I have a family member who is having back issues, debilitating spasms happened once about ten years ago and once about 5 years ago, diagnosed with spondiolesthesis, degeneration of the L5/S1 disk. She has had two debilitating episodes since giving birth, recently. Her PCP is sending her for PT and then hopes to get an MRI approved. The PT is worth a shot as abdominal muscles are pretty useless postpartum. However, I am wondering if anyone has had experience with surgery for this? A friend mentioned spacers. I’m researching, but would love to hear some anecdotal evidence.
Has she actually ever tried PT, exercise, improving core strength? Not even post diagnosis? Is she healthy?
I don’t have experience with this, but IMO she should try everything, twice, before she decides on surgery. Surgery should be the last resort.
With her history and diagnosis, it seems that ongoing follow up with an orthopedist who specializes in the spine would be critical for ongoing treatment recommendations. With a degenerative disease, recent pregnancy and uptick in pain, knowing the current status of her spine is likely important. It is my understanding that this condition can be extremely painful and I wish her all the best. I have an adult child with a complex ortho history and found her PCPs very supportive of having the ortho docs managing the needed care.
I just had a micro-discectomy of the L5/S1 about 4 weeks ago. I’m a bit older (42).
Since mine was degeneration as well as herniation from a serious car accident, PT didn’t help at all. My disc was bulged to the point that it was going down my spinal canal and choking the nerve running down my leg. That’s actually what hurt, not my back.
I did 8 weeks of PT, which actually made my situation worse. I also tried the epidural steroid block, which did precisely nada. It took a couple months of waiting for an opening, but I finally got surgery and I feel great now. Some lingering issues w/ my gait and walking further distances but I see a PT for that in a couple more weeks.
My back didn’t hurt before surgery but it’s a little touchy now. I have very little disc left, so I do baby it a little. I still do all my normal household activities, except for things like have DH or DS change the water bottle in our water cooler.
The worst part of the whole experience was the pain while waiting for surgery. I was loaded up on drugs, but it didn’t really do much. I was still completely non-functioning. And then getting off the drugs! My one piece of advice for anyone is to have a plan for coming off the meds BEFORE surgery. I didn’t and there were a few days of misery that I wouldn’t have had to go through if I’d known better. I was on 2 different opioids for about 4 months. About 24 hours post surgery I felt well enough to stop taking the pain meds. Huge mistake!! I didn’t need them for pain, and I didn’t want to take them, but my body physically thought it needed them. It’s like having the flu, but with an extra helping of anxiety and depression. It won’t kill you, but it’s utter misery. Weaning is the best method for coming off opioids. For me it took about a week to get off them completely.
My daughter had a double spinal fusion in 2009 at age 19. She had Spondylolisthesis. She was an athlete and at some point must have gotten a stress fracture of her vertebrae which caused the vertebrae on top to slip forward. I think because she was in excellent shape prior to surgery she handled the surgery and recovery really well. She did not take a lot of the pain killers because she was so afraid of constipation. Also she has a pretty high tolerance for pain. The surgeon told her it is very important to stay in shape and keep a healthy weight. She has absolutely no issues. She has no restrictions and is very active (snowboards, runs, hikes, yoga, pilates, Orange Theory, etc…).
I am grateful for this question as I am waiting to see a surgeon for back issues. I finally, after weeks of waiting, had an MRI done. For nearly a year I have suffered with “sciatica”. PT made it worse. MRI shows L5-S1 has a disc extension and there is a narrowing of the spinal canal at L4-5. So now I wait to see a surgeon and then, hopefully, get scheduled for surgery. Living with this pain is awful. It comes and goes without cause which makes planning activities difficult.
Parent23, I am especially worried about the narcotics I have been taking. I appreciate your description of your withdrawal. I have been confused about this as I never feel high with the Vicodin I take but now I understand that my body will still want it. I will be more vigilant now as to weaning before surgery.
OP, until she has an MRI there is not enough information to know what course she should take. PT can definitely make things worse. Good luck to her.
I’m surprised your physician didn’t warn you-a patient on narcotics for four months would of course need instruction about how to wean off pain meds. Glad you are feeling better now.
My physician and my Doctor husband have warned me about the narcotics in a general kind of way. Not until Parent23 described her withdrawal did I even begin to understand. I thought if I do not get high (I do not) why would I feel withdrawal. Love CC–now I get it.
