Annular Tears, chemical radiculopathy.

[guymontag]

Hi All

First off I just want to thank Mark Mintzer for creating this site. It's a great site and there is a lot of intelligent thoughts, unfortunately we have all lived with or still live with a lot of pain. I've been lurking here for the past year almost.

History: I've been a chronic sloucher and herniated my L5-S1 on the right side. I saw 2 specialists and both said it was operable based on the MRI scans. Both believed I should have it done due to my pain level. My pain level was high to the point where I couldn't sit for very long and I'd be exhausted by the end of the day. No mention was made about annular tears or internal disc disruptions. I didn't know about these concepts pre-op. I hadn't researched enough and trusted these Doctors, that 90% of micro-discectomies were successful and I would have resolution of symptoms post-op. I went with the 2nd specialist and was slotted in for a 1st of july microdiscectomy. The thing was I was feeling better (could sit with some pain), by the date of the op, and was almost in two minds about proceeding.

Had the op, and felt immediate relief. Previously could only manage a 15degree leg raise. I could now do a 50 degree leg raise. I felt I had my life again. Went back to work at week 4 but had slight stumble over some cables. It wasn't even a big stumble but it must of been enough to place stress on the damaged disc. I felt immediate sciatic surge of pain. But from that time on, things started to go downhill. I soon developed the right foot numbness again, pins and needles whenever I sat down. I phoned the specialist and the nurse said don't worry, nothings wrong its normal. I still wasn't convinced as I was getting very odd sensations. Pain in the left side, which wasn't there pre-op, pain in the hip even. I requested an MRI quite early on and again nothing showed up, certainly no nerve compression. Again the Surgeon doctor never mentioned Annular tears or Internal disc disruptions. He said I'm worrying too much, stop worrying. Just live your life. do some exercise.

Well I did just that, but since a lot of my job is sitting. The pain increased as I sat each day. To the point where I couldn't sit anymore. It's at this point I did more researched and learned about annular tears and chemical proteins affecting the nerves.

I now suffer from numbness that comes and goes in each foot. Nerve pain along both sides of the back of my legs that seem to follow the S1 dermatome. aching calf muscles that come and go. sciatic surges in the right side periodically. I know if I sit down for over 30 mins there will be hell to pay later. Activity will flare it up. Can't stand up for more than a few hours (fortunately). I can still move around and do a 50degree leg raise.

What I've found.

There is a definite process occuring in the disk. It's almost like the disc will try to heal, I will have leg pains for a few days, then I will feel sciatic like surges on the right side the next day. The day after I will feel increased numbness in my feet and will seem like I'm having a good day as I don't get any leg nerve pain. then the process starts again. This was occuring for weeks.

The pathology I feel that is occuring (note: I'm no doctor and am probably whistling in the wind) is that the disc is constantly generating this fluid, its is being contained in the disc, but some is leaking out through a tear. All the while the fluid level builds up in pressure until it can't be contained and then escapes out through a weak spot on the right side causing sciatic surging in the back. The fluid level reacts constantly with the nerve all this time but by the end of the cycle has emptied itself out into the epidural space, so you get this day that it seems you have less leg symptoms.

I've been taking glucosamine for the past 3 months 1gram in the morning and 2 grams at night. I also haven't been sitting for more than 15 mins, as I feel this is just opening up the annular tear further. And mostly stand or lie down. My pain symptoms have dropped, so I think I'm doing something right. Chirogeek speaks about possibly up to 2 years for healing if at all. I will give it 2 years as I certainly don't want a fusion, as my pain levels are manageable.

Anyway I'll keep adding to this thread, just in case it gives people food for thought or might help.

[dshobbies]

Hi Guy and welcome,

I'm sorry you're experiencing all this pain but we are here for you. First, should you need more surgery, you may not be limited to fusion but that bridge is something you can cross later.

Have you tried Neurontin or Lyrica? Both of these work very well on nerve pain though they do have their side effects. Though I have now chosen to deal with the pain instead of those side effects, these drugs were invaluable during the earlier stages of my surgical healing. It was two years before my pain was managable and I am grateful these drugs were there. If you're you are going to wait two years before addressing another surgery, you might find these drugs make your life easier.

Just for the telling, I've never heard that it takes two years for a disc to heal. Mark?

Dale

[guymontag]

Thanks for the words of encouragement. I may get some pain killers but I too am worried about side effects. Anyway, time will tell. If it gets worse we'll see.

