Hi, I am a 36 year old female. I am having major problems and really want to find relief. My injury began 17 years ago,giving birth to my son, herniated L4L5 S1. Was bad off couldn’t walk etc. Neurosurgeon refused surgery, said I was to young (19) I went through extensive therapy, work hardening and after a few years, got back to being able to manage. For all these years would have bouts of “back being out” muscle spasms etc. -Always been very active worked out etc always been right weight.

About two years ago it all changed, extreme back pain sciatica left leg. Had no medical insurance, doctor sent me to pain managment had LESI and a CODL nothing changed at all. Physical therapy, nothing changed. Began vicodin and could manage through the day, pain best in morning and as day goes on, back pain worse and worse. Vicodin helped me keep going. Never sat around, kept going. Two surgeons recommended artifical disc replacement, diagnosed me as degenerative disc disease. But wasn’t approved yet, and they said I want the surgeons to have practice. They both said no to fusion, and told me most surgeons would just fuse me. I continued on, walking four miles a day at one point, no back pain relief. Finally in feb of this year, I couldn’t continue. My general doctor told me I needed to quit working..dog groomer…and I felt like I was going to die. Sitting kills me, lifting kills me etc. Left leg etc.- Since being off work sciatica a little relieved at times. Finally approved for state medicaid. Vicodin has quit working.

Now left leg is still killing me back and now the right leg is started to occasionally do the same thing and somethimes sharp pain in vaginal area. Dr ordered new MRI, it states severe degenerative disc disease, minimal retrolisthesis of L5 on S1. Associated broad based bulging annulus/disc protrusion as well as spur. Completely flattening the anterior thecal sac. inferior aspect of the neural formina are slightly narrowed especially on left. Mild fact arthropathy is present with small amount of fluid within joint as well as hypertrophic spurring and minimal buclling of ligament flavum..

Went to ER when started having pains in vaginal/groin area. They got me into see neurologist, she said she didn’t think I needed surgery, she said my right leg has delayed reflexes and i probably need physical therapy and injections again. But did refer me to neurosurgeon which isn’t for a month.

I don’t understand why two surgeons told me I need artifical disc, and neurologist says no surgery. My family doctor said not to listen to neurologist that i need to be seen by surgeon, that there is a big difference between the two doctors.

I don’t WANT back surgery, but I want my life back. I am trying to walk atleast a mile a day again. Combination of regular sciatica and shooting pains, needles, numbness, burning in left leg, and burning on back etc. The weird thing is it never stays the same, it seems like its shifting or something.

I am at the point of just someone please fix it. i have been researching and it seems that injections only offer tempory relief, but haven’t given me any. By my stuff, what do you think?

I know this is long-winded, just trying to be specific. I am going to be attending the teaching hospital truman medical center in kansas city. I am very afraid of being blown off and want my life back.

Dr. Sinuhe’s Answer:

Thanks for your question. Chronic back pain is impossible to solve over the Internet, especially without seeing the MRI, but I’ll try to present some talking points for your visit to the Truman Medical Center.

Sciatica/radiating pain:
In general, nerve root L5 is most often affected by herniated disc (or hypertrophic spurring) between vertebrae L4 and L5, whereas S1 root by something bulging between L5 and S1. Now, irritation of the L5 root most often causes sciatica to lateral thigh, radiating further to the front side of calf and even further to the top of the foot towards the big toe. S1 root irritation, in turn, tends to cause sciatica radiating to the back side of your calf and heel towards the little toe. If you have one of these rather specific pains as well as something compressing the particular root on MRI, chances are that surgery would be helpful. Judging by your MRI report alone, it is not possible to say whether you need an operation.

Instability:
As strange it may sound, local back pain very often is not relieved by spine surgery. If you have symptoms of instability, things are, however, a little bit different. These symptoms are often local, sudden, knife-like pains related to movements or trying to stand up after brushing one’s teeth, for example. If MRI also shows signs of instability, fusion may be an option. Especially so if the root pain (sciatica) is worsened at the same time (suggesting that the irritation of the root gets worse when the vertebrae move a little). While symptoms are the most important thing, MRI can also give a hint about instability, but sometimes a flexion-extension MRI with forward and backward bending of your spine may be needed to rule out instability. Operative treatment of instability is much more complicated than “simple” disc surgery for sciatica, technically as well as due to difficulties in knowing who will benefit from surgery and who will not. Artificial disc, in turn, has possibly been suggested to you by your neurosurgeon because of your young age - is is not always a good idea to make a “classical” fusion in a very young person. Artificial discs are a relatively new thing.

Pain types:
Before your visit to Truman Medical Center, please take a look at Dr. Joshua’s previous answer to a chronic pain question to learn about the difference between “normal” (nociceptive) and neuropathic (due to chronic nerve tissue damage) pain. The fact that your pain is not constant suggests it is not neuropathic by nature, which makes surgery an option (surgery may actually worsen neuropathic pain).

Conclusion:
All in all, when deciding whether to operate or not, it is crucial to know where the pain is and how it feels and compare this to the MRI . Otherwise it is impossible to determine whether an operation is needed or not, and if it is, then exactly what kind of an operation - just simple removal/decompression of the disc/bone compressing the nerve root, or a bigger operation with fusion or artificial disc. Please keep us informed how things turn out.

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