t know what the guy who read this was counting but usually the last disc above the sacrum is L5S1. It looked like a L4/5 disc to me. Kinda of a big disc. See if the read is correct
My2c you really need to see the axial images to see if it 4/5 or 5/1

 

[moparharn]

I felt and feel your pain.
Mine started in 1978 at age 18. Surgeries in 2004 and 2013, and several focal blocks along the way. Your impingement is not minor, and with foraminal narrowing you may likely be looking at a lamenectomy versus a simple resection. I think I read you are going on a vacation? If so, be kind to yourself and do what feels best. If you should lose bowel or bladder control at any point you have roughly 6-8 hours to get into surgery or the nerve damage could become permanent. Surgery should be your last and final exhaustive choice. Go only once you are begging for it because nothing else less invasive worked. I broke a disc off (fragmentation) in 2009. We chose not to go in and get it out of the central spinal canal. That nerve damage is now permanent. I get muscle cramps up the inside of my thighs from my knees to my nuts when I over do it. The pain is sinister. You will be fine, but if your vacation is taking you well away from a competent surgeon you might want to postpone this trip until this issue is resolved. My personal opinion is that with an impingement like yours I would skip the chiropractor and inversion table until it has receded some. No significant movement of that area for a little while. Choose your chiropractor carefully and only invert to about 210 degrees or so at first. Good luck ( you won’t need it) and welcome to hell for a short time.

 

[Maryboo]

Not a doctor but I feel compelled to say this. I speak from experience. What’s going on in that xray should not be any where near a chiropractor, and the good ones will surely tell you to see the surgeon and not do any damage. Weigh your risks of getting in serious trouble at sea or out of the US and the visit to the surgeon wont look nearly as bad as those. This is beyond a rum and coke. Don’t risk permanent damage.

 

[Tim]

Stenosis Surgery

I had a pinched nerve at L3 and could barely walk around the block without stopping to squat and stretch my back. Had very successful surgery, went home the same day and was walking pain free 3 days later. Still lingering after effects of nerve damage done before surgery. Don’t wait on this. First discovered when doc asked me to walk on my tiptoes. No strength whatsoever in right foot. Has been 5 years and still no problems. Surgeon cut a piece out of vertebra freeing the nerve running down to my right leg. Good luck and get it taken care off.

 

[Poach]

back pain

I had a similar back thing. My doctor and a physical therapist suggested that before I undergo surgery, I get a book called something like Heal Your Own Back. The author is a doctor named Makenzie (sp). It is not written in doctor-speak and has a lot of interesting info on relieving back pain including immediate relief through a particular exercise. In my case, in the end I had to have surgery. It was day surgery, through a scope, and I went home that day. No significant issues since, but I keep my Makenzie handy.

 

[Knot Salted]

Careful!

Had the same issues L5S1.

Waited too long trying chiro, stretching etc for..months.
Finally locked up standing in a pool of pain and sweat.
Ambulance ride with surgery next morning.
Awoke pain free for the first time in years.
Coulda done jumping jacks!!

Numbness in outside calf and top of foot is permanent.— 17 years later still.
Waited too long. Had another 10 years later as symptoms began on the other side. I went straight to the same surgeon and got it headed off.
They wanted to put screws and pins in and I told them absolutely NOT.
Been fine again since. Stenosis will catch up again sometime though.
No more He Man stuff.

 

[obenton]

Bulging disc

I am a urologist and unfortunately I have a disk problem as well. A bulging disc can certainly be decompressed where itis impinging on the cord. It looks like you have some decent disc Remaining between the vertebral bodies. Good luck with the surgery.

 

[localboy]

Lower back pain sucks. I have the same issue, bulge between L5/S1. Mine is luckily not chronic, yet.

On the good news side, my wife was a gymnast and suffered a severe lower back injury in her teens. It became chronic pain in her late twenties which only worsened. She finally resorted to surgery, but not fusion. She has one of the first artificial lumbar discs implanted in her lower back. She was part of a clinical study in the U.S. of the efficacy of disc replacement vs fusion. The surgery was already being done in Europe but not in the U.S.

Over a decade pain free and she still has full motion in her lower back. Her model is the Kiniflex. I have no idea if it ever got full govt approval or not but there are other versions that have. Google Charite. I believe it’s FDA approved.

You don't chose surgery, it choses you.

So true. She did years of PT, lumbar corticosteroid shots etc and got only temporary relief. She finally could no longer live with it and would wake up with a “dead leg”. She finally looked for an alternative and was a perfect candidate for the clinical trial. Luckily, it has been positive.

 

[Palmbeachphil]

Why would you look to this forum, or the internet for that matter, to seek an answer to a medical problem. It’s like looking to a cooking site for an answer to your boating questions.

 

[BruceK]

Why would you look to this forum, or the internet for that matter, to seek an answer to a medical problem. It’s like looking to a cooking site for an answer to your boating questions.

I don`t think the OP is doing that. He appears to have sought and be undergoing treatment from skilled practitioners in the area.
It`s obvious a number of members have personal experience of back issues and treatments, of aggressive,conservative, and even non mainstream kinds.Sharing experiences seems fine.Reading them reveals common features of related experiences, which may well be a comfort to the OP. I`m surprised the identification of the affected level came under gentle question but it has, from people with some qualifications to read an Xray.

 

[menzies]

Why would you look to this forum, or the internet for that matter, to seek an answer to a medical problem. It’s like looking to a cooking site for an answer to your boating questions.

Who did that?

