surgery recommended; I have concerns

[laughnsmile]

Hello,

I've been in pain (sciatica primarily in left hip down leg to ankle) for 9 months. It is excruciating at times and I am constantly in pain.  It is worse with sittinge and walking.  I am unable to perform daily living activities without excruciating pain (such as showering and brushing my teeth).  Pain lessens when I sit on right hip and lie flat on back and have someone push my leg back over my head and crossed over body.  Pain returns though.

MRI says broad based disc osteophyte with encouchment upon neural foramina bilaterally.  Contact of the inferior
aspect of the existing nerve roots. Narrowing of the neural foramina by significant facet arthropathy.  Apparent pars defect (grade 1)  Present at L4, L5, S1.  anterolisthesis of L5 on S1.

Two orthopedic physicians have said surgery rebuilding from L4 down including a fusion.  I have tried medication, 3 lumbar spinal injections, physical therapy and chiropractic.   I had severe pain with physical therapy and chiropractic.

Is there any options to not be in pain and to be able to enjoy activities daily besides surgery.   What kind of surgery
would I need performed?   Would a fusion be necessary?

Thanks much,  Rachel

[opus88]

thx for the info I will talk to my PM doctor abt it.

[toolmaker]

I have a tens and have been using it for almost 3 years.My pm prescribed one and my ins. did pay for it.A guy that works for me went to his chiro and got one and paid $90 for it.I tried to get him to file with the ins. co. but he told me it was well worth what he had to pay out of pocket.

[opus88]

Hi Red   can you tell us all more abt the TENS unit you use please.
for instance you say you have a good unit, so I would like to know the make and price range of it....and also if possible the website where it can be purchased.
thx

[Red931]

There are all different medications out there. The question is what medication or combination of medications is going to work for you?

Your current physicians seem to be concentrating on inflammation in an attempt to relieve pressure on the sciatic nerve and decrease your pain. In a perfect world that just might work, but as stated before we are all different.

I am not a doctor, I am actually a police officer, but you are asking for advice on what medications may help you with your particular pain issue which I have some experience with so I am going to give you my opinion on what medications you might try to avoid surgery.

You need an extended released pain medication for your condition as your pain is constant. Vicodin will not work and as you have stated it hasn't. The Fentanyl Patch, Oxycontin, or Opana ER may work for you along with any other anti-inflammatory mediation. I just wouldn't use Prednisone on a long-term basis myself as it is hard on the liver.

Specialists will not prescribe you this medication long-term or at all for that matter and you have stated and for some reason PM doctors also have not. Specialists recommend surgery because that is how they make their money. It is sad but true. You will have to return to your PCP and express your concerns with having the surgery and that you would like to try all other options first. If your PCP is a good doctor he or she will do what they can for you and experiment with medications to see if they will work for you. My PCP tells me that the surgeons do their surgery and then leave the patient in most case with more mobility but still in pain. Once the surgery is over they won't prescribe pain medication for long and then it is up to him to make sure that I am taken care of properly in this regard. After thirteen surgeries, I can tell you that he is correct in his statement.

You do not need a prescription for a TENS Unit. They are easily available on the internet and reasonably priced. They operate on DC current and are easy to use. You just have to experiment with placing the pads in different places around where your injury is located on your back and the levels of current until you achieve a satisfactory result.

Good Luck. Let us know how you make out.

[Tuckamore]

I understand your concern and confusion. My guess is that when you twisted your hip and dislocated your knee you also unknowingly twisted your spine. When that happened it flared a smoldering spinal problem.

Our body structure is all intertwined and connected. When we injure one part of the structure other parts can become inflamed or painful also. Based on your MRI results I think it was only a matter of time before the stenosis and discs produced symptoms.

I have severe SIJ Dysfunction. It only made sense to do an MRI of my spine when I was referred to a neurologist several years ago. The MRI revealed multiple inoperable spinal nerve root cysts and facet joint disease. I have no pain in my back other than the very low one sided back pain attributed to the SIJ. It's obviously to all the specialists that I should have pain or I very soon will have pain.

Our bodies are all different. MM can make a difference. Stenosis can cause permanent nerve damage if not treated in a timely fashion. Surgery would scare me but I think I would do had I had to do to avoid permanent damage.

Good luck to you,
Tuck

[laughnsmile]

I would definitely like a medication that would stop the pain.  It took me 2 1/2 hours to get to work this morning.  Showering is excruciating.  At this time my leg will not move.  At work I have to lie down and sit in
"funny" postitions.  I am a therapist and it is difficult to be attentive with the pain.  I feel I use to smile easily and basically be a happy person.
Now it is a struggle and the smile does not feel genuine.  The pain effects everything.  I am sure you all can relate.

I do not want surgery.  But I know my life is greatly impaired and I am not the person (mother, caregiver, wife) that I use to be.  I would like
medication that works.  My general physician referred me to specialist for medication suggestions when previous meds did not work.  Specialist would not prescribe meds...said surgery was necessary.
Pain management specialist only did injections.  I contacted my general physician who called in a few days of predinsone.

What meds work for all of you?  The TENS unit I am not familiar with.
How does it work?  Is it prescribed? How would I go about getting one?


I dislocated my knee in December and when my hip twisted is when I

began to feel the pain.   MRI says I have stenosis, pars defect, 2 bulging
discs and the neur formana (msp) openings very small.  These are all
pressing on nerves.  My question with MD's is that I had no pain, not even a backache before the knee dislocation.  It is difficult for me to
accept that I have 4 problems that surgically need corrected.  All 4 occurring at the same time?

