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Herniated disc, CT results - opinions?
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Herniated disc, CT results - opinions?

I'm new here, although I've been reading for awhile.
I have suffered from lower back pain for about 4 years, thought never severely. I tried physio and pain meds, but there was never much of a change.
About 6/7 weeks ago I woke up in agonizing pain. Went to the Dr who prescribed me oxycodone and sent me for a CT scan.
In summary, the CT scan said -
-Retrolisthiasis of L5 on S1
-Left paracentral disc protrusion with mild calcification
-Mild indentation on the thecal sac
-Marked compression of the left side S1 nerve root.

Ever since this episode I have been unable to do most of my normal activities. I am housebound, and struggle to shower and dress myself.
My left leg hurts all the time, burning down the back of my thigh and calf, on the side of my knee, and numbness and tingling on the outer side of my left foot.

I am getting an MRI in 5 days, and then seeing a neurosurgeon a week later.
I am going nuts trying to figure out what he will recommend - steroid injections, physio, surgery?

The level of pain in my back and leg are debilitating, and I cant see it improving anytime soon.
Does anyone have any opinion or advice?
NB: I am currently on Lyrica, Oxycodone, panadeine Forte and Diazepam.
24 Comments Post a Comment
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Avatar_m_tn
Sorry to hear you've been having so much pain. Doctors don't general recommend surgery right off the bat, unless their is some type of major Neurological concern or  some other type emergency or danger.

And I know here in the U.S a lot of insurance companies won't let them. The other treatments you mentioned like injections, different meds and physical therapy are a lot cheaper, and quite frankly are worth trying, they sometimes help. Surgery is very serious business and should only be done as a last resort.

It seems that your Doctor's on top of the situation, but It troubles me that you were sent home for 6 weeks with out a referral to Physical Therapy or to see a Chiropractor. I know  you can barely walk and that your pains bad, but any little bit of therapy you could do, could help. Being inactive often makes your pain worse, and your muscles tighten up more.

I've been where you are and I know what your going through, believe me. I know improvement doesn't seem possible, but it is. And very possibly without surgery. I don't want to tell you my story right now, it's too long.

Whatever you do, don't give up, if you need someone to talk to, I'm here.

Take Care

I
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Avatar_f_tn
Thanks for your reply :)

I dont want to have surgery if I can avoid it, and I'm happy to try anything at this point.

I know that this cant last forever, but I'm having trouble seeing the light at the end of the tunnel lol
At the moment the pain meds help me to be a bit more mobile, when I take them I only need the walking stick for (rare) trips out lol, and I can do a little more around the house.

I'm a little concerned at the strength of the painkillers, but I'm happy to take them as long as I have to.

Thankyou ,snapdragon
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Avatar_f_tn
I forgot to add, I'll explain a bit about the system in Australia.
While most of our medical expenses are covered, we do have huge waiting lists for things like physical therapy, neurosurgeons, any specilaists etc

My GP (family doctor) ordered the CT scan, and as far as I can tell, was completely unsure as how to proceed while waiting for the neurosurgeon appointment (which was originally Jan 8th). He didnt want to dens me to a physio or commence any treatments without me consulting with a neurosurgeon.

This week he called the neurosurgeon and basically begged him to get me in earlier, so we've had to rush around to organize an MRI and the yravel (3 hrs) to see the specialist.

Sorry for being long winded, the health system here can be great, but at the moment I hate it.
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Avatar_m_tn
Your health system sounds very similar to Canada's, they have long waiting lists too. As far as the Doctor not wanting you do P.T. until your consult, I can understand that, it makes sense. You know, as long as you try to be as active as you can, (don't hurt yourself or do too much) it will help in the long run.

I'm sorry, I miss the part in your 1st post where you said that you had already had some physiotherapy. You found that it didn't help at all? You have low back pain as well as pain down the leg? Was there something that happened that made you worse, are both the back and leg pain much worse? How bad was it before this happened?

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Avatar_f_tn
Ive been taking some short walks when my pain allows me (usually about an hour after I take my meds lol), and even if its not helping, i like getting out of the house.
I've had back pain for about 4 years, never as debilitating or as long lasting as this, and never accompanied by buttock/leg pain. I did a ten week course of PT this time last year, and I felt improvement after each appointment but it didnt seem to help in the long run.
Before I woke up in crippling pain, about 8 weeks ago now, I was in pain, but nothing severe enough to stop my normal activities.
MRI tomorrow, so I'll get the report on Wednesday :)
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Avatar_m_tn
Hope everything goes okay, last one I had, the technician was yelling at me for moving around too much. I couldn't help it, I was in a lot of pain.

