Hi, I need some help understanding the conclusion on my MRI. I don't know if it's serious, minor, or somewhere in between. I'm also trying to figure out if it looks like there is another surgery in my future. I will find out more from the doctor, but this is workers compensation doctor and I'm beginning to feel like I'm not getting the care I need.
A brief history of my problem began in August 2012. I fell at work lifting boxes. An MRI revealed a bone fragment at my L4/L5 level. In November 2012 I had a laminectomy to remove the fragment. As I recovered and returned to work, I continued to have severe pain in my back that radiated down my leg. I had another MRI in January that showed nerve impingement from a disc bulge at L3 and scar tissue pressing the L4/L5 nerve root. I was sent to a pain management doctor who recommended epidural steroid injections. I wanted a more conservative treatment, so we tried gabapentin for two months and lyrica for one month.
Ultimately, and because this is a workers compensation case and I am limited in my treatment options, I had to agree to the injections, which i had on Monday, April 15th, 2013. I have a severe, severe fear of needles and developed an extreme panic attack by the time I arrived in the office. My heart rate elevated to around 145, I was hyperventilating, shaking, and my chest was tight. They gave me two Valium to try and calm me down, but proceeded to do two injections while I was in this state, at the L3 and L5 level. The following day, I developed a severe headache, unlike anything I'd ever experienced. I do have a history of tension headaches and take topamax for them, but this was nothing like that. I also had horrible pain in my back, which I thought might be expected following the injection. I called the doctor and told him about the headache, but he said it was unrelated to the injection. He said to call back if it got worse and that he would call in some pain medication. On Thursday, I called again. The headache was unbearable anytime I was out of bed. The doctor told me there was nothing he could do for me and would refer me back to my original doctor. Finally on Saturday, I went to the ER and was immediately hooked up to an IV and given pain medication to stop the headache. I had an MRI to check for an epidural abscess, which there was not, thank goodness. The ER said that I had a small leak of spinal fluid from the injection. They gave me the MRI report, which says:
General: Since the prior study a Schmorl's node has developed within the superior endplate of the L5 level. This is associated with subtle loss of L4/L5 disc height
L4/l5: loss of disc height and disc hydration with L5 Schmorl's node as described above. There is a broad based disc bulge which extends into the right neural foramen. There is complete effacement of the soft tissue in the right neural foramen with subtle enhancement following administration of intravenous gadolinium. Differential considerations are those of a disc fragment versus post procedural changes related to recent spinal injections.
L5/S1 mild bilateral facet hypertrophy. Subtle left paracentral disc bulge.
Any insight into this mess is so appreciated. I just want some help understanding why I'm in so much pain.
I am sorry to hear you are in so much pain. Regarding the headache—you have developed a spinal headache. A headache that worsens on standing up and improves or disappears on lying flat is a spinal headache. This happens when the CSF pressure in the brain falls. This usually happens after spinal anesthesia (also includes epidural shots), spinal taps, or spinal injuries. A procedure called an epidural blood patch, if is successful, even temporarily, it generally means the patient does indeed have a spinal headache. A small amount of the patient’s own blood is injected into the space between the dura and the bony spine known as the epidural space. If this causes temporary or permanent cure of headache, the diagnosis is confirmed.
Regarding the low back ache, you need to change the nature of your job. It is important to not lift weight. Spinal traction should be helpful along with other physiotherapies. Along with pain medications, physiotherapy, hydrotherapy and manual traction should help. Please discuss with your doctor. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
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