I would strongly encourage your family member, and anyone suffering from back pain, to read a book, Mind Over Back Pain: A Radically New Approach to the Diagnosis and Treatment of Back Pain by Dr John Sarno. I suffered - really suffered -from back pain for years before reading this book. My sister had it worse than I did, and was very close to having surgery before seeing Dr Sarno (he wrote the book in 1986 and he died 2 years ago so you can’t see him).
Read the book. It’s cheap. No drugs, no surgery, no PT. no acupuncture. All those options will still be available to you if the book doesn’t help. Worst case, you get a different perspective.
@Nrdsb4 Hindsight, I am too. Maybe he assumed I’d still be on them by the time he saw me for post op? He gave me another script for recovery that I never touched.
That’s another thing I need to figure out… how to get rid of the meds still in my home.
@ChaosParent23 CVS near us has a drug depository for turning in drugs. Don’t know if all have. Also our police dept has held a drug turn in day. Could check that out.
We just confirmed with the secondary X-rays that is it Spondylolisthesis with Pars defect, so a fracture there. Yes, she was an athlete as a kid & in HS. Not so much as an adult as her back has been very touchy and painful for 20 years, which is when the initial Spondylolisthesis was diagnosed.
She did PT during her pregnancy because of the long time back issues, but has not yet begun postpartum PT. I expect her to be following that regime for several months, I just want to research the options ahead. If the PT does not make a significant difference, I want to be ready with the next steps already researched.
Yes, being physically dependent on narcotics is NOT the same as being “addicted.” Being addicted typically means that in addition to the physical dependence, tolerance, and physical symptoms that accompany abrupt withdrawal of the medication, you are wanting, “needing”, seeking these drugs after the medical indications for them are no longer present, or you are psychologically dependent on them for the side effects that are helping you to deal with psychological or emotional issues.
There are many medications that shouldn’t be withdrawn suddenly or they can cause unpleasant symptoms. We don’t usually refer to patients in these instances as addicted.
For anyone interested, The Economist, a highly respected weekly magazine, recently published an interesting article on back surgery. In a nutshell, it is not very effective at all. There is a lot of evidence supporting the findings. The vast majority of people who have had it don’t need it.
In short, the article said that there are noninvasive approaches to chronic back pain that are proving much more effective at helping to alleviate symptoms. It appears that the brain isn’t “switching off” pain signals, and so it needs to be reprogrammed.
I can’t link the article, as we get The Economist on paper, but I know some newspapers have published the findings reported in The Economist.
Here’s The Economist article @Lindagaf referred to: https://www.economist.com/briefing/2020/01/18/back-pain-is-a-massive-problem-which-is-badly-treated
Never mind.
I can agree that pain some mild back issues can be controlled through alternative measures. But in general, “switching off pain signals” is a dangerous blanket idea. Until you’ve experienced the pain from a nerve that’s compressed by a severely herniated disc, you just don’t realize how serious it is. Furthermore, permanent nerve damage can be done, leading to lifelong numbness and weakness in the extremities. Generalizing back pain solutions like this eventually contributes to sub par care and delayed resolutions. How many people’s docs have told them that “many people have disc herniations with no pain”, interpretation “you should have no pain too”? It’s the last thing you want to hear when you are unable to walk, stand, sit at your desk at work, etc…
There’s no shame in resorting to surgery, if the pain gets that bad. We have to use our best judgment. I, personally, worked for months on every alternative measure possible before I decided on surgery. And only after a serious unexpected setback did I decide to proceed. 100% worth it.
We are in the throes of this with my dh.
Without derailing the thread, but hopefully giving helpful insight to the OP and others similarly situated about what to expect, can any of you speak to the situations you have encountered re: how long it took to get back surgery approved by your insurance companies?
Dh has been jumping through hoops. L5-S1 herniation with bilateral pars defects. Has done PT, had his first ESI yesterday (which has seemingly done nothing). Had to battle insurance on that because he has not yet had enough PT. Not sure if insurance will require a series of three ESIs or not. This seems to be typical. Scheduler at neurosurgeon said everyone has to battle their insurance company to get back surgery.
What challenges, if any, did you encounter getting surgery approved and how long did it take from request to approval?
Thankfully I had no insurance hoops to jump through b/c the wait to get an appt w/ the neurosurgeon takes quite long enough.
I had an xray Oct 25
MRI Nov 1
Referred to neurosurgeon Nov 6.
Saw neuro Dec 6.
Surgery Jan 17