New to DDD

[banhorn]

Hey guys,

I've been trolling these forums since my diagnosis with DDD in January, but I thought I'd finally introduce myself.

I'm 33 years old and live up in the Great White North (Canada). Shovelling all the snow sure is getting to be a chore!

I'm not sure where I'm going or how I'm going to try and treat my condition, but there have been a number of you that have helped me to come up with a general course of action.

My Diagnosis:

L5-S1. No Malalignment or destructive marrow leasion. Developmentally narrow lumbar central canal, particularly at L3 and L4 due to short pedicles. Conus terminates normally at the L1 level.
Discs and facet joints at L1-2 and L2-3 are well maintained with no evidence of spinal or foraminal stenosis.
At L3-4 the disc is well preserved. There are mild-to-moderate hypertrophic degenerative facet joint changes bilaterally with mild thickening of the ligamenta flava, without significant aquired central spinal stenosis. Foramina remain patent.
L4-5: There is mild disc space narrowing, desiccation and a combination of fatty and edematous endplate signal changes. No paraspinal soft tissue swelling. There may be very minimal enhancement of the disc and adjacent vertebral bodies but this is quite subtle. There is a mild disc bulge identified, eccentric to the left along with a central annular fissure. Mild to moderate degenerative facet joint changes are seen bilaterally with mild thickening of the ligamentum flavum resulting in mild acquired central spinal stenosis and left lateral recess stenosis. There is moderate left and severe right foraminal stenosis predominantly related to encroaching facet degenerative change.
At L5-S1, the disc appears well-maintained. Mild-to-moderate degenerative facet joint changes. Spinal canal and foramina are widely patent. No impingement of the descending roots.

The long-short is that it hurts like heck to bend/twist and absolutely aches when I'm sitting and in bed. The NSAID's help a little, but I've read that they can interfere with cartilage healing in the long run and they kill my stomach. Damned if I take them and Damned if I don't.

I've been exchanging emails with Mike86 and have read all about Tyler's experiences with the M6 and Mr. Boeree in the UK. I've exchanged a number of emails and phone calls with surgeons and have settled on Mr. Boeree IF I decide to go the surgery route. However:

1) I'm trying to exhaust any and all non-surgical treatments first
2) The surgery isn't covered by our government healthcare

My symptoms have lasted just over 6 months and are getting worse as I become more and more inactive. Pre-injury(DDD), I was up to 3 nights a week of hockey and a couple of nights of yoga per week, while I sat in a desk all day.

I'm living with the pain, but the tingles and numbness in my toes/hamstrings are concerning me greatly... they come and go, but I've read that is a troubling sign.

I've had a history of back problems at L4-5 and the first bulge/protrusion happened about 10 years ago. Losing 40 pounds and picking up yoga along the way kept in check until last September when this current bout of pain began. I'm currently at 6' tall, though I've lost 1cm in this ordeal somehow, 165 pounds and until September, was in the best shape of my life. My core strength is still pretty good, so making it stronger has been of no help.

I'm not sure where this leaves me, but any pointers will be greatly appreciated... Why can't cartilage just repair itself!

Until my appointment with my local specialsts here in Calgary (3 month waiting list - I'm in on April 8th), I'm popping glucosamin, chondroitin, MSM, omega fatty acids and collagen supplements in hopes that my lame disc can rehydrate itself - if even just a little. Gentle excercises hurt a bit, but I'm trying everything I can to get the transfer liquid and nutrients in and out of the disc. Physio has been a bust.

Cheers,

-Brett

L4-5 dessication, mild height loss, DDD and foraminal stenosis, mild-moderate facet degeneration

[ajj1001]

My core strength is still pretty good, so making it stronger has been of no help.

Hiya Brett and welcome, you'll never know if it has helped and it sure of heck won't have made your back any worse. Sorry that you are unsure of what to do next. Trying to keep moving and strong whilst you get your medical opinions is all I can suggest, I can't walk very far or lift anything but still drag myself through the water in the pool using my arms only, where there's a will!

alison x

[banhorn]

Well, it's been about 8 months since my initial fall and injury to my disc(though it seems to have been a long time coming)

Thanks for the response Alison!

I've been trying a number of things without much result. Chiro has helped a little through traction/flexion/extension to take away a little of the numbness in my toes and left hamstring. That's a plus! My pain levels are pretty much the same as October 2010, though the pain in my shins and ankles seems to be getting worse.

Physio, accupuncture and swimming have yielded little in terms of results and I'm core strengthening every night.

I'm still walking every day and resting on the couch in the evenings... sitting in front of a computer all day isn't helping much, I bet! I take breaks every hour.

I've gone through the gammit of consultations with my local and foreign doctors/surgeons and here is the breakdown.

My only affected level (for now) is L4-5.

For Surgery:
1) Boeree – M6 & Decompression (UK)
2) Clavel – M6 & Decompression (SPAIN)
3) Ritter Lang – M6 & Decompression (GERMANY)
4) Flood – Mulitple Laminectomies and stem cell disc injections (US)
5) Pimenta – Fusion via XLIF or ADR via lateral XL-TDR (BRAZIL)
6) Specialist Referral Centre/Cambie – Microdiscectomy for my leg pain only. They cannot help with the back pain nor do they offer artificial discs (CANADA)
7) Dr. Zigler at the Texas Back Institute. Prodisc and decompression at L4-5. (US)

Interestingly, they all agree I have no contraindications.

Against Surgery:
1) Caleo – Core work (CANADA) - My facets are too hypertophied, pedicles too short and spinal canal too narrow as a result for ADR.
2) Physio – Core work & swimming (CANADA)
3) Chiro – Flexion/Extension as allowed. Offered discogram, steroid injections and thinks I should get some second opinions outside of Caleo. (CANADA)

I'm still waiting to hear back from the LA Spine Institute, as I was looking into the freedom disc trial.

