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L5-s1 Annular Tear Serve Persistent Pain For 5 Months Now
Question: L5-s1 annular tear serve persistent pain for 5 months now tried all conservative options but doctor won't perform fusion surgery due to age and unreliability of helping back pain looking for next step also workers comp case.
L5-s1 annular tear serve persistent pain for 5 months now tried all conservative options but doctor won't perform fusion surgery due to age and unreliability of helping back pain looking for next step also workers comp case.
Brief Answer:
Perhaps another conversation with the surgeon....READ ON.....
Detailed Answer:
Good afternoon and thank you for your question.
Although it is highly likely you've already seen some nice looking pictures of what your ANNULUS FIBROSUS looks like (everyone should know what theirs looks like! LOL) here is a link to show you a little normal anatomy with some terminology since I'm going to use it:
https://en.wikipedia.org/wiki/Intervertebral_disc#/media/File:716_Intervertebral_Disk.jpg
Here is also a very good YOUTUBE video that shows you what an ANNULAR TEAR may look like on both MRI photographs as well as in a cartoon format so you can compare to the normal anatomy drawing in the first link above. I will CAUTION YOU though that the people who made the video also are trying to promote STEM CELLS as a therapy and I do not suggest this to any of my patient at this time. And as of XXXXXXX 2019 NEITHER DOES the FDA. But the video ain't half bad for teaching purposes:
https://www.youtube.com/watch?v=VvFPHL7Epqk
You've not provided your age for discussion purposes or your general health status such as presence of comorbid conditions such as diabetes, heart disease, hypertension, respiratory problems, etc. Age is not nearly as much a barrier as much anymore as before to surgery of almost any type unless the person is not in good health for some reason, or represents a poor operative risk for pain management afterward due to the presence of chronic pain syndromes that are poorly controlled, multiple surgeries at the same or proximate sites, etc. You also did not mention whether or not the surgeon you consulted explained to you the DIFFERENT surgical approaches that might be available for the repair of annular tears such as using laser cautery, or minimally invasive
endoscopic repairs which tend to have a higher success rate and lower postsurgical complications than radical open procedures.
It is true that one of the most common reasons for ANNULAR TEARS in individuals is AGE followed by Traumatic injury+Age, followed by traumatic injury....not sure whether that last statement was clear or not. In other words, if this is a WC comp case and it is established or presumptively established that a specific accident at work caused the annular tear then, my guess is that the surgeon is not happy on the prospect of surgery since he/she feels that your age plus the fact it was a traumatic event makes a successful outcome less likely. Or if you do heal according to expectation that your risk for another injury to that particular disk is higher than the surgeon is comfortable with so they prefer you choose a nonsurgical approach.
Now, you did mention FUSION surgery which is considered a bit of an older style approach to treating this problem as opposed to electrocautery techniques such as laser "sealing" or endoscopic minimally invasive diskectomy, So, perhaps it would be useful for you to clarify with the surgeon if they were thinking JUST in terms of segmental fusion (which is clearly not likely to give as optimal an outcome in the LONG HAUL as minimally invasive procedures) or were other surgical approaches considered?
You may wish to seek one more surgical opinion on your status from a surgical perspective but be cautious...lots of people may be willing to take a WC case without being entirely forthright on the potential complications or LONG TERM consequences expectations. Again, not trying to make you sound too terribly old or anything....but I'm sure you would readily admit that AGE and AGING clearly play a role in how a treatment or surgical procedure like this MAY NOT function in 5-10 years from now when your spinal column and discs will continue to lose hydration status, which means the central liquid core (nucleus pulposus) will continue to dry which means that the ANNULAR element to the disk will be more likely to crack and cause yet another tear in the very place where it was repaired. And there's also no guarantee that you will be PAIN FREE (which I'm sure is an important feature when talking about the success of this procedure?) after the procedure is complete.
So, bottom line, is that if your surgeon feels that age or anything else represent obstacles to success then, be wary of others out there who may wish to promise you a PERFECT result simply due to technology being more advanced than doing segmental fusions. Also, keep in mind that if you are diagnosed strictly with an ANNULAR TEAR then, by definition you are NOT oozing or leaking fluid into the area, you should not really be suffering a herniated disk, and ANNULAR tears generally have a favorable prognosis for self healing and sealing up though they still may remain painful.
NONSURGICAL OPTIONS
Perhaps, 5 months is not enough time for YOUR tear to heal up and perhaps a bit more AGGRESSIVE NONSURGICAL therapy such as:
1. AQUATHERAPY
2. PERCUTANEOUS ELECTRICAL STIMULATION (TENS UNIT)
3. Ultrasound/Diathermy sessions to stimulate angiogenesis (sprouting of new vascular channels to aid in healing the disk which is normally not heavily perfused with blood supply). Typically, 8-12 weeks of Ultrasound/Diathermy is felt to be sufficient for angiogenesis to get rolling though healing may still be well this time frame.
4. Vagal stimulator which is not entirely NONSURGICAL since a device would have to be implanted but be careful again, this is kind of a commitment (once in..it's typically there unless it gets infected or malfunctions).
