Herniated Disc - L5

[Spokoignan]

Hi,

This is my first post on this forum, just been searching for forums that talk about back issues and came across this one.

Apologies in advance for the length of this post - I have a habbit of doing mega long posts

Im 32 and have had a back issue for a number of years. Anyway, here's the history of my back issues.

When I was about 24 I was in work and just got a sharp pain in my lower back - hit me like a bolt of lightening at the time! This resulted in my not being able to move and I made a mistake of lying down and then really struggled to get back up again. Anyway, after a few days this subsided and after a few sessions of physio at my local surgery it seemed to get better. For a few years after this I would then suffer every so often from muscle spasms in my lower back which were very painful but would get easier after a day or so and after a couple of weeks would be fine.

Anyway until a few years ago this was as bad as it got, but the problems started coming more frequently. I have always done the stretching exercises and pilates techniques to strengthen core muscles which helped since the first time it happened, but it was getting worse and worse. I hate to say this but my local surgery were totally useless with this, but being that I have Asthma and Gastric Reflux this means I cannot take anti-inflamatories so their hands were tied a little. They did refer me to Physio at the local hospital and after about 12 weeks this came through - but again they didnt really help, advised me against seeing a chiropractor or osteopath because X-Rays showed that there were no structural issues with my back and it was probably just muscle spasms. Eventually it just started to subside, but the pain was always still there just more bearable. It then went again just over a year ago and I was referred back to physio.

I had to kick up a fuss about the fact that the physio had made it worse at points, and that we were getting nowhere before they eventually referred me for an MRI earlier this year, but I was told that it would be unlikely that anything abnormal would be found - this made me feel that they werent taking it serious and that I was making it all up. Some of the things that the physio and consultant physio implied led me to believe they thought I was just trying to get out of work! Thats the last thing I wanted - do they not realise how depressing it is to be stuck at home not able to do anything (or did they think I was living the life of Riley whenever I had time off with it!). When the results of the MRI came back I was told by my physio that there was an issue with the disc and we should keep up with the physio. In the meantime I had yet more episodes with the back (it would get worse, then slowly more bearable, then worse etc. - all the time I was unable to walk without a limp). Eventually when I had seen my GP regarding pain medication he said that I should be referred to a Neurosurgeon to assess it. I mentioned this to my physio and he got all upset saying that he could do the referral if thats what I wanted and it made more sense for him to do it! If this was the case, then why hadn't he already done it?

Anyway my referral came through to see the consultant. A week before I saw him I had the worst episode with my back I had ever had - basically it went and I could not move for a week. Standing up was not possible, I had to crawl if I went anywhere and lying down was the only thing that relieved the pain. When I saw the neurosurgeon, I was just about able to walk - I walked into the consultation, he asked if I had any pain in my right leg, which I did have along with loss of sensation at times, showed me the MRI that I had previously had (when my back was in one of its best periods) which clearly showed a big problem with the L5 disc. He said I needed surgery to correct it (microdiscectomy). He did say that if by the time my surgery comes around I am not having the issues they wont do the surgery - but when I told him just how many times I get the issue and how long it had been going on he said they definately would in any case (because I would still be having issues at the time in any case). 3 minutes to look at the MRI, ask me questions.

Anyway, after asking a few questions after I had seen him I got a rought estimate that I would be looking at December/early next year before the appointment for the surgery would come through. Last week I sneezed and yet again had the same issue. Coudn't stand or walk until last Saturday and as I type this I am lying down because standing and walking are very painful, and more annoyingly driving 33 miles each way and sitting down at a computer for 8 hours are a no-go just yet so I am off work yet again.

Now heres the good bit (I hope). After 5 years the full benefits at work kicked in which included private medical cover. I though this would have a pre-existing cause in it, but it doesnt - so first thing I did last Wednesday morning was ring PPP healthcare, make a private appointment to see the same consultant, so go to see him this Thursday (at the local private hospital this time). Hopefully can get this procedure done and all being well start to get back to a normal life - get myself back in the gym and get my fitness back (cant believe how out of shape I now am), and enjoy our family holiday in Majorca in mid-September.

Thanks for reading all of that - its been kindof therapy for me just to type it

 

[incepaype]

Hello Again Dave,
Just read your thread and what a battle uve had over the years. So many things get missed because MRI scans are not done sooner....and the reason why they are not done is because.........IT COST LOTS OF MONEY. The one good thing out of all your pain and suffering is that you have finally got an diagnoses,so you can look into alternative treatments....im so mad that they told you not to go to a chiropractor or an osteopath.... as this would have been the first place i would have gone too........

Anyways good luck for your consultation on thur and let us know how you get on.