I'm set on Mr. Boeree for surgery, but the price tag and potential complications are a little disuading. I have no hope of any insurance reimbursement in Canada and am a little afraid of going out of country for a procedure of this nature. I've never even had surgery before, let alone a serious one out of country! How do you guys work up the guts to pull the trigger? My window for surgey is July (pre-baby #2) or any time after October (post-baby #2). Should I go before or after? Or should I wait indefinitely?

I had also signed up for the Mesoblast phase II MPC trial, but was rejected due to my bulge being greater than 3mm. My large facets seem to have frightened them off a little too!

I also looked into the DePuy rhGDF-5 phase II trial as well, but it seems a little more risky for some reason and I've opted against it. It's also a lot of money for travel and accomodation if you get stuck as a control.

I'm scheduled for a dexa scan to ensure my bones can handle an ADR if I proceed.

I guess my biggest questions are:

1) Will my back get any better by just waiting?
2) Will my back get worse by just waiting?

Here's a link to my scans from January, for any of you armchair MDs.
My Diagnosis « "Backup"

The pedicles thing kind of freaked me out, but Mr. Boeree has assured me that my facets still have 2 visible layers of articular cartilage, they are bigger, but normal, without osteophytes and short pedicles aren't an issue for ADR. Anyone else have fat facets and short pedicles? LOL

Thanks guys,

-Brett

[banhorn]

I almost forgot... My local Ortho's in Calgary want me to tough out the pain for another 20 years, when they will operate to fuse the bottom 3 levels. They said any surgery now (I think they meant fusion), will result in at least 1 or 2 more over the course of my life time. Is there any truth in this?

My issue with this was that my other two lumbar levels around L4-5 are ok still. Will an ADR actually help them to not degenerate? I guess the jury is still out, eh?

-Brett

[Justin]

I almost forgot... My local Ortho's in Calgary want me to tough out the pain for another 20 years, when they will operate to fuse the bottom 3 levels. They said any surgery now (I think they meant fusion), will result in at least 1 or 2 more over the course of my life time. Is there any truth in this?

My issue with this was that my other two lumbar levels around L4-5 are ok still. Will an ADR actually help them to not degenerate? I guess the jury is still out, eh?

-Brett

Hey Brett,

Somehow I missed your initial post. Welcome to the Spine Patient Society.

I just sent you a lengthy email.

[banhorn]

Thank you very much Justin! It was a great read and gave me a lot to think about.

[banhorn]

Well, after some long thought (thanks Justin) and a consultation with my local spine doc.... I've decided to bite the bullet.

July 13th with Mr. Boeree in Eastleigh.

The kicker was my doc confirming that after 8 months, there is no way I'd see any improvement in my symptoms at L4-5. He said that if it were him, he'd be flying to Europe because they're way more advanced with ADR than us in Canada. He booked my surgical consultation with our local Ortho, but it's a 2 year wait just to see the guy!

It's been a weird road to get to this point, but thanks again for providing this site! It's been invaluable to my decision making thus far.

Cheers,

-Brett

[ajj1001]

well done on making a decision as to what is best for you. hope your planning for the trip goes well.

[runagain]

Brett,

Welcome to this site.
In my humble opinion, seems like you have made a good decision.
I peeked at your films, your L4/5 disc is comparatively darker than the other discs, which means (if you don't already know) that it has less fluid in it. But it looks like your discs have good disc height, which is good. You said your bulge was more than 3 mm. When I herniated my disc in 2007, the bulge was 3.5 to 4 mm and that was considered medium or so.
You are going to a surgeon who has a good rep. I was surprised you got so many opinions, stuck out in the Great White North. That is good because the more you are informed about your case, the better you can make decisions about your health I believe.

It is scary going into surgery, but you do what you said, "You bite the bullet." Get your house ready and in order, enlist some people to help you when you get back to your home after surgery, get supplies you might need at the hospital and you go for it.
Be aware that once a surgeon goes in and gets a peek, the surgeon's plan of action may change. I found major surgery to be difficult but some people fly through it regularly with out too many bleeps and others have a prolonged course. No matter what, it takes a while to recover and for your body to heal.

Don't think that a strong core is not important, because it is and it helps recovery and it is something you want to have for the rest of your life. My core right now is admittedly sucky (not very strong) but I keep working on it. I got a thing I used in PT and really helped in my recovery, called a Bose ball (kind of like a cut off exercise ball), you can find them on line and they help with core stability. I got it because i was waiting for surgery and expected to use it and it was on sale at Target of all places. Also helpful are sturdy ice packs that last. I got some from my PT and then I went on line and bought some recently when one of mine got lost at the car wash, after I left it on top of my car and forgot it LOL.

I keep them (the ice packs) in my freezer and when I feel bad i rotate them, while I sit or lay on the couch (which is my most comfortable position for me) when I am hurting a lot. Don't get my wrong, I am using them because I have been trying to get my second ADR surgery for the past two years. I had an undetected second disc that was bad and started showing its ugly head about 6 months after my ProDisc was put in. For some reason, my discs don't look too bad but they were still pain-generators and I had the misfortune to have a doctor that did my first discogram,attribute pain at L5/S1 as "referred" pain while in reality, that disc was bad. Surgeon did not get full report and I accepted "referred" pain so as a result another surgery is in the cards. That in a nutshell is my story.

Hopefully, you have a good recovery and you will see how better you feel.

You will find there are a lot of helpful people on here, who can relate to your problems and help you with recovery.

Wishing you the best,

Runagain