5. Epidural and/or FACET injections but these have significant limitations and can ultimately cause structural instability in the ligaments that support the spinal column since some of the chemicals contained in these injections can have direct toxic effects of tissues into which they are injected. I don't know of very many pain management folks that tell their patients or referrals that information. They just tell them that they can't inject them too often. Now, you know why! HA!
6. PROSTHETIC DISKS to replace L5/S1, however, in your case I believe that is a very aggressive move if all you have is an annular tear. If the tear heals (and it should do that on its own) then, even though it is painful it is structurally likely to outlast a prosthetic disk since just the insertion of that artificial disk itself means some compromise of the normal integrity of the spinal column has to occur....you just can't avoid having to move SOMETHING around to get the bad disk out and the good one in...and that manipulation could be potentially enough to cause the prosthetic disk to fail earlier than anticipated. So again, careful with those who may promise more than they can provide if you inquire along these lines.
Another possible diagnostic test that could be performed if there were any doubt as to the actual contribution of the annular tear to the pain you are suffering is to perform what is known as DISCOGRAPHY which can specifically outline each disc in the lumbar spine with injected XXXXXXX and could either corroborate or REFUTE MRI results. MRI may not always be the best test for problems such as this since in discography there is direct visualization with XXXXXXX placement exactly at the disc or discs of interest while MRI's XXXXXXX is placed intravenously and then, distributes on its own without being able to control anything.
There is no doubt that your problem is challenging and the NONSURGICAL APPROACHES are relatively few but if it turns out that surgery really turns out to be out of the question then, start back at the beginning of the conservative treatment board and try slightly different combinations of techniques along with the judicious use of anti-inflammatory and analgesic medications (BTW, opiates and anti-inflammatory drugs have recently been shown in studies to produce overall similar levels of pain relief in the long run).
If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?
I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.
You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.
CHEERS!
This query required 90 minutes of professional time to research, assimilate, and file a response.
Perhaps another conversation with the surgeon....READ ON.....
Detailed Answer:
Good afternoon and thank you for your question.
Although it is highly likely you've already seen some nice looking pictures of what your ANNULUS FIBROSUS looks like (everyone should know what theirs looks like! LOL) here is a link to show you a little normal anatomy with some terminology since I'm going to use it:
https://en.wikipedia.org/wiki/Intervertebral_disc#/media/File:716_Intervertebral_Disk.jpg
Here is also a very good YOUTUBE video that shows you what an ANNULAR TEAR may look like on both MRI photographs as well as in a cartoon format so you can compare to the normal anatomy drawing in the first link above. I will CAUTION YOU though that the people who made the video also are trying to promote STEM CELLS as a therapy and I do not suggest this to any of my patient at this time. And as of XXXXXXX 2019 NEITHER DOES the FDA. But the video ain't half bad for teaching purposes:
https://www.youtube.com/watch?v=VvFPHL7Epqk
You've not provided your age for discussion purposes or your general health status such as presence of comorbid conditions such as diabetes, heart disease, hypertension, respiratory problems, etc. Age is not nearly as much a barrier as much anymore as before to surgery of almost any type unless the person is not in good health for some reason, or represents a poor operative risk for pain management afterward due to the presence of chronic pain syndromes that are poorly controlled, multiple surgeries at the same or proximate sites, etc. You also did not mention whether or not the surgeon you consulted explained to you the DIFFERENT surgical approaches that might be available for the repair of annular tears such as using laser cautery, or minimally invasive
endoscopic repairs which tend to have a higher success rate and lower postsurgical complications than radical open procedures.
It is true that one of the most common reasons for ANNULAR TEARS in individuals is AGE followed by Traumatic injury+Age, followed by traumatic injury....not sure whether that last statement was clear or not. In other words, if this is a WC comp case and it is established or presumptively established that a specific accident at work caused the annular tear then, my guess is that the surgeon is not happy on the prospect of surgery since he/she feels that your age plus the fact it was a traumatic event makes a successful outcome less likely. Or if you do heal according to expectation that your risk for another injury to that particular disk is higher than the surgeon is comfortable with so they prefer you choose a nonsurgical approach.
Now, you did mention FUSION surgery which is considered a bit of an older style approach to treating this problem as opposed to electrocautery techniques such as laser "sealing" or endoscopic minimally invasive diskectomy, So, perhaps it would be useful for you to clarify with the surgeon if they were thinking JUST in terms of segmental fusion (which is clearly not likely to give as optimal an outcome in the LONG HAUL as minimally invasive procedures) or were other surgical approaches considered?
You may wish to seek one more surgical opinion on your status from a surgical perspective but be cautious...lots of people may be willing to take a WC case without being entirely forthright on the potential complications or LONG TERM consequences expectations. Again, not trying to make you sound too terribly old or anything....but I'm sure you would readily admit that AGE and AGING clearly play a role in how a treatment or surgical procedure like this MAY NOT function in 5-10 years from now when your spinal column and discs will continue to lose hydration status, which means the central liquid core (nucleus pulposus) will continue to dry which means that the ANNULAR element to the disk will be more likely to crack and cause yet another tear in the very place where it was repaired. And there's also no guarantee that you will be PAIN FREE (which I'm sure is an important feature when talking about the success of this procedure?) after the procedure is complete.