I have no prior experience with back orthopedics so maybe my theory
doesn't hold water.  Any input is appreciated.  Thanks again  Rachel

[1dayatax]

I forgot when using the pillow between your legs, bend your legs at the knees as if you were sitting,,try both legs or one or even w legs straight , also you can put under lower legs when laying on your back,,..whatever works best 4 you...

[1dayatax]

i had back surgery bout 13 year ago,w similar problems, i was 25. b4 surgery I couldnt straighten my leg out when in a sitting position,like lift foot off of floor 4-6 inches at the most wo excrutiating pain,post op I could and still can wo pain except at the numeruos times I have reocuring disc bulges/herniated..I to for 5 years b4 surgery was scared of it bc of knowing of others and the multi ops they have had,,,when I did have surgery I had no choice I was doubled over at the waistline,couldnt sit up, stand up straight or lay straight,I had a complete blockage in my spine the dye used for a mylogram would'nt even go through it into my lower spine to do the mylogram....I had spinal stenosis the docs (nurosurgen & ortho both in the op room for 4 hours) hollowed out about 40- to 60 % of my vertabras & unroofed my canal...1 year to recover...it helped for sure especialy for the leg straightning and for the next 5 or so years but its a life long battle unless jesus heels you and he can for sure...I just try to take 1 day at a time,sometimes it better than others....
but as to suggestions for relief prior to a surgery,or after,PRAY,..PRAY..AND moderation everything you do do it in moderation...a nsaid for the inflamation on the nerve roots such as motrin (ibubufren 800mg 4 times a day) laying on your good side with a pillow between your legs,it will relieve pressure on you low spine got to do w ur hips(they made me in recovery post op) I still sleep with one ,the only way I can.. it works even during day when I cant get relief without laying down...try hot or cold pack one works better for others than the other myself I use hot,like heat pad w a wet wash rag or use a mircowavable heating pack or both...back stengthning exercises when you can ie pain wise n mobility ,,,,walking  and rem. moderation.  
lastly pain med theirs nothing wrong with taking if taking for right reason and pray again...
I sure hope/ n pray you get to feeling better..rem someone is always worse off the you r or me....

[Tuckamore]

Hi Rachel,

Welcome to the Pain Mangement Forum. I am sorry to hear about your spinal issues and pain. I have not had spinal surgery so cannot comment on that process.

Red & Opus have offered some good opinions. As previously said what is right for one may not be right for another. I think only you and your surgeons can make this decision. Surgery does not often alleviate all pain, hopefully it will ease it.

The one thing that is apparent in your post is that you do not have good pain control. A TENS Unit as Red suggested may be helpful. There are medications that can also reduce your discomfort. Life is too short to struggle though every day of their are other choices.

I too am a caregiver and know how much it can demand from you. I hope you will find some solutions to your pain. Please keep in touch and let us know what you decide and how you are doing. Our community is great at offering support.  We'll look forward to hearing about your progress.

Peace,
Tuck

[Red931]

I have almost the exact injuries to my back that you do as L4-L5 L5-S1. Of all of my orthopedic problems this one is the one I am able to control the best.

I was told that I would need disc replacement surgery about three years ago. I have had plenty of surgery, but this one I was not going to have without trying other alternatives first. I am glad that I did.

I have the same symptoms that you have with the pain running down my left leg and numbness albeit for me it may not feel as bad but I have a pretty high tolerance for pain. This is not been a good trait for me because I also have high blood pressure.

I deal with this issue with with pain medication, simple stretching, and a TENS Unit. While a lot of people don't have success with electronic stimulation, I have found if you get yourself a decent unit and mess around with the placement of the pads as well as the level of current until you achieve the right result it does wonders in combination with medication and a few simple stretching exercises. I also apply cold gelpaks after or with the stimulation not heat as they do in therapy.

Most of the people I know, including my brother and brother in-law who had back surgery, especially fusions still have a considerable amount of pain after the surgery. The reason they had the surgeries was because the numbness they were experiencing was too severe. My brother could not feel his legs at all at one point that is why he had to have surgery.

For me at this point the pain is more of an issue than the numbness so I choose to avoid back surgery until such symptoms present themselves that severe if they ever do. But everyone is different and has to take into consideration what they are feeling.

I also did the epidural injections and found they didn't do much for me at all, except for the first series that were done.

Good Luck, I hope this helps.

[laughnsmile]

Hi and thanks for your reply.

I have tried antiinflammotory meds, steroids, vicodin and other pain pills and neurontin
which has been increased.  Prednisone helped some for about 2 days.  None of the others have helped at all.  the 1st steriod injection helped but the other 2 did not and now
symptoms have returned.  I am unable to work a full day.  I have 2 young children and an
elderly mom which needs my care.  I am only caregiver.

I tried physical therapy but after initial eval was unable to walk out and  had to call husband to get home.  I know i can not go on this way.  But I am fearful of surgery.
My understanding is that the opening were the nerve root comes out is very small and
pinching on nerve.  I think the pars defect caused this (but I am not sure).  I have an appoitment the 28th for another opinion.   any other suggestions you may have will be appreciated.  thanks

[opus88]

Hi Rachel, I have similar back issues and have tried physio over the years to rid me of that terrible sciatic pain that you also suffer....worked with it for years but pain was unbearable at times. the doctors I have consulted (not orthopedic)...have all warned me abt surgery, it could be successful however there are alot of risks, maybe you will get some reply's from someone who has had this surgery and than you will be able to make a choice.
I ask you what medications have you tried for this sciatica? I've been on an anticonvulsant neurontin(gabapentin)..for a few years the dose has had to be increased occasionaly however it does mask most of the burning pain down the butt and legs.
have you tried any of the anticonvulsants?