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Old 05-22-2013, 08:20 PM #1
rmschaver rmschaver is offline
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Default Advice please

I was injured at work almost a year ago. Won't bore you with the details but I am seeking opinions from people who have been thru it so to speak. I have a paracentral bulge at T7 and T8 and a bulging disk at L4 and L5 that is impinging on the nerve exitint the left formina. There are also multiple other bulging disks in both the thoracic and lumbar regions.

One Dr. a nuerologists told me I had degenerative disks desease and it was normal for my age. He also toldd me that there was nothing on the Mri that he could see to indicate why I had pain in the T and L regions. The pain management dr seemed more interested in the T region even though the L region can be so painful walking, standing or most any other activity is unbearable.

To date I have had PT, myofascial release, bilateral steroid injections 2x. What is the likely course of my treatment from here?
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Old 05-23-2013, 01:41 PM #2
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Do you have the MRI report, by any chance? I'd like to see it if I could. It would be much easier to give you advice if i could see the report.

I can tell you the degenerative disc disease IS normal and everyone gets it. What it is, is drying out of the discs. As we age, they dry out and flatten. And when they flatten, they tend to bulge and that can cause them to push on nerves and that can HURT. Some will even herniate, but that does NOT necessarily mean pain. There are millions of people walking around on this earth with herniated discs and they don't even know it. Weird, huh? It's just we're the "lucky" ones that happen to get the pain. Our discs end up pushing on the nerves and causing extreme pain!

If you cannot get the MRI report, from what you've told me I would suggest physical therapy. Do NOT rush to have surgery!!! Surgery should be a LAST RESORT after all conservative methods have been exhausted! Not only that but surgery is ONLY for mechanical problems. It usually will NOT ease your pain. You will be left with the same pain or worse after surgery. Plus there is the "domino effect" after surgery. The levels above/below the surgery site will FAIL due to having to take on more of the load, and that will mean MORE surgery. It's a vicious cycle, and it goes on and on. The doctors don't tell you this.

So opt for physical therapy for as long as you can. It is usually very effective. Please let us know how you come out. And if you CAN get the MRI report, please post it here, okay? God bless & please take care. Hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
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Old 05-23-2013, 07:38 PM #3
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Report as follows.

No marrow signal abnormalities. Spinal column is normal in volume and signal.

Thoracic spine is normal in alignment.

T1/T2-T4/T5 Unremarkable

T5/T6 Shallow disk protrusion with no canal or foraminal stenosis.

T6/T7 Shallow left paracentral disc protrusion with no canal or foraminal stenosis.

T7/T8 Shallow disk protrusion with no canal or foraminal stenosis.

T8/T9 Right paracentral disc extrusion up to 4 mm in diameter with flattening or the ventral margin of the cord but no associated canal stenosis. T8 neural foramina are widely patent.

T9/T10 Invertebral disc is normal in height and signal. T9 neural foramina are patent.

T10/11-T12/L1 Unremarkable
Paraspinal soft tissues are within normal limits.

As I understand it there are small bulges at T5/T6, T6/T7, and T7/T8 but they do not indicate any reason for the origination of pain. The T8/T9 however may or is pushing on the spinal cord? I do have pain that is between my shoulder blades but it is not as bad as the lumbar region.

L5/S1 Shallow left paracentral disk protrusion and annular tear noted with no mass effect upon the lateral recesses or canal stenosis. L5 foramina are widely patent. Incidental note is made of asymmetry to the appearance of the right S1 nerve root sleeve representing conjoined appearance of the proximal right S1 and S2 nerve roots.

L4/L5 Generalized bulge of the disk annulus and ligamentum flavum thickening noted with no associated canal stenosis. A left extraforaminal disc protrusion and annular tear noted, abutting the exiting left L4 nerve root. The spinal canal is relatively well-preserved with no canal stenosis or lateral recess narrowing. The right L5 foramen is mildly narrowed from ligamentum flavum thickening and vertebral endplate spur.

L3/L4 Mild ligamentum flavum thickening. No disk herniation, canal stenosis or foraminal stenosis.

L1/L2 Tiny central disk protrusion noted at this level with no associated canal or forminal stenosis.

Paraspinal soft tissues are within normal limits. No marrow signal abnormalities. No evidence for marrow or ligamentous injury.