So, bottom line, is that if your surgeon feels that age or anything else represent obstacles to success then, be wary of others out there who may wish to promise you a PERFECT result simply due to technology being more advanced than doing segmental fusions. Also, keep in mind that if you are diagnosed strictly with an ANNULAR TEAR then, by definition you are NOT oozing or leaking fluid into the area, you should not really be suffering a herniated disk, and ANNULAR tears generally have a favorable prognosis for self healing and sealing up though they still may remain painful.
NONSURGICAL OPTIONS
Perhaps, 5 months is not enough time for YOUR tear to heal up and perhaps a bit more AGGRESSIVE NONSURGICAL therapy such as:
1. AQUATHERAPY
2. PERCUTANEOUS ELECTRICAL STIMULATION (TENS UNIT)
3. Ultrasound/Diathermy sessions to stimulate angiogenesis (sprouting of new vascular channels to aid in healing the disk which is normally not heavily perfused with blood supply). Typically, 8-12 weeks of Ultrasound/Diathermy is felt to be sufficient for angiogenesis to get rolling though healing may still be well this time frame.
4. Vagal stimulator which is not entirely NONSURGICAL since a device would have to be implanted but be careful again, this is kind of a commitment (once in..it's typically there unless it gets infected or malfunctions).
5. Epidural and/or FACET injections but these have significant limitations and can ultimately cause structural instability in the ligaments that support the spinal column since some of the chemicals contained in these injections can have direct toxic effects of tissues into which they are injected. I don't know of very many pain management folks that tell their patients or referrals that information. They just tell them that they can't inject them too often. Now, you know why! HA!
6. PROSTHETIC DISKS to replace L5/S1, however, in your case I believe that is a very aggressive move if all you have is an annular tear. If the tear heals (and it should do that on its own) then, even though it is painful it is structurally likely to outlast a prosthetic disk since just the insertion of that artificial disk itself means some compromise of the normal integrity of the spinal column has to occur....you just can't avoid having to move SOMETHING around to get the bad disk out and the good one in...and that manipulation could be potentially enough to cause the prosthetic disk to fail earlier than anticipated. So again, careful with those who may promise more than they can provide if you inquire along these lines.
Another possible diagnostic test that could be performed if there were any doubt as to the actual contribution of the annular tear to the pain you are suffering is to perform what is known as DISCOGRAPHY which can specifically outline each disc in the lumbar spine with injected XXXXXXX and could either corroborate or REFUTE MRI results. MRI may not always be the best test for problems such as this since in discography there is direct visualization with XXXXXXX placement exactly at the disc or discs of interest while MRI's XXXXXXX is placed intravenously and then, distributes on its own without being able to control anything.
There is no doubt that your problem is challenging and the NONSURGICAL APPROACHES are relatively few but if it turns out that surgery really turns out to be out of the question then, start back at the beginning of the conservative treatment board and try slightly different combinations of techniques along with the judicious use of anti-inflammatory and analgesic medications (BTW, opiates and anti-inflammatory drugs have recently been shown in studies to produce overall similar levels of pain relief in the long run).
If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?
I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.
You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.
CHEERS!
This query required 90 minutes of professional time to research, assimilate, and file a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Perhaps another conversation with the surgeon....READ ON.....
Detailed Answer:
Good afternoon and thank you for your question.
Although it is highly likely you've already seen some nice looking pictures of what your ANNULUS FIBROSUS looks like (everyone should know what theirs looks like! LOL) here is a link to show you a little normal anatomy with some terminology since I'm going to use it:
https://en.wikipedia.org/wiki/Intervertebral_disc#/media/File:716_Intervertebral_Disk.jpg
Here is also a very good YOUTUBE video that shows you what an ANNULAR TEAR may look like on both MRI photographs as well as in a cartoon format so you can compare to the normal anatomy drawing in the first link above. I will CAUTION YOU though that the people who made the video also are trying to promote STEM CELLS as a therapy and I do not suggest this to any of my patient at this time. And as of XXXXXXX 2019 NEITHER DOES the FDA. But the video ain't half bad for teaching purposes:
https://www.youtube.com/watch?v=VvFPHL7Epqk
You've not provided your age for discussion purposes or your general health status such as presence of comorbid conditions such as diabetes, heart disease, hypertension, respiratory problems, etc. Age is not nearly as much a barrier as much anymore as before to surgery of almost any type unless the person is not in good health for some reason, or represents a poor operative risk for pain management afterward due to the presence of chronic pain syndromes that are poorly controlled, multiple surgeries at the same or proximate sites, etc. You also did not mention whether or not the surgeon you consulted explained to you the DIFFERENT surgical approaches that might be available for the repair of annular tears such as using laser cautery, or minimally invasive
endoscopic repairs which tend to have a higher success rate and lower postsurgical complications than radical open procedures.
It is true that one of the most common reasons for ANNULAR TEARS in individuals is AGE followed by Traumatic injury+Age, followed by traumatic injury....not sure whether that last statement was clear or not. In other words, if this is a WC comp case and it is established or presumptively established that a specific accident at work caused the annular tear then, my guess is that the surgeon is not happy on the prospect of surgery since he/she feels that your age plus the fact it was a traumatic event makes a successful outcome less likely. Or if you do heal according to expectation that your risk for another injury to that particular disk is higher than the surgeon is comfortable with so they prefer you choose a nonsurgical approach.