 

[menzies]

Had the injection Friday 2/7.

For the medics on board below is the summary.

They said it will start helping after five days but not be fully helping until after 14. It does feel better but not great. Will see what next Friday (14 days) feels like.

------------------------------

PROCEDURE SUMMARY
Indications: Spondylosis without myelopathy
Site: lumbar
Lumbar: transforaminal epidural injection
Transforaminal epidural injection: Left L5
Needle or RF cannula: Spinal
Needle size: 22 G
Needle length: 5 in
Flow: peripheral and central
Patient position: prone
IMAGING
Fluoroscopic guidance: Yes
INJECTED MEDICATIONS
Total volume of injectate (mL): 3
Total steroid in injectate (mg): 10
2 mL bupivacaine 0.25 % (2.5 mg/mL)
10 mg dexamethasone 10 mg/mL
1 mL iohexol 300 mg iodine/mL
PROCEDURE DETAILS
Transforaminal epidural injection - lumbar: After identifying the appropriate pedicle fluoroscopically with an oblique view. A spinal needle was then
advanced under fluoroscopic guidance to the posterior aspect of the neural foramen. Appropriate foraminal depth was determined with a lateral
fluoroscopic view, and AP visualization confirmed needle positioning at approximately the 6 o'clock position relative to the pedicle. After negative
aspiration, contrast was injected using live fluoroscopy and digital subtraction angiography, confirming appropriate transforaminal spread without
evidence of intravascular or intrathecal uptake. A local anesthetic test dose consisting of 1 mL of 2% lidocaine was injected through the needle.
After an appropriate period of observation, a directed neurological exam was performed which revealed no new neurologic deficits. Next, the
injectate was injected slowly and incrementally into the epidural space. Following the injection the needle was withdrawn flushed with lidocaine
as it was fully extracted. The patient tolerated the procedure well and there were no apparent complications. After appropriate observation, the
patient was dismissed in good condition under their own power.

 

[Potomac boater]

The lumbar nerve roots exit beneath the corresponding vertebral pedicle through the respective foramen. For example, the L5 nerve root exits beneath the L5 vertebral pedicle through the L5/S1 foramen. Since most disc herniations occur posterolaterally, the root that gets compressed is actually the root that exits the foramen below the herniated disc. So, a disc protrusion at L4/L5 will compress the L5 root, and a protrusion at L5/S1 will compress the S1 root. Ninety-five percent of disc herniations occur at the L4/5 or L5/S1 disc spaces

From the net but correct

 

[menzies]

And unfortunately I have both, however the L4/5 is impacting the right side nerve but I am not having any issues that side. The L5/S1 is the one impacting my left leg. So that is where the injection went.

 

[Kit_L]

It is possible to have a compressed segmental nerve (via the extruding disc mechanism, as seems to be the case here), and piriformis syndrome at the same time, where a muscle in the hip is compressing one or both of the trunks of the sciatic nerve on that leg's side. All the symptoms (including neurological deficits) of full blown disc-induced sciatic can be caused by p. syndrome and, experientially, is not distinguishable from the disc-induced sciatica.

It is also possible to have piriformis syndrome, with all the neurological deficits that are usually caused by disc extrusion, and have an MRI or CAT scan done and disc pathology found—but for the found pathology to not be the cause of the symptoms.

If this is the case, try the exercises slowly and carefully, and then walk around. If p. syndrome is involved you will know. Do indicated exercises only twice a week. Good luck.

There is much more, but the short story is that sciatica is a threshold phenomenon, and the causal mechanisms can be additive—so, sometimes, removing the p. syndrome cause, if present, can give huge relief. Piriformis has been posited as one of the mechanisms behind the success of chiropractic in some cases, too: the 'lumbar roll' (side lying position, one shoulder restrained, and force applied to the outside of the opposite leg's knee) that is the most common lumbar adjustment also momentarily strongly stretches piriformis, and that can have a seemingly miraculous effect.

In any case, try stretching piriformis. Please go here:

https://www.youtube.com/user/KitLaughlin/search?view_as=subscriber&query=piriformis

And look through the first five exercises; the chair versions are the easiest. You will know immediately if p. syndrome is contributing to your pain: getting into the start position of any of these will reproduce the hip pain component of sciatica immediately. If this is the case, and you are maintaining the shape of the lumbar spine, then you can be reasonable sure that piriformis is at least contributing to the problem.

 

[Potomac boater]

Disc and nerves

Can’t help it. Will chime in one more time
Do a complete exam. Check manual muscle testing, reflexes, and dermatomal pattern. Ask where the radicular component of the pain spreads
Web space of great toe and second toe L5. S1 back of calf to heel. Etc etc etc
Mri only conforms diagnosis and will find odd other DX such as neoplasms , fractures , degenerative disease

Good luck to you
Treat the patient not mri

 

[Kit_L]

Treat the patient not mri

Could not agree more.

 

[menzies]

Can’t help it. Will chime in one more time
Do a complete exam. Check manual muscle testing, reflexes, and dermatomal pattern. Ask where the radicular component of the pain spreads
Web space of great toe and second toe L5. S1 back of calf to heel. Etc etc etc
Mri only conforms diagnosis and will find odd other DX such as neoplasms , fractures , degenerative disease

Good luck to you
Treat the patient not mri

They did all that - the manual exams (one of which indicated zero hammer reaction at the left heel BTW), plus EMT. Pressing against the docs and physios, strength measurements at different places etc. etc.

But to your point, I did stop doing the P.S. stretches - so maybe I need to start those up again.