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update after x-rays

PostPosted: Tue Jan 09, 2007 5:49 pm
by cygnet
Well, I had some x-rays today and learned that my L5-S1 disc is completely collapsed! My sciatica problem is coming from the last remnants of disc gel that leaked into the spinal canal and irritated the nerve. The disc has been degenerating for a long time and probably leaking for months. I also have bone spurs on the two affected vertebrae. Yikes - I'm still just in my thirties!

I've never had significant pain from the degenerating disc. December was the first episode I've had of really severe pain, ever. It's been leaking, but until recently, not in a way that affected the nerve.

I guess the good news is that once I recover from this disc herniation, there will be no more disc to leak. :? hahaha :roll:

There is no misalignment, so if the two vertebrae fuse together, it will be a natural version of spinal fusion. There may be problems further down the road, but I'm hoping for the best and planning to focus on maintaining fitness and doing back exercises religiously from now on to keep the muscles and ligaments strong.

My grandfather had three spinal fusion surgeries - cervical, mid-back and lumbar. I want to avoid that outcome if at all possible.[/i]

PostPosted: Tue Jan 09, 2007 6:54 pm
by randolph
Hi Cygnet.

Hoping you can educate me here.

You had X-rays, right ... not an MRI? And they knew all that stuff about the disc and nearby nerves from an X-ray? I thought X-rays were only good to see bones, and for softer tissues, like a disc, you needed to have an MRI. I'm confused about something here.

But at any rate, they are telling you that your vertebrae will naturally grow together in the absence of the disc that normally is between them. In the process of doing so, possibly painful?

This next paragraph is something I've been wondering about recently. Maybe what your doctors told you can shed some light on it?

It seems reasonable to assume that the disc that has degenerated so much has been doing so for many months, possibly years ... and your doctors are saying that it's only now causing pain because somehow you were lucky enough for the leak to only recently be irritating the nerve. Do they know that, or are they assuming that must be the case because they believe there could only be pain if there was disc material irritating the nerve? Why I'm asking is because I recently read research from a nuerosurgeon (wish I could remember who) who claimed that nerve irritation from mere presence of disc material cannot account for sciatica pain. If nerve irritation was the cause of the sciatica pain, the nerve would have to be compressed much more than any amount of disc fluid could do. His main point was that the presence of disc abnormalities is just coincidental, and not a cause for sciatica. And he states that possible proof for this is that surgery that removes the disc material away from the nerve is just as likely to fail to relieve pain as it is to do so. Like I say, just wondering if your doctors shed any light on this.

Can you give a brief rundown on why your grand-dad had the surgeries, and how successful they were? Spinal fusion therapy is one of the riskier ones from what I've read.

Thanks, Randolph

PostPosted: Wed Jan 10, 2007 9:06 pm
by cygnet
Hi Randolph,

I'll try to give you a little more info...

OK, first, I did have x-rays and not an MRI because I'm paying for the medical costs myself. I'd like to have an MRI, but it's really costly. MRIs show more detail of the soft tissues, but some things can be seen on an x-ray. My x-ray showed that there was virtually no space left between L5 and S1, and it clearly showed osteophytes - bone spurs. The other discs appeared to be a normal thickness.

From this, and from my very specific symptoms, the doctor could diagnose a few things. First, the disc takes time to degenerate, and it takes years for osteophytes to form. So the disc has been busted for quite a while.

Second, the location of my leg and foot symptoms is very specific - the pain runs along the side of the calf, and there was tingling along the top of the foot and in the big toe and next couple of toes. When the pain/tingling runs along that pathway, they know that the L5-S1 nerve root is the one affected. I've also lost some muscle mass in the affected leg - my left calf is a little smaller than the right one now. I think that means that the nerve has been compressed or compromised.

You're right that the sciatica is a new pain, although the disc has been degenerating for years. There has just recently been leaking of the disc gel into an area where it hit the nerve and caused irritation.

From what I understand, there are different stages of disc problems. You can have a bulging disc that presses on a nerve, and not have any pain. If the disc actually ruptures and the "guts" leak out, they may not leak into an area that affects the nerve. Or, you may have disc material touching a nerve - which causes pressure and chemical irritation. The chemicals in the disc material, if they touch a nerve root, can cause irritation and inflammation. Maybe some people are more prone to having that kind of inflammatory response than others.

The part I wrote about the vertebrae fusing together eventually was from a discussion I had with my mother. She has some experience with spine and joint issues as a (retired) RN, and because she and so many people in her family have complicated joint problems and arthritis. I found some useful information at spine-health (dot com). If you go to the degenerative disc disease section and look for the article titled "what is degenerative disc disease" and then find the section "the degenerative cascade", there is a description of the stages of disc degeneration and how the joint stabilizes eventually.

From what I've read, degenerating discs don't always cause pain. It's a very common condition - it happens to almost everyone as we age (although having a disc completely degenerate may be less common).

My grandfather had lots of spine problems for a long time. I don't know all the details,but I know he had three spinal fusions for disc problems, I guess - and then when he was in his 70s he had a steel rod put into his back. He had problems with his vertebrae, not just the discs. That's all I know...I just hope my story takes a different path!

PostPosted: Fri Jan 12, 2007 6:40 am
by randolph
All very interesting, Cygnet.

So the doctors are saying that your sciatica pain is a product of a chemical interaction of the leaked disc material and the nerve tissue ... an interaction that, of course, normally doesn't happen since the two tissues are normally not touching.