Now, you did mention FUSION surgery which is considered a bit of an older style approach to treating this problem as opposed to electrocautery techniques such as laser "sealing" or endoscopic minimally invasive diskectomy, So, perhaps it would be useful for you to clarify with the surgeon if they were thinking JUST in terms of segmental fusion (which is clearly not likely to give as optimal an outcome in the LONG HAUL as minimally invasive procedures) or were other surgical approaches considered?
You may wish to seek one more surgical opinion on your status from a surgical perspective but be cautious...lots of people may be willing to take a WC case without being entirely forthright on the potential complications or LONG TERM consequences expectations. Again, not trying to make you sound too terribly old or anything....but I'm sure you would readily admit that AGE and AGING clearly play a role in how a treatment or surgical procedure like this MAY NOT function in 5-10 years from now when your spinal column and discs will continue to lose hydration status, which means the central liquid core (nucleus pulposus) will continue to dry which means that the ANNULAR element to the disk will be more likely to crack and cause yet another tear in the very place where it was repaired. And there's also no guarantee that you will be PAIN FREE (which I'm sure is an important feature when talking about the success of this procedure?) after the procedure is complete.
So, bottom line, is that if your surgeon feels that age or anything else represent obstacles to success then, be wary of others out there who may wish to promise you a PERFECT result simply due to technology being more advanced than doing segmental fusions. Also, keep in mind that if you are diagnosed strictly with an ANNULAR TEAR then, by definition you are NOT oozing or leaking fluid into the area, you should not really be suffering a herniated disk, and ANNULAR tears generally have a favorable prognosis for self healing and sealing up though they still may remain painful.
NONSURGICAL OPTIONS
Perhaps, 5 months is not enough time for YOUR tear to heal up and perhaps a bit more AGGRESSIVE NONSURGICAL therapy such as:
1. AQUATHERAPY
2. PERCUTANEOUS ELECTRICAL STIMULATION (TENS UNIT)
3. Ultrasound/Diathermy sessions to stimulate angiogenesis (sprouting of new vascular channels to aid in healing the disk which is normally not heavily perfused with blood supply). Typically, 8-12 weeks of Ultrasound/Diathermy is felt to be sufficient for angiogenesis to get rolling though healing may still be well this time frame.
4. Vagal stimulator which is not entirely NONSURGICAL since a device would have to be implanted but be careful again, this is kind of a commitment (once in..it's typically there unless it gets infected or malfunctions).
5. Epidural and/or FACET injections but these have significant limitations and can ultimately cause structural instability in the ligaments that support the spinal column since some of the chemicals contained in these injections can have direct toxic effects of tissues into which they are injected. I don't know of very many pain management folks that tell their patients or referrals that information. They just tell them that they can't inject them too often. Now, you know why! HA!
6. PROSTHETIC DISKS to replace L5/S1, however, in your case I believe that is a very aggressive move if all you have is an annular tear. If the tear heals (and it should do that on its own) then, even though it is painful it is structurally likely to outlast a prosthetic disk since just the insertion of that artificial disk itself means some compromise of the normal integrity of the spinal column has to occur....you just can't avoid having to move SOMETHING around to get the bad disk out and the good one in...and that manipulation could be potentially enough to cause the prosthetic disk to fail earlier than anticipated. So again, careful with those who may promise more than they can provide if you inquire along these lines.
Another possible diagnostic test that could be performed if there were any doubt as to the actual contribution of the annular tear to the pain you are suffering is to perform what is known as DISCOGRAPHY which can specifically outline each disc in the lumbar spine with injected XXXXXXX and could either corroborate or REFUTE MRI results. MRI may not always be the best test for problems such as this since in discography there is direct visualization with XXXXXXX placement exactly at the disc or discs of interest while MRI's XXXXXXX is placed intravenously and then, distributes on its own without being able to control anything.
There is no doubt that your problem is challenging and the NONSURGICAL APPROACHES are relatively few but if it turns out that surgery really turns out to be out of the question then, start back at the beginning of the conservative treatment board and try slightly different combinations of techniques along with the judicious use of anti-inflammatory and analgesic medications (BTW, opiates and anti-inflammatory drugs have recently been shown in studies to produce overall similar levels of pain relief in the long run).
If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?
I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.
You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.
CHEERS!
This query required 90 minutes of professional time to research, assimilate, and file a response.
Perhaps another conversation with the surgeon....READ ON.....
Detailed Answer:
Good afternoon and thank you for your question.