Take Care
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Avatar_f_tn
It went ok, had to start over halfway through, because apparantly I was moving. I have no memory of consciously moving though.
Ill get the report tomorrow morning
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Avatar_f_tn
As promised - my MRI report

Findings -
Sagittal alignment of the lumbar spine is intact.

Vertebral body heights and bony signal intact.

Posterocenteral discopathy noted at L5/S1, degenerate disc signal. Remaining disc signals are intact, allowing for Schmorls nodes at all levels T12 - L3.
The conus is identified without significant changes to the conus.

L2/L3/L4/L5 - disc, thecal sac, foramina are intact.

L5/S1 - Mild left paracentral disc protrusion impinges on the S1 nerve root to the left. Canal diameter is 11.7mm.
Annulus bulge touches the exiting L5 nerve root on the left.




There are two differences between this and my CT scan (13 days prior).
1. I had retrolithiasis on the CT
2. My canal diameter was measured at 12.2mm

So, I know that this probably looks like its not causing me much pain, but I promise that it is.

Also, I've been changed from Lyrica to Neurontin today
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Avatar_m_tn
Its good that the MRI didn't show the retrolisthesis,which is when one of the vertebrae become displaced and move backwards.There's various degrees of I think, I'd have to look it up, I don't remember exactly, anyway sometimes it's not significant enough to worry about.

You don't have to convince me of your pain, I can relate. Often these reports often don't tell the whole story. From what you said, it looks like the problem could be with the "so-called" mild disc protrusion at L5/S1 impinging on the S1 nerve root, in addition to the Annulus bulge touching the L5 nerve root. Both those cause similar symptoms. Do a search on  the internet for L5 and S1 radiculopathy, they have little charts and diagrams that show the areas that each of these effect.

What's the next step,are you going to see your Neurosurgeon soon?
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Avatar_f_tn
Thanks :)
I often feel like I have to 'justify' my pain for some reason.

I'm feeling a bit of relief from the neurontin, probably the same level as the lyrica which is good :)

I'm seeing the neurosurgeon on Monday (5/11), and weirdly , I'm looking forward to it. I just want to know whats going to happen :)

I'm not sure if it's related, but I've been getting kind of a shooting pain in my groin?

Hope you're well :)
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Avatar_m_tn
I'm okay,Thank You for asking.

Seems like we always have to justify our pain to somebody, particularly the so-called medical establishment. It's bad here, back pain and chronic pain in general have such a stigma attached to them.The doctors are always looking for psychological reasons for pain, they think people don't want to work, their drug seekers, unhappy marriage anything but the actual problem. Granted some people do have ulterior motives, but the vast majority don't, they just want to get better.

The 1st surgery I had was the result of a bad fall and was pretty serious, so I knew the surgeon was going to want to operate, but when my PCP (GP) sent me to see a Neurosurgeon several years later about my neck and he recommended Physical Therapy, I was so relieved and happy. I ended up having a fusion 30 days later, but at least I got a 30 day reprieve. I can understand you wanting to know what's going to happen.

I never taken Lyrica, my insurance company said it was too expense, but I have taken Neurotin several times, it did help my nerve pain, but I got off of it as soon as I could, too many side effects, I couldn't function on that stuff. Is Lyrica similar?

Your groin pain is probably related to your sacral nerve root problem, I have something similar, particularly when I lean forward. Who knows what it is? Well I guess I've written enough for now, don't want to put you to sleep.

Try to Have a Good Day!
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Avatar_f_tn
Glad you're well.

It's a similar situation here, anyone complaining of long term pain, especially back pain is a drug-seeker or a hypochondriac. It seems to be a stigma within the medical community here that younger people (I'm 21) can't have serious medical issues.

I'm glad you got someone to listen to you, I understand how frustrating it can be :)

I was on lyrica for 4 or 5 days, each day I slept 16/24. While it did releive my symptoms, it wasnt worth it. I find I get less relief from the Neurontin, but less side effects as well. Im only on 900mg a day as well, once it gets a bit higher it might be better.

So far the reviews I've gotten on the neurosurgeon I'm seeing on Monday are really good :) Is it sad I'm excited? I just want some answers.

Have a good day/night )

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Avatar_m_tn
You're only 21? I saw that when I clicked on your nickname, but to be honest, most people lie about their age among other things. So you've had back pain for about 4 years, so that would mean that you started having problems when you were 17? Where you in some type of accident? Mine started as a result of one.