There is a note in the impressions that the L4 disc protrusion to be correlated clinically for any dermatomal symptoms. I assume this to mean that this is the most obvious cause of the lumbar pain I experience. I hope this helps and thank you for responding.
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Old 05-23-2013, 09:23 PM #4
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While you have several quite small herniations, none should be causing the pain you describe.

The T8-9 "flattens the front margin of the cord" but there is no cord stenosis or narrowing. So the T8-9 isn't really doing the cord any real damage at this point.

At L4-5 with the bulge of the disc annulus & disc protrusion & annular tear abutting the nerve root -- that could HURT. Anytime we mess around with nerve roots, it does hurt.

However, I still don't think this is a surgical event. I would HOPE no surgeon would do surgery, as I just don't think it's called for -- YET. And your pain would probably NOT be relieved.

I know you're hurting, and you should probably see a pain management doctor if you haven't already. The only trouble with them is that they always want to do steroid injections -- and they rarely work. But, I hope you find some relief. Please take care and God bless. Let us know what happens, will you PLEASE? I'd REALLY LIKE TO KNOW! Big hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
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Old 05-27-2013, 04:12 PM #5
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I have had a series of two bi-lateral steroid injections. I am very lucky as they have helped. No one is recommending surgery and I am not seeking it. The information I have found leads me to think I might be a candidate for widening the foramina in the area where there is the nerve impingement. Not what I want though. I continue to have low back pain and worry that the days of me riding a motorcycle are over. It has been almost a year since I have ridden and I am no closer to knowing if I will ever be able to comfortably ride again. I have some fine motor skill compromise and I worry that in the event I drop my bike I will have to pick it up by myself and ruin what little integrity is left in my low back. Thank you for your time and information. It has been hard to get a straight answer for most of the doctors I have seen and the one that has is my GP and he is careful as to what he says.
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Old 05-27-2013, 04:33 PM #6
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Where would the foramina be widened? I didn't see anywhere, where it was being narrowed? It did say the L5 foramen was MILDLY narrowed, but that certainly is not something a surgeon would even consider touching at this time.

The annular tear COULD be a source of pain, as the contents of the annula "spilling" out onto other nerves is painful. I should have mentioned that previously.

With all your bulges/herniations, you would be well-served to put the motorcycle away, or even sell it. I don't think you'll be riding anymore. At least you shouldn't!! That bouncing on the bike is going to REALLY mess with your spine. And SHOULD you happen to dump the bike, even attempting to pick it up is going to really do some damage -- not just from picking it up, but from the fall itself! Seek some other kind of healthy hobby. LOL I know nothing replaces riding the bike -- but you're going to have to do something else, my friend.

Keep us posted, will you? I know this sucks (pardon) but having lived with this now for 28 years, I can tell you that major changes have to be made in our lifestyles. ICK.

God bless and i hope we hear from you again. Hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
.................................................. ...............Orestes
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Old 05-27-2013, 05:01 PM #7
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I appreciate the straight talk. I have not ridden because of the health risk. BTW I am not a squid on a sport bike. Mine is a K1200 BMW. It is a very plush ride but it is a very heavy bike over 800 lbs. There is a method for picking bikes up but it will put a lot of pressure on ones back. It will be a hard decision to sell but I have been considering it. Thanks again.
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Old 05-28-2013, 04:18 AM #8
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No, I didn't think you were on some dirt bike, or some 250 or something. I figured you were on a pretty good ride. That's why I also figured that if the bike went down, it was going to be pretty rough getting it back up. I know there are special ways of getting them up, but still - it takes POWER to do it, and the back is going to take a beating!

My ex rode bikes the whole time we were together, so I'm well versed in them. He had an 1100Gold Wing International so it rode very well too -- but it still made MY back hurt like the devil! Of course I always sat on the back seat, and that makes a difference but at least I had a back rest. LOL Still I suffered something awful after a ride on that thing. I HATED it, but he always insisted. I finally put my foot down, and said NO MORE!

I know it will be hard for you to get rid of it, but it's a shame to have it just sit there. Anyway -- keep us posted on how you're doing, okay? Hugs, Lee
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recovering alcoholic, sober since 7-29-93;severe depression; 2 open spinal surgeries; severe sciatica since 1986; epidurals; trigger points; myelograms; Rhizotomy; Racz procedure; spinal cord stimulator implant (and later removal); morphine pump trial (didn't work);now inoperable; lumpectomy; radiation; breast cancer survivor; heart attack; fibromyalgia; on disability.



Often the test of courage is not to die, but to live..
.................................................. ...............Orestes
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