Although it is highly likely you've already seen some nice looking pictures of what your ANNULUS FIBROSUS looks like (everyone should know what theirs looks like! LOL) here is a link to show you a little normal anatomy with some terminology since I'm going to use it:
https://en.wikipedia.org/wiki/Intervertebral_disc#/media/File:716_Intervertebral_Disk.jpg
Here is also a very good YOUTUBE video that shows you what an ANNULAR TEAR may look like on both MRI photographs as well as in a cartoon format so you can compare to the normal anatomy drawing in the first link above. I will CAUTION YOU though that the people who made the video also are trying to promote STEM CELLS as a therapy and I do not suggest this to any of my patient at this time. And as of XXXXXXX 2019 NEITHER DOES the FDA. But the video ain't half bad for teaching purposes:
https://www.youtube.com/watch?v=VvFPHL7Epqk
You've not provided your age for discussion purposes or your general health status such as presence of comorbid conditions such as diabetes, heart disease, hypertension, respiratory problems, etc. Age is not nearly as much a barrier as much anymore as before to surgery of almost any type unless the person is not in good health for some reason, or represents a poor operative risk for pain management afterward due to the presence of chronic pain syndromes that are poorly controlled, multiple surgeries at the same or proximate sites, etc. You also did not mention whether or not the surgeon you consulted explained to you the DIFFERENT surgical approaches that might be available for the repair of annular tears such as using laser cautery, or minimally invasive
endoscopic repairs which tend to have a higher success rate and lower postsurgical complications than radical open procedures.
It is true that one of the most common reasons for ANNULAR TEARS in individuals is AGE followed by Traumatic injury+Age, followed by traumatic injury....not sure whether that last statement was clear or not. In other words, if this is a WC comp case and it is established or presumptively established that a specific accident at work caused the annular tear then, my guess is that the surgeon is not happy on the prospect of surgery since he/she feels that your age plus the fact it was a traumatic event makes a successful outcome less likely. Or if you do heal according to expectation that your risk for another injury to that particular disk is higher than the surgeon is comfortable with so they prefer you choose a nonsurgical approach.
Now, you did mention FUSION surgery which is considered a bit of an older style approach to treating this problem as opposed to electrocautery techniques such as laser "sealing" or endoscopic minimally invasive diskectomy, So, perhaps it would be useful for you to clarify with the surgeon if they were thinking JUST in terms of segmental fusion (which is clearly not likely to give as optimal an outcome in the LONG HAUL as minimally invasive procedures) or were other surgical approaches considered?
You may wish to seek one more surgical opinion on your status from a surgical perspective but be cautious...lots of people may be willing to take a WC case without being entirely forthright on the potential complications or LONG TERM consequences expectations. Again, not trying to make you sound too terribly old or anything....but I'm sure you would readily admit that AGE and AGING clearly play a role in how a treatment or surgical procedure like this MAY NOT function in 5-10 years from now when your spinal column and discs will continue to lose hydration status, which means the central liquid core (nucleus pulposus) will continue to dry which means that the ANNULAR element to the disk will be more likely to crack and cause yet another tear in the very place where it was repaired. And there's also no guarantee that you will be PAIN FREE (which I'm sure is an important feature when talking about the success of this procedure?) after the procedure is complete.
So, bottom line, is that if your surgeon feels that age or anything else represent obstacles to success then, be wary of others out there who may wish to promise you a PERFECT result simply due to technology being more advanced than doing segmental fusions. Also, keep in mind that if you are diagnosed strictly with an ANNULAR TEAR then, by definition you are NOT oozing or leaking fluid into the area, you should not really be suffering a herniated disk, and ANNULAR tears generally have a favorable prognosis for self healing and sealing up though they still may remain painful.
NONSURGICAL OPTIONS
Perhaps, 5 months is not enough time for YOUR tear to heal up and perhaps a bit more AGGRESSIVE NONSURGICAL therapy such as:
1. AQUATHERAPY
2. PERCUTANEOUS ELECTRICAL STIMULATION (TENS UNIT)
3. Ultrasound/Diathermy sessions to stimulate angiogenesis (sprouting of new vascular channels to aid in healing the disk which is normally not heavily perfused with blood supply). Typically, 8-12 weeks of Ultrasound/Diathermy is felt to be sufficient for angiogenesis to get rolling though healing may still be well this time frame.
4. Vagal stimulator which is not entirely NONSURGICAL since a device would have to be implanted but be careful again, this is kind of a commitment (once in..it's typically there unless it gets infected or malfunctions).
5. Epidural and/or FACET injections but these have significant limitations and can ultimately cause structural instability in the ligaments that support the spinal column since some of the chemicals contained in these injections can have direct toxic effects of tissues into which they are injected. I don't know of very many pain management folks that tell their patients or referrals that information. They just tell them that they can't inject them too often. Now, you know why! HA!
6. PROSTHETIC DISKS to replace L5/S1, however, in your case I believe that is a very aggressive move if all you have is an annular tear. If the tear heals (and it should do that on its own) then, even though it is painful it is structurally likely to outlast a prosthetic disk since just the insertion of that artificial disk itself means some compromise of the normal integrity of the spinal column has to occur....you just can't avoid having to move SOMETHING around to get the bad disk out and the good one in...and that manipulation could be potentially enough to cause the prosthetic disk to fail earlier than anticipated. So again, careful with those who may promise more than they can provide if you inquire along these lines.
Another possible diagnostic test that could be performed if there were any doubt as to the actual contribution of the annular tear to the pain you are suffering is to perform what is known as DISCOGRAPHY which can specifically outline each disc in the lumbar spine with injected XXXXXXX and could either corroborate or REFUTE MRI results. MRI may not always be the best test for problems such as this since in discography there is direct visualization with XXXXXXX placement exactly at the disc or discs of interest while MRI's XXXXXXX is placed intravenously and then, distributes on its own without being able to control anything.