Yes true about alternative therapies. I have read about IDET. but it looks a bit hit and miss.

this technology looks promising...

Biostat Disc Augmentation System

Spinal Restoration - Products

Again time will tell if its truly successful... here's to hope!!!

[mmglobal]

I have 3 clients with the 'biologic disc sealant' injections with mixed results. It's very interesting and may be worth trying for the good candidates.

Unfortunately, the school of hard knocks that I mentioned in another thread came on my wife's case. If you look at her imaging on her GPN story page, you'll see that her disc is really severely compromised. I don't have her full MRI, but the sagittal images shows buckled annulus across the entire back of the disc. The chance for long-term success from the endoscopic-d was probably not so great. (My apologies... her story page needs updating. She had a wonderful result fo 2.5 months, then started having radicular pain on the other side. She had a 2-level ADR in March 2008 and is not back at work full-time as RN, now almost 8 months post-op. Newer info in her surgery blog.)

Regarding chemical irritation of the nerve roots... I agree that many surgeons pooh-pooh the idea, much like most used to pooh-pooh discogenic pain and discography. (Same problem exists w/piriformis syndrome and so many other bastard diagnoses.)

I was in the OR with Tony Yeung and he said something like, "Look here Mark, do you see the way the nerve root is all smooth and red. This patient has very little fat insulating the nerve root. He can have what appears to be a minor disc protrusion that is not distorting the nerve root and must surgeons will look a the seemingly benign MRI and not believe that this is the problem." Later in the day, he showed me the same nerve on a different patient. "You see all the fat surrounding the nerve? This patient can have a substantial herniation with substantial compression of the nerve and have no symptoms or more minor symptoms than one might expect based on the MRI." The pictures do not always tell the story.

Dr. Yeung also talks about "interpositional disc tissue" as a reason for discectomy to fail. A fragment of nucleus material that is stuck in the annular tear will keep the tear from healing and will 'wick out' the neurotoxic juices that are produced in the disc. This is one of the advantages of SED. Working visually from inside the disc, he can see the annular tear and he can also see how the annulus responds to the thermal annuloplasty as he is watching it as he applies energy to it.

Gotta run... Thanks for the post. The discussion of chemical irritation is very interesting and I hope this helps.

All the best,

Mark

[guymontag]

Mark. Thankyou. Your a wealth of information.

Speaking of buckled annulus on the sagittalimage, I looked at my MRI and noticed exactly the same thing post op. I never asked the surgeon about it at the time as I didn't know about chemical radiculopathy. But it makes sense now. I might post it here for comment.

That's really interesting about the wicking out of nucleus fluid.


All the more reason to avoid a discectomy if you can.

I'm still going to wait 2 years and keep trying with the glucosamine.


anyway thanks again Mark..

[martyusa]

Originally Posted by guymontag

I'm still going to wait 2 years and keep trying with the glucosamine.


anyway thanks again Mark..

Talk to your Doctor or a Sports Medicine Doctor if you think this might help. But here's some homework in advance. I think I found it too late.

Drug Classification: Chondroprotector
Active Life: approximately 24-36 hours

Alflutop is the trademarked name of a product produced by the pharmaceutical company Biotehnos. The Alflutop produced by this company contains sea fish bioactive concentrate, which itself contains low molecular mass peptides, mucopolysaccharides, and amino acids. Also included are trace elements including zinc, copper, sodium, calcium, iron, and magnesium. Most often the compound is packaged in one milliliter amps which each contain ten milligrams of sea fish bioactive concentrate, as well as phenol which possesses anesthetic properties as well as acting as a preservative.

The medical use of Alflutop is primarily for the treatment of degenerative joint disorders such as tendonitis, ankylopoietic spondilitis, bursitis, spinal disc injuries and arthritis-related disorders (1). Obviously these are the same uses that bodybuilders and strength athletes will want to utilize Alflutop for as well.

Alflutop works in numerous ways to help stop tissue damage from happening in joints, while also repairing tissues that have already been damaged. This occurs via cartilage regeneration and a reduction in free radical damage within joint tissues. As well, the contents of Alflutop help to inhibit overproduction of hyaluronidase, an enzyme that catalyzes the breakdown of hyaluronic acid in the tissues of the body. Excessive production of this enzyme can lead to serious damage within joints. Alflutop will also help to restore and maintain homeostasis within chondrocytes, the structures responsible for the production and maintenance of the extracellular matrix of cartilage.

