Hi, I am new to this forum but unfortunately not to neck, back problems.

This question is about my 24 year old son. He had been having significant lower back pain for about 5 months. Three months ago, he had an MRI which showed that he has a ruptured disc with impingment of the sciatica nerve at L-5.
We had started out seeing a general ortho who referred my son to a pain management doctor. So far my son has had two epidurals and is having PT and traction 3x a week. He had pain relief for about two weeks following the first epidural but after two weeks, the pain/sciatica started to return. He had his second epidural last week and has found that there is relief but he is still experiencing intermittent pain. The pain management doctor's plan is for three epidurals three weeks apart. Does this plan sound right? Should he see a spinal surgeon for an opinion sooner or wait a few more weeks? If we are facing surgery, would a spinal ortho or neurosurgeon be best or does it not matter?

Tell him NO MORE EPIDURALS!! He's not getting sufficient pain relief to have THAT MANY EPIDURALS -- besides, there's supposed to be a limit as to how many you can have -- I didn't think you could have that many but I could be wrong.

If the epidural was giving him 6wks of relief, I'd say have them, but NOT just a couple of weeks, or just ONE week!! Besides, there are risks in these injections. There are risks with ANY injection into the spinal space. One could be scar tissue, and another could be Arachnoiditis, which is an incurable ailment which is very painful although RARE. There could be other risks too. But he should be getting more pain relief than this -- and he's not, so tell him to tell the doc no more!!! The steroids are NOT GOOD FOR THE BODY. They are harmful to the bones too.

For one thing, your son cannot expect to be pain-FREE.

He should avoid surgery at ALL COSTS. Stay as conservative as he possibly can, and use ALL conservative methods before opting for surgery. Surgery is ONLY for mechanical problems and does NOT take away pain!! After surgery, you're usually left with the same pain or worse! Also, after surgery, the levels above and below the surgery site will fail because they've had to take on more of the load -- it's called the "Domino Effect." It happens all the time. It happened both times after my surgery, and it's happened too everyone I know on these forms, and on another forum I visit -- and I'm talking about hundreds of people. Since I got a computer in 1998, I've talked to thousands of people, and it's the same with them. And I've done TONS of research on this, and it's a very common thing to happen. Unfortunately, the doctors don't tell their patients about the "Domino Effect" before surgery. If they did, patients would be able to make better informed decisions.

Your son should take his MRI to a Neurosurgeon ONLY FOR AN OPINION and nothing else. He should NOT be pressured into surgery!!! The ONLY reason for surgery in his case would be if his spinal cord was being compressed or if he was in danger of permanent nerve damage, and from what you say it doesn't sound like it, but I'd have to read his MRI report to be sure. If you can post it, it would be helpful.

Physical therapy is best in cases like his. Many times it works great for sciatica. In fact, people who have had physical therapy have the same results as people who have had surgery -- according to latest studies!!!

I wish your son the very best! I hope you will keep us posted as to how he comes out. God bless and please take care. God bless. Hugs, Lee

Thank you for your response. The sciatic nerve is being compressed which is resulting in intermittent severe leg pain. Last week, the only way he was able to get from the living room to the bathroom was to use the wall to support himself. I have a cousin who is a neurologist in Florida. I just emailed him and he asked us to have the radiologist email him my son's MRI. My cousin said that if the herniation is large enough and the root is being compressed then surgery is indicated. I am happy that my cousin who has no ulterior motive but my son's best interest will give us his opinion. We are not necessarily looking at fusion but possibly removing only the herniated part of the disc. Apparently three epidurals spaced three weeks apart is the accepted protocol. This second epidural has not even offered the pain relief of the first one which is why I question the wisdom on continuing with the epidurals.

I completely understand the problems with the domino effect. I have severe degenerative disc disease, especially in the cervical area. Eight years ago, I was starting to loose some funcion in my hand due to compression. I went to Pittsburg to have a two level foraminectomy WITHOUT fusion. The neurosurgeon said that looking at the way the nerve was being compressed, I would have had permanent loss of function of my hand if the surgery had not been done. He also was adament that if I ever had a fusion, I would end up being permanently disabled due to the domino effect as the areas above and below are not wonderful. The hand symptoms resolved.

^What she said

Removing only part of the disc is what they did for me back in l986, and I STILL have sciatica and looks like I'll have it forever. That probably will not be your son's outcome. NO ONE can tell me why I still have it. I've seen the heads of Neurosurgery in 3 large hospitals, and still I can get no answers. I guess I just have to live with it. There's been no recurrence of herniation, so that's not it and there's no bone spurs either.

Three epidurals might be protocol, but not when you're not getting proper pain control. And not when you're already had 2 that didn't do the trick! That's just too much steroid in the system! Sorry but I disagree with your cousin.

I'm glad tho that you have a cousin that reads the MRI's. That's great to have someone like that in the family! Will you let us know what he says? I'd appreciate it. God bless & I'll keep my fingers crossed! Hugs, Lee

I agree with Leesa 100%. These shots cost a fortune. If they don't work the first time, ususally a whole series won't help either or last. No, go to a different doctor, who may have another approach. My doctor did just two, and then he said what really needed to be done. I hope you see another opinion. ginnie

I am picking up a copy of the CD with images this afternoon to send to my cousin,

The MRI results T-12-L-3 were ok
L3-4 broad based disc bulge w/o stenosis
L-4 - L-5 broad based bulge w annular tear abutting the right L-5 nerve root
L-5-s1 right paracentral disc extrusion measuring 8mm and extending 5 mm below the superior endplate of S1 resulting in compression of the right S1 nerve root

Please help me interpret how bad this really is

I too have had the exact same problems as your son, I have 3 bulging disks at L3,4,5 for about three months I too had to walk bent over hanging onto the wall just to get to the restroom. I did they 3 injections three weeks apart and I too questioned my doctor about that many shots that close apart, for me the injections and the pain medicine eventually made it better for a couple of months and after RF Ablation the pain in my back and down my left leg is back in full force. I have not had surgery either but after five years of dealing with this I am really considering it. So I wish your son the best of luck and totally understand what he's going through.

Ok ~

At L4-5, besides the broad based disc bulge, there's an annular tear. The annula is a sac that the disc sits in, and when it tears it releases fluid that kind of "burns" from what I understand. Plus the bulge is abutting the L-5 nerve root, which is gonna hurt.

L5-S1 There's a disc extrusion (herniation) of 8mm (big) resulting in compression of the S1 nerve root (OUCH)

Remember, I'M NO DOCTOR -- but from this, if I were a doctor I wouldn't do surgery. Instead, I'd send you to physical therapy, or a pain management doctor. Surgery would just cause you MORE trouble. Pain management would give you more options for pain relief.

Even tho it's a large herniation, he only has intermittent leg pain. At this point therapy would be the best option. Having surgery would honestly cause him more problems than he has now -- no kidding! He would regret it later on. But he's the one who has to make the decision. I would HOPE that he would get other opinions besides your cousin.

God bless and please take care. Hugs, Lee

I would do the same as Leesa recommended, get that second opinion or even third before thinking about surgery. In my case, my surgery turned out OK, but alot of others have trouble, and sometimes get worse with pain. I wish you all the best. ginnie