There is no doubt that your problem is challenging and the NONSURGICAL APPROACHES are relatively few but if it turns out that surgery really turns out to be out of the question then, start back at the beginning of the conservative treatment board and try slightly different combinations of techniques along with the judicious use of anti-inflammatory and analgesic medications (BTW, opiates and anti-inflammatory drugs have recently been shown in studies to produce overall similar levels of pain relief in the long run).
If I've provided useful or helpful information to your question could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving?
I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turned out.
You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.
CHEERS!
This query required 90 minutes of professional time to research, assimilate, and file a response.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry I am 27 years old full time firefighter I do have the tear along with substantial fluid leaking out of the disc into the spinal canal I have had tens unit , chiropractic Care ,injections , decompression inflammatory meds ,steroids ,pshyical theapry being told it could or could not heal within 2 years or never at all with symptoms of bilateral leg numbers and tingling with bladder and bowel problems I am cane depended at this point as well and cannot walk long periods of time I am open to less invasive surgery but he told me the only surgery option was fusion in my case that he could not deal or replace the disc and with my pshyical job I am afraid of re injury and at this point I cannot perform my job at all
Sorry I am 27 years old full time firefighter I do have the tear along with substantial fluid leaking out of the disc into the spinal canal I have had tens unit , chiropractic Care ,injections , decompression inflammatory meds ,steroids ,pshyical theapry being told it could or could not heal within 2 years or never at all with symptoms of bilateral leg numbers and tingling with bladder and bowel problems I am cane depended at this point as well and cannot walk long periods of time I am open to less invasive surgery but he told me the only surgery option was fusion in my case that he could not deal or replace the disc and with my pshyical job I am afraid of re injury and at this point I cannot perform my job at all
Brief Answer:
Conventional Wisdom directs doctors to do no harm FIRST...
Detailed Answer:
And so you are on the OTHER SIDE of the age spectrum with an annular tear....which apparently is leaking....so almost by definition your problem is closer to the symptoms of a herniated disk syndrome than a garden variety annular tear.
I think I now understand the surgeon's concerns. You are a very YOUNG person with a vocation that requires very physically demanding duties and with a career ahead of you likely LOTS of scenarios in which a defect like this at the L5/S1 will be stressed time and time again in situations that are going to be also critical ones in which your safety or others' are going to depend on the integrity of that back to get you through. And so yes, I understand how the surgeon's very reasonable concerns come into play. In medicine, there is a phrase, PRIMUM NO NOCERE which translates roughly to First, Do No Harm. I believe the surgeon's trepidation stems from the fact that he knows that about your annular tear ("leaking disk") will eventually heal....time frame variable due to the leaking material and possibility that the scar will represent a more weakened area than if there had been no leak. This area is going to be under a lot of stress at your age and doing what you do such that a repair or segmental fusion may or may not result in a long term fix. The surgeon can better quote the recurrence rate of REPEAT surgery since only he really the extent of your problem. You've already stated that he feels FUSION is the only reasonable surgical approach as opposed to minimally invasive, electrodessication (laser), or any other form of approach.
I believe the only way the disk can OPTIMALLY HEAL ON ITS OWN is if you really really RESTED IT AND ALLOWED it the time it needs to fully consolidate. Pain may or may not subside since scarring can leave nerve fibers very irritated and therefore, a good pain management program would likely be beneficial to help bridge you through that healing period. But, I think the line of work you're in is a really rough obstacle to get the healing you need. Nobody can reliably predict the amount of time you'd need for full recovery (without surgical intervention). 5 months is not that long in the scheme of a problem like this but it will only be prolonged if you cannot give it the rest that it needs either. It appears that you are on full rest from your job at this point....but again, 5 months is not that long for this sort of tear to heal. And I know you're chompin' at the bit to get back. But I completely understand the surgeon's reticence in cutting on you.....I know you do as well.
But I still stand by the alternative approaches including AQAUTHERAPY....did you try that? Water jogging is my favorite recommendation for a super exercise to keep the low back limber with the least amount of stress on the disks, ligaments, and nerves.
BTW, I hope you're not playing rugby right now either if you're on full rest.....LOL....Half the guys on our team (Cleveland Rovers) are either firefighters or cops....we got a couple of medical students in training that hit pretty good...but I'm the only stupid doc doing it! LOL!
But anyways, your concern of re-injury is valid...and isn't of being "afraid" of reinjury...you can up the chances of good recovery but trying to do everything to avoid surgical procedures that may need to be repeated and leave you with more problems than you started. I know you wanna get things moving. Therefore, the only other thing that might make sense is the minimally invasive approach...but that would be to the discretion of the surgeon looking at you so perhaps a 2nd opinion from a qualified person is in order. You could look at one of your academic centers in your area such as the Univ. of Cincy. Top notch medical facilities down there and all medical school affiliated. My only conctacts are really up here in XXXXXXX so you'd have to do a little searching to find an experienced person who might be willing to take on a challenge like this....but honestly, I think the BEST road to follow is to late Nature heal it up in conjunction with a tight pain management and good aquatherapy program and THEN, see where things go after the next 6-12 months before allowing surgery to be an option.