Along with the injectable version of Alflutop, Biotehnos also produces a topical ointment as well as a suppository form of the compound. However both of these forms of the drug will of course be less efficient as a delivery method of the compound and less effective. The injectable version of Alflutop is also the more commonly found form of the compound. For these reasons, the majority of users will want to administer the drug via injections.


Use/Dosing

Due to the active life of the compound, frequent dosing is required. For the most part, most users find that injecting one amp, 10mgs sea fish bioactive concentrate or one milliliter in volume, every day or every other day for a period of approximately twenty-one days will bring substantial relief in the majority of their symptoms as they relate to joint discomfort and/or damage. However this protocol has basically been devised by way of anecdotal information passed on from one user to another. In clinical trials the length of administering the drug has ranged from less then seven days to as long as several months. It was found that various lengths of time were needed to treated individuals and these were based on several factors including the amount of damage/trauma that was inflicted upon the joint(s), how well the individual reacted to the drug, and how much physical activity and recuperation methods the individuals used in conjunction with the drug treatment, among others. For this reason, no set standard needs to be adhered to when using Alflutop and the length of use should be determined by the results achieved with the compound.

The injectable version of Alflutop is administered via intramuscular injections. It seemingly does not matter which muscles that the compound is injected into as it will affect all of the joints of the user equally. There is no additional benefit to administering the drug into the area of the injury or trauma. This, along with the frequency of the injections, would allow the user to spread the injections throughout several muscle groups so as not to cause undue irritation to the muscles that the compound is being administered to.

In terms of use for females, it appears that the same dosages can be translated to women as they are for men. No real changes to the volume or frequency of the dosing of the drug need to be made, with no increase of severity or frequency of potential side effects being seen in women.

Like the duration of the administration of the drug, the frequency with which a user chooses to cycle the compound seemingly will not be hindered by side effects either. If one chooses to run Alflutop several times within a short period of time, this appears to be beneficial. In fact in the case of rheumatoid arthritis, this is the protocol for treatment using the drug in many cases (2). However anecdotally users have reported only needing to use the compound once or twice for years at a time and have never had a reoccurrence of their symptoms. Of course, a number of factors could also contribute to this, most notably being that most would not subject themselves to the activity that had caused the initial damage or trauma in the first place.


Risks/Side Effects

From the available research that has thus far been conducted it seems that Alflutop is well tolerated by nearly all subjects that have received it as treatment. It is also important to note that the vast majority of this research has been completed using elderly patients due to the research primarily concerning itself with use of the drug in those individuals who suffer from rheumatoid arthritis, among other conditions. This is important since many of these older patients may suffer from other age related diseases and/or conditions. From the research that has been conducted it appears that Alflutop has had not negative effects on those patients suffering from heart conditions, gastrointestinal distress/diseases or diseases of the thyroid (2, 3). Obviously these findings should also presumably hold true for younger, healthier individuals.

The only real negative side effects associated with the administration of Alflutop are some reports of irritation related to the frequent injections. Some post-injection pain was noted by some patients while others tolerated the frequent injections well. However no major complications related to the injections were reported in the available research and literature related to Alflutop.



References

1. Noskov SM, Fetelego OI, Krasivina IG, Dolgova LN. [Alflutop in local therapy of shoulder periarthritis] Ter Arkh. 2005;77(8):57-60.

2. Svetlova MS, Ignat'ev VK. [Use of alflutop in the treatment of patients with osteoarthrosis] Klin Med (Mosk). 2004;82(6):52-5.

3. Taran AI, Puzanova OG, Lapenko OIe, Sol's'kyi VI, Samoilova SM. [Experience gained with the use of local administration of medicinal remedies in rheumatic diseases] Lik Sprava. 2001 Sep-Dec;(5-6):182-5.

[mmglobal]

Originally Posted by guymontag

All the more reason to avoid a discectomy if you can.

I don't agree on avoiding discectomy. All spine surgeries should be avoided if possible. However, if you are a good candidate for a discectomy; properly done in a timely manner, it represents an excellent opportunity heal up and avoid bigger surgeries. I DO NOT believe the "90% of discectomy patients never need another spine surgery" statement that we hear from the surgeons. I do believe that for SOME of us who do not respond well to conservative treatment, it represents the best chance for long term success. (Long term success may be defined as simply avoiding bigger surgeries for some number of years... not necessarily forever.)

Mark