First post, advice needed!

[rbrown]

Hello to all,

I'm happy to have found this site but also sad to hear about others suffering. I'm 43 years old male. I had lamenectomy/discectomy 2006. I guess it was succesful. My wife took me to emergency for severe right leg pain. The surgery happened the next morning. Apparently had massive herniation that left disc material in my spinal canal and was causing the issue. I would say compared to a lot of what I have read my problems are not as severe. Normally I have pain in both legs to some degree worse when sitting. Fast forward to present, low back pain has increased a lot since the end of 2012. More occurance of it "going out" on me. MRI and x-rays were done in April this year. Neurosurgeon said my report doesn't look that bad and asked me what I wanted to do. He said he could do a fusion but unknown if it will be better after. Things have changed big time. Muscle spasms so bad in the low back right side I can't stand, walk or get up after sitting. My primary called in Prednisone which helped almost immediately. I was able to walk and sit without too much pain. I had an appointment last week with pain management anesthesiologist and he wants to give me facet joint injections. While I was waiting on that to be approved I saw a chiropractor that is very trusted with my sister and other family members. In between seeing the PM Dr. and the Chiro the Prednisone course had finished. The day after it was gone the spasms were back to complete failure. I called Saturday and asked for more but they said no. My wife called Sunday and it was called in again and almost immediately helped a lot. The chiropractor looked at my x-rays with me and said he could clearly see the problem. He said it was facet syndrome, that the lower facet joints were out of alignment and that he could fix it no problem. He said to give him 6 weeks. In the mean time the Prednisone will run out this Sunday. I am suppose to see the chiro again Monday. If the spasms are back he wont be able to do anything with me. I have basically been in bed for nearly two months and still dont know or understand what my diagnosis is or what happened. I cry almost everyday and am extrememly frustrated, in pain, depression etc. Neurosurgeon's diagnosis is "your a young guy with a bad back". Pain management Dr. didn't say much either besides lemme give you some shots at random. I feel undiagnosed. Impossible to get better if nobody knows whats wrong. I'm sceptical about the Chiropractor but dont know what else to do?

[rbrown]

MRI Lumbar Spine without and with Gadolinium 3/30/2011:Clinical Indication: Chronic low back pain and bilateral radiculopathy; history of surgery 2006.
Findings:
There is evidenc of a prior right hemilaminotomy at L4. There is no evidence of epidural fibrosis.
The L3-L4, L4-L5 and L5-S1 intervertebral discs have diminished height and signal intensity.
There is a grade 1 anterior spondylolistheses of L5/S1 which appears to be secondary to bilateral spondylolysis. Bulging of the L5/S1 disc is present. There is no secondary spinal stenosis or impingement on the S1 nerves. The alignment abnormality is producing bilateral L5 interbertebral foraminal excroachment with possible mild impingement on the left and right L5 nerves.
Minimal disc bulges are present at L3-L4 and L4-L5 without significant excroachment on the spinal canal.
The remaining disc levels are normal. The facet joints and intervertebral foramen are normal.
The distal spinal cord and conus medullaris are normal. No intradural, vertebral marrow space or paraspinal signal abnormalities are present.
No abnormal enhancement is present on the postcontrast injection images.
Impression:
Status post right L4 hemilaminotomy.
Grade 1 anterior spondylolistheses at L5-S1 which is producing bilateral L5 intervertebral foraminal encroachment and possible left and right L5 nerve impingement. There is no central spinal stenosis or S1 nerve impingement.
Bulging discs at L3-L4 and L4-L5.
Otherwise normal MR examination of the lumbar spine.