Take care
Rachelx

 

[Bails B]

Thanks for the reply

The MRI costs money and they were doing everything they could to avoid doing one. Not exactly in the best interests of the patient (i.e. me). Its the fact that they were totally 'we will do it, but we wont find anything wrong' attitude that got to me, and if I hadn't kicked up a fuss I would still be waiting for something to be done.

Even when the results came in, they hadn't actually seen the MRI scans themselves and just said there was an issue there. Its only when I saw the scans myself when I saw the consultant I could see that the disc was bulging quite badly (in my non-medical opinion anyway) and this was when my back was in one of its good periods. When I saw the physio again after seeing the consultant he asked me what the MRI looked like - surely he should have seen it himself (its all centrally computerised - I should know I work for one of the companies that provides this to the NHS). He just said I am under the consultants care now so discharged me from the physio.

Just makes me a bit angry that I have been passed about when this issue could have been sorted out long ago. Now luckily I have private cover which should get me in for the procedure quicker, but if things were done more efficiently in the first place I would have had the procedure over a year ago on the NHS and might be all OK now. Im not expecting miracles from the procedure because they can be unsuccessful, but its a start and worth a go.

 

[krascow_jr]

Yes .....You have good reason to be angry.....(although try not to dwell on it to much as its not good for you)
One thing ive learnt over the years is that with the NHS you have to fight and push until you get some where....I was told that my little boy was making his illness up and that it was all in my mind.....So me being me and knowing better i went to Great Ormond street and got him dignosed...he was suffering from Colitis.
The best advice is:- listen to your body.... and trust in your intuition.

Love and sunshine
Rachel.

 

[Ananymous]

Thanks again Rachel. Im trying not to dwell on it at all now - it could be sorted out pretty soon so focusing on that. Was depressed as hell last week though cause I was completely immobile again with it, but feeling a lot better at the minute and able to at least stand up and walk a bit

 

[wutda!*&!]

Dave

do you live anywhere near leicester? I know a specialists there who deals with buldging disks.

cheers

ian

 

[Noobalizer]

No, I'm in the North West. I get to see the Neurologist tomorrow, but privately this time so hopefully he can arrange the microdiscectomy very soon otherwise I will be waiting till December at the earliest on the NHS.

 

[Luka Van der vaart]

Had my consultation before. He straight away said that he could do the Discectomy privately as he remembered my details from when I saw him on the NHS. As I was waiting for the appointment I did start to get pain down my left leg too, which I havent had for quite a while (have had this before but problems predominently down right leg). He said cause of this it would be worthwhile doing another MRI so will be having that next week. The last MRI was done when my back was in one of its good phases between flare ups as I had to wait for the appointment to come through.

Hopefully will all be sorted out before we go on Holiday on 18th September - which will be good cause the holiday will help with the recouperation as I tend to swim a lot on holiday which helped last year

 

[ck01]

Hello Dave,
Thats good news. Hope you get sorted before your hoilday.
Take Care
Rachel

 

[skyee.]

dave problem with MRI's is that they are a snap shot in time picture of your lower back with no gravity/pressure on the spine - sometimes v misleading. if you MRI'd 100 people with no problems many of them would have some irregularities with the spine but never have any problems. Dito for people with back problems many of them report back 90%+ clean MRI's! It would be a very good idea to get another MRI which might show up something more conclusive.

Re surgery you need to be 100% sure which disk (if any) is the true cause of your problem. If an MRI scan is inconclusive i wouldn't fancy being cut open only to find that was not the cause of your problem. I had a friend who had terrible sciatica but his MRI's only reported back small bulges at several 2 levels without any clear compression. He was in such a state that he needed surgery BUT to ensure they were operating at the right level he had to have a load of other tests carried out to identify which disk was the cause of the problem (injections, probes etc etc). when it came to the op the nerve was definitely being touched by the bulging disk. At the other disk that looked worse on the MRI there was no compression. It was the host of test carried out that convinced him/the Dr that they were operating on the right disk
PS rehab after surgeyr took a long time and this is what totally sorted his problems out in the long term. The surgery fixed his disk but it was the rehab that really fixed his underlying back problem

 

[jbedqzrd]

Ive seen the original MRI which was done because the consultant showed me on the computer when I first saw him (on the NHS). All the other discs on the MRI were absolutely normal, and the problem one stood out like a sore thumb (or rather sore disc). The reason he wants to do another MRI is that I mentioned to him that I had a little discomfort in my left leg at times, and had when I was in the waiting room. Up to this point I think he was just going to get the details already on file sent to him at this hospital and arrange the procedure. This way he can compare the two scans to see if there has been any considerable change - which I think there will be because I am just getting over a flare up.