Lemme know your thoughts....
Conventional Wisdom directs doctors to do no harm FIRST...
Detailed Answer:
And so you are on the OTHER SIDE of the age spectrum with an annular tear....which apparently is leaking....so almost by definition your problem is closer to the symptoms of a herniated disk syndrome than a garden variety annular tear.
I think I now understand the surgeon's concerns. You are a very YOUNG person with a vocation that requires very physically demanding duties and with a career ahead of you likely LOTS of scenarios in which a defect like this at the L5/S1 will be stressed time and time again in situations that are going to be also critical ones in which your safety or others' are going to depend on the integrity of that back to get you through. And so yes, I understand how the surgeon's very reasonable concerns come into play. In medicine, there is a phrase, PRIMUM NO NOCERE which translates roughly to First, Do No Harm. I believe the surgeon's trepidation stems from the fact that he knows that about your annular tear ("leaking disk") will eventually heal....time frame variable due to the leaking material and possibility that the scar will represent a more weakened area than if there had been no leak. This area is going to be under a lot of stress at your age and doing what you do such that a repair or segmental fusion may or may not result in a long term fix. The surgeon can better quote the recurrence rate of REPEAT surgery since only he really the extent of your problem. You've already stated that he feels FUSION is the only reasonable surgical approach as opposed to minimally invasive, electrodessication (laser), or any other form of approach.
I believe the only way the disk can OPTIMALLY HEAL ON ITS OWN is if you really really RESTED IT AND ALLOWED it the time it needs to fully consolidate. Pain may or may not subside since scarring can leave nerve fibers very irritated and therefore, a good pain management program would likely be beneficial to help bridge you through that healing period. But, I think the line of work you're in is a really rough obstacle to get the healing you need. Nobody can reliably predict the amount of time you'd need for full recovery (without surgical intervention). 5 months is not that long in the scheme of a problem like this but it will only be prolonged if you cannot give it the rest that it needs either. It appears that you are on full rest from your job at this point....but again, 5 months is not that long for this sort of tear to heal. And I know you're chompin' at the bit to get back. But I completely understand the surgeon's reticence in cutting on you.....I know you do as well.
But I still stand by the alternative approaches including AQAUTHERAPY....did you try that? Water jogging is my favorite recommendation for a super exercise to keep the low back limber with the least amount of stress on the disks, ligaments, and nerves.
BTW, I hope you're not playing rugby right now either if you're on full rest.....LOL....Half the guys on our team (Cleveland Rovers) are either firefighters or cops....we got a couple of medical students in training that hit pretty good...but I'm the only stupid doc doing it! LOL!
But anyways, your concern of re-injury is valid...and isn't of being "afraid" of reinjury...you can up the chances of good recovery but trying to do everything to avoid surgical procedures that may need to be repeated and leave you with more problems than you started. I know you wanna get things moving. Therefore, the only other thing that might make sense is the minimally invasive approach...but that would be to the discretion of the surgeon looking at you so perhaps a 2nd opinion from a qualified person is in order. You could look at one of your academic centers in your area such as the Univ. of Cincy. Top notch medical facilities down there and all medical school affiliated. My only conctacts are really up here in XXXXXXX so you'd have to do a little searching to find an experienced person who might be willing to take on a challenge like this....but honestly, I think the BEST road to follow is to late Nature heal it up in conjunction with a tight pain management and good aquatherapy program and THEN, see where things go after the next 6-12 months before allowing surgery to be an option.
Lemme know your thoughts....
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Conventional Wisdom directs doctors to do no harm FIRST...
Detailed Answer:
And so you are on the OTHER SIDE of the age spectrum with an annular tear....which apparently is leaking....so almost by definition your problem is closer to the symptoms of a herniated disk syndrome than a garden variety annular tear.
I think I now understand the surgeon's concerns. You are a very YOUNG person with a vocation that requires very physically demanding duties and with a career ahead of you likely LOTS of scenarios in which a defect like this at the L5/S1 will be stressed time and time again in situations that are going to be also critical ones in which your safety or others' are going to depend on the integrity of that back to get you through. And so yes, I understand how the surgeon's very reasonable concerns come into play. In medicine, there is a phrase, PRIMUM NO NOCERE which translates roughly to First, Do No Harm. I believe the surgeon's trepidation stems from the fact that he knows that about your annular tear ("leaking disk") will eventually heal....time frame variable due to the leaking material and possibility that the scar will represent a more weakened area than if there had been no leak. This area is going to be under a lot of stress at your age and doing what you do such that a repair or segmental fusion may or may not result in a long term fix. The surgeon can better quote the recurrence rate of REPEAT surgery since only he really the extent of your problem. You've already stated that he feels FUSION is the only reasonable surgical approach as opposed to minimally invasive, electrodessication (laser), or any other form of approach.