Its great that your Neurosurgeon has a good reputation, most don't have much of a bed side manner, but that's okay, as long as they know what they're doing. I can understand you being excited, you've been waiting a long time. You don't want surgery, do you?

What makes you think I have someone to listen to me? I don't know if you've noticed yet, but people, family, get tired of hearing about all this after awhile. Particularly people  that have never experienced any of it and have no clue what you're going through. Maybe it's different for you. With my medical history patience ran out a long time ago. When it gets real bad for me, it's impossible for everybody not to notice, but for the most part, I just live my life, try not to complain. I'm never going to be pain free again and I accept that. No one wants to hear your problems after awhile, its only normal. That's why I spend a little time on here, to share my experiences, I've had a lot of them.

You're so young, I have to be careful not to say anything to scare you. But at your age, you should be able to recover from this 100% .Here in the U.S. they would never operate on a person as young as you unless it was an emergency or something, like when I had mine.

What's the weather like there now, what season is, you do have different seasons I assume.How many hours different are you from us? Sorry about the stupid questions, I'm just curious.

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Avatar_f_tn
Lol yeah I'm only 21. Ive had mild back pain since I was around 17, but I've never been in an accident of any type, it just happened. I dont want surgery, I'll pretty much do anything I can to get out of it.

I understand, this has only been a big problem for 8 or 9 weeks now and noone wants to hear about it anymore, so I just try and grin and bare it. Its hard.

At the moment its spring, so warm during the day and a little chilly at night. Im not sure about the time difference, its currently 1345 here :)

All good, I dont mind answering questions.
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Avatar_f_tn
I saw the neurosurgeon yesterday.
I'm having an nerve root block this week, and if, in 3-4 weeks, the pain hasnt resolved we'll go back to discuss options for surgery.
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Avatar_m_tn
Well, hopefully the nerve root block will help, still feeling pretty bad?
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Avatar_f_tn
Hopefully. Its booked in for the 15th, so I'm hoping it helps.

Feeling pretty crappy today, 5 hour return drive to the neurosurgeon, and he did a lot to 'recreate' the pain so he could see it. He told me to take it easy until I get the block, no lifting, bending, twisting and if I have to walk a decent amount to use a walking stick to take the pressure off my leg.
He didnt seem very optimistic about the nerve block working due to the level of sciatica i.e down below my knee and causing numbness and tingling in the foot, plus my knee jerk reflex was absent.

Oh well, see how we go :)

How are you doing?
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Avatar_m_tn
That sounds like a very long trip, you didn't have to drive I hope. I know when my sciatica was bad, driving was agonizing.

At least the Doctor's not filling you with false hope and is being straight with you, but you never know, the nerve block might help. I still can't get over the fact that you're going through all this at such a young age. It's a lot to deal with, it definitely gives one a different perspective on life.

Sorry to hear you haven't been feeling well, I hope you feel better.
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Avatar_f_tn
Hey :)

Yeah its a long drive. We live pretty rural, so its a pain. We used to live in Sydney (Capitol of NSW) and moving out here was a biiiiiiiig change!
I didnt drive, I haven't really driven since this started, mostly because of the pain and partly because of the meds.
The NS was great, showed me the parts on the MRI that are concerning and did a very thorough physical exam. Like a lot of surgeons he didnt have the greatest bedside manner, but that's OK, he answered my questions and was happy that I was asking them.

I ended up going to the emergemncy department last night, I was in so much pain and my foot went completely numb. They said it must have been a muscle spasm irritating the nerve caused by the car ride.
So now I'm on the 12mcg fentanyl and 100mg tramadol twice a day. So I'm finally feeling more like myself!
I'm so sick of this crap. I was crying to the nurse I had last night that I was too young for this, I cant work, cant study, can barely clean the house most days. I hate feeling useless.

Thanks for reading that novel lol

How are you feeling
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Avatar_m_tn
Sorry to hear you had to go to the E.R. last night, this trip seems to have taken a lot out of you. Maybe you should take it easy for a while. Hope you don't have to drive 5 hours to have your nerve block.

I just thinking the other day when I was responding to you, that most people in your situation are angry at the world and generally very bitter, but you seem to be dealing with this quite well. Try not to get too discouraged and don't worry about what you can't do, they'll be time for that later. The main thing right now is trying to keep your pain under control.

Fentanyl and Tramadol, what a strange combination. On a scale of 1 - 10 Fentanyl is like a 11 and tramadol is a 2, I doubt if you'd even feel it, maybe.

