Before you consent to prolotherapy, read some personal reports from people who have had it. And understand the procedure. I believe that if more people knew what they were in for, prolotherapy would have gone the way of leeching in the practice of medicine.
Your story is shared by millions. Early degenerative disc disease, maybe a disc bulge or two, and idiopathic LBP.
Treatments so far involve failed NSAIDs, failed oral steroids, failed PT (it usually does at L5/S1), and now you're having a surgical consult.
While some surgeons are excellent about choosing proper candidates for surgery, others like to operate as often as they can. Surgery should always be reserved as a treatment of last resort, only after more conservative methods of treatment have failed.
The wrong surgeon will convince you that you've already failed all conservative forms of treatment.
L5/S1 is the disc that usually fails first, because it supports the entire spine, and it sits slightly skewed to accommodate pelvic tilt.
Discs are innervated and can therefore cause pain -- it's called discogenic pain. Often, these annular tears are microscopic and impossible to see on MRI even with contrast. A discogram is an interventional procedure that involves injecting die into the intervertebral space, watching a fluoroscope in an attempt to reproduce your back pain. It is the only definitive way to find discogenic pain.
Imagine a house when a part of the foundation fails -- that house will tilt. Same when a disc bulges, the upper vertebra tilts, tearing connective tissue, decreasing the intervertebral space, and placing pressure on one or both of the facet joint capsules, which leads to facet hypertrophy and osteoarthritis of the joint -- another source of LBP.
Broad-based disc bulges often efface the thecal sac, and sometimes spill into the intervertebral foramen. Both situations can cause pain of spinal stenosis in the former case, and foraminal stenosis in the latter.
But it's not visible on the MRI, so it's not real....
Remember that MRIs are static images and catch you when you are supine and at rest. It's almost like saying "smile for the camera." In actuality your back bends and flexes all day long. What may look like a simple bulged disc effacement can be a protrusion into the thecal sac, depending on position and activity.
And where there are disc bulges, osteophytes will soon follow. These tiny bits of calcified scar tissue group into hard chips and spurs that, when pressed against the cord or nerve root, cause pain.
There are other sources of pain invisible to MRI too, that come with more advanced cases of DDD.
Why not see an experienced spine and pain specialist -- a doctor with the DABPM credential. This is a board certified doc, usually an anesthesiologist, with advanced training in the neurology of chronic pain, advanced use of pain medication, the spine, and interventional pain procedures.
Instead of looking at surgery, you might consider a new treatment options -- stem cell therapy to repair that disc bulge, or platelet rich plasma therapy to help heal that disc and related soft tissue.
You might try the diagnostic procedure called medial branch block, that can diagnose a major source of spine pain -- an arthritic facet joint. When followed with an non-surgical procedure called a medial branch neurotomy, you might have 50% less LBP for up to a year.
Explore these options before you consent to surgery. You can recover from neurotomy -- the ablated nerve regenerates. You cannot recover from discectomy and fusion.
Learn all you can about the spine, your spine disease and its variants, potential treatment options, what they entail, and what you can expect as potential risks and benefits from those treatment options.
Visit a site like spineuniverse.com or spine-health.com for information on spine disease and its treatment.
Thank you. Who does these other things you mention- the branch block, the stream cell treatment? The physiarist I went to did injections of some kinds, but didn't mention them to me.
Physiatrists are pain specialists who in general, work with the techniques of rehabilitative medicine.
Interventional anaesthetists (or anesthesiologists) are another kind of pain doctor that perform the kind of procedures I mentioned above. In the US we call them interventional pain physicians and they carry the credentials DABPM (diplomate, American Board of Pain Management.) In the UK, you would find this kind of doctor in the field of Anaesthetists, perhaps with the credential of FPMRCA, which stands for Faculty of Pain Medicine of the Royal College of Anaesthetists.
Thank you. I went to my PC and he is sending me for a second opinion with a sports medicine doctor. I will then probably see a DO or Pain Doctor depending on what he says.