I'm assuming the body has ways to clean up the mess ... did they give any indication how long it would take to heal, and things you could do to help the healing.

Thanks, Randolph

PostPosted: Fri Jan 12, 2007 1:13 pm
by cygnet
Hi Randolph,

Yeah, the disc material supposedly gets reabsorbed, or dries up, or scar tissue forms around it that may help protect the nerve from the chemicals. I was told it takes several months.

Dean's articles about pinched nerves and herniated discs talk about this too. I like the positive tone of Dean's articles. It's encouraging.

I'm looking forward to doing the RYB exercise program once my pain subsides enough to stretch and exercise more. Not being able to do more to help with my healing has been extremely frustrating.

I'm doing some limited walking in the mornings, but still can't get very far before the pain gets severe and I *have* to sit down. I'm an active person, and this lack of mobility has been really hard.

How are you doing these days? Hope you're still feeling 100% better. It's really nice that people like you and Ken, who are feeling better, come back to check in on these boards sometimes.

PostPosted: Fri Jan 12, 2007 2:26 pm
by randolph
Hi Cygnet

Last month you mentioned receiving a cortisone injection .... and possibly, later, getting a medrol pack for pain relief. Did the first injection end up helping any?

The NYTimes article should be very encouraging for you. I definitely believe the doctors have a good idea encouraging us to push ourselves more than we'd be inclined to think possible. I erred on the side of babying my back too much ... and I think I unnecessarily delayed my recovery by several months. NJ Ken was pushed pretty hard by his PT, after receiving his epidural, and it seems to have worked for him.

I'm back running again ... building up my endurance (up to a couple miles every other day) after more than a year off due to the sciatica. And just spent a lot of the days the last week digging out a big ol' stump with a shovel and pick. Got a lot of sore muscles ... but it's that good sore from using muscles a bit more than I've been used to lately. It reallly feels good to resume life again, without worrying about my back.

Hopefully, you've got some good things to do when the pain makes you lay down. I actually ended up having quite a lot of fun while I rested during that acute stage you're in now, playing board games with the kids, reading lots of good books, writing letters to friends, watching movies, and surfing the net.

I almost ended up getting a microdiscectomy (recommended by an osteopathic surgeon), but folks here encouraged me to continue giving the PT a try. So being recovered without doing the surgery motivates me to want to visit here as much as I can, and encourage others who might be going thru the same thing. Those first few months of sciatica are pretty hard.


PostPosted: Fri Jan 12, 2007 9:35 pm
by cygnet
Hi Randolph,

Running again - that's great! Good to hear your success story.

Yup, I had an injection a few weeks ago, but it wasn't an epidural. I'm not sure what it was - some kind of nerve block. It didn't have any noticeable effect. May not have gone to the right area.

My doctor gave me a prescription for the Medrol dosepak last week, but I just now filled it. The pain is still bad, so I'm going to try it soon.

Ken said that if you have a positive response to the Medrol, you are a good candidate for the epidural injection. Wish me luck, everyone.


Good luck....

PostPosted: Sat Jan 13, 2007 9:21 am
by krd
Hey Cygnet

Just so you know, it took about 4 days till I noticed any results from the medrol pak, and that change was only minor. I noticed it most of all in my calf area, the cramping was not constant.

If you opt for the epidural injections, make sure they do it under "guided fluoroscopy". They actually use an Xray machine to make sure that the medication is being placed in the right area of the spine. It took 2 for me spread out over 3 weeks. The first was amazing, and the 2nd took about 1 week later to kick in.

Remember, try to find a McKenzie certified PT in your area. You can google McKenzie and find their national site. From there you will find a list of PT's in your area. Whatever you do, even after you are done with the PT, continue to do your exercises everyday. That is the bottom line. According to my PT, 80% of people that get an epidural fail within the first year because they don't continue to work on the core exercises and strengthening exercies.

Good luck with the Med pak, and I will be checking in on your progress.



PostPosted: Wed Jan 17, 2007 9:54 pm
by cygnet
Hi everybody,

I haven't been online as much because I finally gave up dealing with sciatica alone and went to stay with relatives. It's better. I'm feeling a bit less anxious now that I'm not stuck at home alone. :-)

With the Medrol dosepak I noticed something similar to what Ken described: there was no noticeable change until the 4th day, and even then it was very slight. All I noticed was that I was finally able to lie flat on my stomach, and do the cobra stretch (just a bit, on elbows) for 10-30 seconds at a time. Not much, but it's a milestone for me because this was the first week I was able to lie on my stomach or do the cobra at all.

My doctor said that there would have been a more dramatic effect from the Medrol if I had taken it earlier on in the course of the sciatic nerve inflammation. Still, it must be helping some. From what he said I'm guessing that if the nerve has been inflamed for a long time, it will take longer to heal.

My doc also said that it will be six months before the healing is complete. I have some nerve damage and loss of muscle mass. I assume the pain will gradually lessen over the next several months. At the six week mark (today) I still can't walk any distance without pain, or stand for very long either. least I can start doing the cobra!

On the insurance front, no luck yet, but I'm still trying to find coverage (what an inhumane horrible system we have!!!) that will allow me to get physical therapy. Perhaps now that I've lost my job due to this injury, I can qualify for medicaid.

If I can find insurance coverage, I'd like to try the epidural injections at this point in order to move forward with physical activity. There is a spine clinic near where I'm staying that offers PT that incorporates McKenzie exercises. I hope to find a way to access their services.