I'm doing fine by the way, thank you for asking!
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Avatar_f_tn
Yeah it's taken quite a bit out of me, in feeling more myself today thank god.
No I don't have to go 5 hours for the nerve block thankfully, they do it in the local hospital :)

I'm trying to keep positive, I've been doing what I can around the house, if I'm honest, probably doing a bit too much, but each thing I do feels like a little accomplishment. That must sound strange, but it helps me.
I've also started setting little goals for myself every day to deal with the boredom. Just things like, I will read five chapters of my book today, or I will get to the next level on my crossword game ( on my DS, it's been my boredom buster, I have heaps of puzzle games :) ).
And tonight, I found the list of subjects my class will be studying next semester and starts reading the material so my brain doesn't atrophy lol.

It was actually the er doctors suggestion, it's for the few hours between taking the patch off and the next one kicking in, and at night when my pain is at it's worst. It seems to be working so far.

My GP (primary care provider I think you guys call them) did say that it might take a few different combinations and strategies before we find the right one, but at least he listened this time when I said oxycodone wasn't working anymore.

Glad you're well :)
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Avatar_m_tn
You sound a lot more motivated than most 21 year olds I know, healthy ones at that, maybe we're more lazy here.

I was trying to thing of what I did during extreme periods of pain, besides complain and drive everyone crazy. Some of the worst times I recall were recovering from surgeries, that's when the slightest movement hurts, I remember after one of my neck surgeries I couldn't ride in a car for a couple weeks because of the motion and bumps.

A lot of those times, I was so drugged up, I couldn't do anything if I wanted to. Normally, I'm a very hyper person and tend to do too much, a lot like yourself.

I'm not knocking your pain med regiment, whatever works you know? I've taken all those drugs and the only time I've ever taken Tramadol is when I didn't have anything else. And your Doctors right, you often have to experiment to find the combination that works. Sounds like you have good Doctors there, do they spend more than 15 - 20 min maximum with you like the ones here do?

Did you have to stop going to school this semester, if you don't mind me asking, what are going to school for?
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Avatar_f_tn
I'm not usually this motivated, but after doing nothing much but lying around complaining and driving my family and nuts for two months, I decided I should try something different. I have a history of depression so its very important that I dont get too bored. It gets difficult because like you were, I'm doped up a lot of the time and can't do much at all.
I havent had any back surgeries yet, so I cant compare, but I can imagine how hard that must have been for you :(
However, if you look at what I have been setting as goals for myself, all can be done in bed or on the couch because that is where I spend 95% of my time. I have the pillows and cushions set up just so they support me in all the right ways, so that helps with the pain as well.

I didnt think you were knocking it, I was just explaining :) So far it is working, but it has only been two days lol. We have a lot of different types of doctors. I've been through 3 trying to find a good one and I finally found one :) If they have to spend 30 min -1 hr with you, then thats the time they spend with  you although that would be quite rare.

I was studying nursing, and planning to be a nurse practicioner or a nurse working in a drs office. I'm still planning on doing that, because neither of those require a lot of physical exertion, bending or lifting. No more than any other job anyway :)
i love studying nursing, its fascinating, thats why I'm starting to do the reading, partly because i love it, and partly so that i dont forget everything I've learnt over the past year :)

We went grocery shopping today, and my back didnt hurt as much as it nornally did, so of course,  stupid me thought that was a great reason tyo clean the house. Silly silly me :/
Now I'm pretty much stuck on the couch.

How have you been?
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Avatar_m_tn
I can understand you wanting to keep busy, it's good for the mind and soul. And it seems like you're setting realistic goals for yourself. My real painful periods were never that organized, I think I lived from one Doctors appointment to the next.

You ever hurt so bad that all you wanted in the world was for it stop or at least not to be so bad. And then when it did lessen, it really felt good, almost euphoric, I've  experienced that so much. That's kind of sad isn't it, feeling good because you don't have excruciating pain, but we take what we can get.

You do setting high goals for yourself, Nursing is a very demanding profession, and requires a very special type of individual. My cousin graduated a couple years ago, she's an RN, very special and very caring person. 1st job she gets is in the ICU, very high stress, critical patients, calling Doctors all hours to update them on patients, conflicting orders from different Doctors regarding patient care, Doctors being rude ( the Nurses that have been there a long time don't let this bother them) but my cousin's kind of sensitive. She lasted about a year, she works in a walk in clinic now, she's much happier.

My Mother has really serious back problems, I try to help her out as I can. Her cycle is similar to what you described, she feels a little better and she does too much, then she's hurting and can't do anything, then she feels a little better and so on. I can't tell her anything, she wouldn't listen.

No much going on with me, Winters coming, cold, short days, long nights.... I don't like it, oh well.
Talk to you soon
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