I believe the only way the disk can OPTIMALLY HEAL ON ITS OWN is if you really really RESTED IT AND ALLOWED it the time it needs to fully consolidate. Pain may or may not subside since scarring can leave nerve fibers very irritated and therefore, a good pain management program would likely be beneficial to help bridge you through that healing period. But, I think the line of work you're in is a really rough obstacle to get the healing you need. Nobody can reliably predict the amount of time you'd need for full recovery (without surgical intervention). 5 months is not that long in the scheme of a problem like this but it will only be prolonged if you cannot give it the rest that it needs either. It appears that you are on full rest from your job at this point....but again, 5 months is not that long for this sort of tear to heal. And I know you're chompin' at the bit to get back. But I completely understand the surgeon's reticence in cutting on you.....I know you do as well.
But I still stand by the alternative approaches including AQAUTHERAPY....did you try that? Water jogging is my favorite recommendation for a super exercise to keep the low back limber with the least amount of stress on the disks, ligaments, and nerves.
BTW, I hope you're not playing rugby right now either if you're on full rest.....LOL....Half the guys on our team (Cleveland Rovers) are either firefighters or cops....we got a couple of medical students in training that hit pretty good...but I'm the only stupid doc doing it! LOL!
But anyways, your concern of re-injury is valid...and isn't of being "afraid" of reinjury...you can up the chances of good recovery but trying to do everything to avoid surgical procedures that may need to be repeated and leave you with more problems than you started. I know you wanna get things moving. Therefore, the only other thing that might make sense is the minimally invasive approach...but that would be to the discretion of the surgeon looking at you so perhaps a 2nd opinion from a qualified person is in order. You could look at one of your academic centers in your area such as the Univ. of Cincy. Top notch medical facilities down there and all medical school affiliated. My only conctacts are really up here in XXXXXXX so you'd have to do a little searching to find an experienced person who might be willing to take on a challenge like this....but honestly, I think the BEST road to follow is to late Nature heal it up in conjunction with a tight pain management and good aquatherapy program and THEN, see where things go after the next 6-12 months before allowing surgery to be an option.
Lemme know your thoughts....
Conventional Wisdom directs doctors to do no harm FIRST...
Detailed Answer:
And so you are on the OTHER SIDE of the age spectrum with an annular tear....which apparently is leaking....so almost by definition your problem is closer to the symptoms of a herniated disk syndrome than a garden variety annular tear.
I think I now understand the surgeon's concerns. You are a very YOUNG person with a vocation that requires very physically demanding duties and with a career ahead of you likely LOTS of scenarios in which a defect like this at the L5/S1 will be stressed time and time again in situations that are going to be also critical ones in which your safety or others' are going to depend on the integrity of that back to get you through. And so yes, I understand how the surgeon's very reasonable concerns come into play. In medicine, there is a phrase, PRIMUM NO NOCERE which translates roughly to First, Do No Harm. I believe the surgeon's trepidation stems from the fact that he knows that about your annular tear ("leaking disk") will eventually heal....time frame variable due to the leaking material and possibility that the scar will represent a more weakened area than if there had been no leak. This area is going to be under a lot of stress at your age and doing what you do such that a repair or segmental fusion may or may not result in a long term fix. The surgeon can better quote the recurrence rate of REPEAT surgery since only he really the extent of your problem. You've already stated that he feels FUSION is the only reasonable surgical approach as opposed to minimally invasive, electrodessication (laser), or any other form of approach.
I believe the only way the disk can OPTIMALLY HEAL ON ITS OWN is if you really really RESTED IT AND ALLOWED it the time it needs to fully consolidate. Pain may or may not subside since scarring can leave nerve fibers very irritated and therefore, a good pain management program would likely be beneficial to help bridge you through that healing period. But, I think the line of work you're in is a really rough obstacle to get the healing you need. Nobody can reliably predict the amount of time you'd need for full recovery (without surgical intervention). 5 months is not that long in the scheme of a problem like this but it will only be prolonged if you cannot give it the rest that it needs either. It appears that you are on full rest from your job at this point....but again, 5 months is not that long for this sort of tear to heal. And I know you're chompin' at the bit to get back. But I completely understand the surgeon's reticence in cutting on you.....I know you do as well.
But I still stand by the alternative approaches including AQAUTHERAPY....did you try that? Water jogging is my favorite recommendation for a super exercise to keep the low back limber with the least amount of stress on the disks, ligaments, and nerves.
BTW, I hope you're not playing rugby right now either if you're on full rest.....LOL....Half the guys on our team (Cleveland Rovers) are either firefighters or cops....we got a couple of medical students in training that hit pretty good...but I'm the only stupid doc doing it! LOL!
But anyways, your concern of re-injury is valid...and isn't of being "afraid" of reinjury...you can up the chances of good recovery but trying to do everything to avoid surgical procedures that may need to be repeated and leave you with more problems than you started. I know you wanna get things moving. Therefore, the only other thing that might make sense is the minimally invasive approach...but that would be to the discretion of the surgeon looking at you so perhaps a 2nd opinion from a qualified person is in order. You could look at one of your academic centers in your area such as the Univ. of Cincy. Top notch medical facilities down there and all medical school affiliated. My only conctacts are really up here in XXXXXXX so you'd have to do a little searching to find an experienced person who might be willing to take on a challenge like this....but honestly, I think the BEST road to follow is to late Nature heal it up in conjunction with a tight pain management and good aquatherapy program and THEN, see where things go after the next 6-12 months before allowing surgery to be an option.
Lemme know your thoughts....
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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