[rbrown]

MRI of the Lumbar Spine 4/23/2013:Clinical Indication: Remote microdiscectomy in 2006. Recent redevelopment of bilateral lower extremity pain associated with numbness and paresthesia.
Siemens Espree 1.5 Tesla
Sequences: Coronal PD; sagittal T1, T2 and STIR; axial T2.
Comparison: March 30, 2011
Findings:
Redemonstrated is the grade 1 anterior displacement of L5 on S1. The lumbar vertebral body heights are maintained. Degenerative marrow changes at redemonstrated opposite the L3-L4 and L5-S1 disc spaces.
The L1-L2 and L2-L3 disc spaces remain normal.
L3-L4: Redemonstrated is the right hemilaminectomy and partial right facetectomy. The central canal remains widely decompressed. Normal neural foramina bilaterally.
L4-L5: There is mild posterior annular bulging without canal or foraminal stenosis.
L5-S-1: The bilateral pars interarticularis detects are redemonstrated. There is stable mild posterior annualar bulging. There reminas mild to moderate narrowing of both neural foramina.
Normal conus medullaris. Normal paravertebral soft tissues.
Conclusion:
1. Overall, no significant change from the March 2011 exam.
2. Stable post-operative changes at the L3-L4 level without residual or recurrent canal or neural foraminal stenosis.
3. Stable degenerative disc bulging at L4-L5.
4. Stable grade 1 isthmic spondylolisthesis of L5 on S1 with stable mild to moderate bilateral neural foraminal narrowing.

[jsewell]

Hi Randy,
I actually live in Duarte, almost in Monrovia now. Still neighbors. I am no good at interpreting MRi's that is for sure . but in reading yours what i want to say first is i have had some MRI's that have stated mild changes which hurt like you know what. So i don't believe everything that is stated is correct regarding pain. I had a right hip MRi that stated no arthritis. My hip surgeon did arthroscopic surgery looking for a simple tear and found my whole hip was arthritic on both weight bearing surfaces. Next step total hip replacement.
So in reading yours it sounds to me like the L5-S1 is impinging on nerves for sure and could certainly be the cause of your problems.
I know you have been to a few different health professionals. But have you had a second opinion with a spine surgeon? That would be my first step. "And quickly.
I have had 9 spine surgeries in the last 5 years and most with the same surgeon. I trust him, but i just cancelled the surgery which was planned this summer after getting a second opinion. The second opinion doc made so much sense regarding my problem with walking and even standing. My whole spine is very out of sagittal alignment. I can't stand up anywhere near straight and it is getting worse . So a total reconstructive surgery is now planned with this surgeon that i just saw on Monday.
I am ok when i am sitting up in bed and that is where i have spent the whole day. Standing and walking i am all hunched over and it gets more painful the more i do it. My spine no longer has the normal curves it needs.
Good luck in getting to another doc soon.
Judy

[rbrown]

Any recommendations for a 2nd opinion? I'm in Monrovia, Los Angeles County. I have United Health Care HMO and am in the Healthcare Partners network. We are thinking about switching to PPO if needed!

[Maria]

Hi and Welcome
I agree w/Judy re MRIs sometimes stating things in a manner that would appear nothing much should be bothering one or not so much and the reality is quite different in terms of pain. I also suggest seeing a good spine surgeon.

If your spine situation isn't Workers Comp and you have an HMO you are pretty limited in who you can see w/o paying cash. I'd definitely switch to a PPO if able to. The only thing is you will still be limited to surgeons within a network and if you go out of network you'll pay probably at least a 40% of the costs.

Can you find out what spine surgeons would be in a PPO plan that you might be able to obtain and then see if you can switch to that plan? Or would you want to pay cash for consultations while you're in an HMO?

Do you want to see a Neurosurgeon or an Orthopedic Surgeon or both for opinions?

My last spine surgery consults were in 2006 and I saw Rick De La Marter (sp) in Santa Monica, John Regan (think he was at Cedars) and Frank Coufal in San Diego.

The first two surgeons mentioned are orthopedic spine surgeons and the last one is a Neurosurgeon. I decided not to have more spine surgery (had 2 discectomies back in '89 and 92).

Good luck and keep us posted! Maria