Question
QUESTION: I fell 8 years ago and injured my back I have had pain throughtout the years but nothing i couldn't deal with. I had an MRI and was told i Had a mild herniation at L5. I was only 19 years old when this happened and a surgeon said i was to young to have surgery. anyways about 8 months ago my legs gave out and i fell and the pain in my back became very intense I went to my primary doctor and she ordered an MRI this is what it showed at L4-5 there is disc dessication compatible with degenerative disc changes. additionally there is a large central/left paracentral disc extrusion with mild inferior protrusion of disc material. the extruded disc material measures in the spine 1.2 x 1.3cm. in dimension with significant thecal sac impression. the remainder of the disc levels in the lumbosacral spine are unremarkable without disc bulge or protrusion. I was told by primary dr. that i need to have surgery immediately so she referred me to a surgeon. I had my first surgery and was fine for about 6 weeks then the pain come back but this time was worse it went further down my leg into my foot on my left side so my surgeon ordered an MRI but i didn't get these results he just said that i had a reaccurance and this time was worse than the first and there was more material protruded into the disc space and that i would need another discectomy. So he did the second surgery 4 months after the first. This time he said he got rid of all the material and i wouldn't have any more problems. But the problem is the pain didn't go away this time it got a little less intense but it was still there he said to give it time because i had 2 surgeries back to back but i was worried because the pain was the same before both surgeries with pain in my lower back into my left buttock and down my leg into my foot. So i got him to order another MRI and this is what was done
multiecho imaging of the lumbar spine with supplemental 3D virtual MR myelography as well as pre and post contrast enhanced T1 weighted images were obtained these are the findings there is a left paracentral laminectomy at L5-S1(previously called L5)there is a recurring disc herniation at this site with recurring extrusion of disc material into the prior discectomy site. this has produced compression of the left descending S1 nerve root with effacement of the thecal sac. I should emphasize that there is severe surrounding enhancing scar at this location as well. lumbar vertebra appear otherwise normal displaying normal marrow signal intensity throughout. conus medullaris is at T12-L1 which is normal.  I am wondering what all this means and is it normal to have 2 surgeries and still have this much pain and what my options are my surgeon was talking about another surgery if this last one didn't take care of the problem any advice would be appreciated
Thanks
Tricia

ANSWER: Tricia,

You had a ruptured disc.  The surgery removed the disc material that was pressing on the nerve root, causing the pain down your leg.  However, it did nothing to the underlying cause of the disc rupture, which you revealed by your story:  the back injury sent your back muscles into intense spasm, which alone causes pain from the muscles.  However, the spasm also pulled your L5 vertebra against S1 (uppermost sacral) vertebra with sufficient force, over time, to cause the disc to rupture.  The surgery did nothing to correct that condition, so the pressure continued, leading to a subsequent recurrence.

You need to take a step that your doctor hasn't talked about:  to learn sufficient control of your back muscles to relax them.  Without that, the problem is likely to continue.

Please see the articles on back pain at somatics.com/page4.htm.  The process will support the intended effects of the surgery by relieving pressure on the disc and nerve root.

These statements are based on the information you provided and would require an examination to be verified as accurate.  But that's the way it sounds from your description.

with regard,
Lawrence Gold



---------- FOLLOW-UP ----------

QUESTION: Thank you for your answer i just have a couple more questions or concerns i went to the doctor today and he told me i might have to have the disc removed and fused together i am kinda worried about this procedure and he also said i shouldn't be having pain in my leg because the disc material is on the other side of where he did the surgery and not by any of my nerves but i thought the mri said the disc material was compressing the s1 nerve root does that mean something else and is the doctor right and if he is why do you think i would still be having all the pain in my leg?
I appreciate any answer you could give me
Thanks
Tricia

Answer
Hello, Tricia,

There are two S1 nerve roots -- left and right.

The pain in your leg sounds like nerve pain, but I can't be sure from the information you've given me without an examination.

In any case, a disc fusion without freeing you of the muscular tension is only a partial solution.  I would start with somatic training for the muscular tension before the surgery and see if the problem resolves.  Surgery is a last resort.

practitioner list:  somatics.com/practitioners.htm

with regard,
Lawrence Gold