Up until about 3 months ago I would still have been hesitant about having the surgery on it, but have had 2 quite bad flare ups (one still ongoing but slowly improving since last Tuesday) which have made me really want the procedure. I know it may not work, or work long term but at least there is hope that it will. I think if I can get it done a few weeks before we go away that gives me a little time to recouperate before we go on holiday. Once we are on holiday I can only see it getting better because I will be swimming for a few hours at least each day. Last year on holdiay I had one muscle spasm flare up where it took me about 4 hours to get to the pool outside our apartment because it was that painful but after about half an hour just moving slowly in the pool it had eased considerably. It was still sore for a few days after that but swimming helped.

If the outcome of the procedure (if its done that is, cause you never know what will be the outcome of the MRI) is that I can start to get my fitness back, that will help hold off any future re-occurences of the problem. I think the reason it has been bad over the past few years is that I changed roles in work which meant I wasnt able to go to the Gym at work every lunchtime which I had been doing. Another positive is I am changing locations soon so instead of a 65 mile round trip daily it will be about 25 will help too so less time stuck in traffic which doesnt help.

He did say that it would be advisable not to be working until its sorted out, but I really do want to get back to work because being at home and not being able to do anything is driving me up the wall. If I am in lots of pain at work or I start to lose sensation down my leg quckly again (not particularly safe when driving) then I can review it cause he said just phone up and he will have a sicknote waiting for me if I need one, but I really want to avoid this. It will be good to get back to work - a concept lost on a lot of my colleagues who will think I am mad wanting to go back, but better this than having a pain free back but a mental illness

 

[idic5]

Dave,
you say that you were denied a scan to save money but this is too simplistic and cynical a view.
Where scans are freely available for back pain the surgery rate increases but the eventual outcome is no better (sorry not what you wanted to hear before surgery). The need for surgery really has to be assessed on clinical grounds rather than treating a scan abnormality. Experienced surgeons will not operate on a disk if the scan abnormality does not fit with the clinical findings. Also surgery is not to be taken lightly. My view is that it is a last resort after everything else has been tried unless there are clear neurological signs such as leg weakness or disturbance of bladder function.
Once you have a scan and it shows an abnormality it is very difficult to deny the patient surgery so it is easier not to ask for the scan or hope that the symptoms have gone by the time the scan is done. A surgeon doing this might really be acting in your interest and one of the less tangible benefits of the NHS is that the doctors have no financial interest in recommending surgery or a scan. I think most doctorsin private practice in the UK act ethically too as it would be obvious to everyone if a doctor investigated and treated their private patients differently in order to increase their income but some doubt must always be lurking when someone offers to operate on you privately.

 

[IceCreamFreak]

The problem is that in places like the US, any problems like those I have been experiencing tend to have a much faster turnaround if the problem continues. The first step is physio, and if after about 6 week there is no positive improvement then they take it to the next stage which is doing other investigations (such as MRI). The fact that I had to wait months before even being referred to Physio, the physio made things worse, they then only did the MRI when I kicked up a stink (over a year after the start of these ongoing issues), and even then I only got the referral to the Neurologist when my GP said it had gone on way too long - which should have been done by the physio. Even the physio when told that I had seen the MRI for myself asked me what it looked like, does that sound like they were providing me with appropriate treatment? As I have said above, the Neurosurgeon when he saw me had looked at the MRI, read my notes, asked me a couple of questions about the pain and said I need surgery to try and correct the issue.

Anyway, I have had the 2nd MRI last Thursday and see the Neurologist on Tuesday where I will find out whats required. The MRI I had the other day I think was in much more detail and lasted longer (I think they did 4 scans) so he should be able to really asses it and decide whats the best way forward on it. I dont really care if its surgery, or physio again thats done so long as its a positive solution because having 2 bad flare ups that leave me incapacitated within a few months isnt really nice and indicates to me that the issue is getting worse - this alone and the fact that I have had issues like this every few months shows that its not healing on its own.

Im fully aware that there is always going to be the chance that any surgery will not work, but its worth a go if thats the road we have to go down - the alternative is to have this issue for the rest of my life, which isnt really an option as it technically means I am disabled and would have to consider giving up work.

 

[Epotrebitel]

Dave - I'm sorry that you had such a bad experience with physiotherapy - we're not all that bad. All physios follow their own pathway of continuing professional development so the treatment that you get depends on where their training has taken them. Back pain is known to be a recurring problem that can usually be controlled/resolved with treatment as necessary and self-help between episodes. It very occasionally needs referring for further investigations and treatment and at that point you join the queue to be seen
I hope you get sorted

 

[mcq316]

My problem isnt with the physio's because although the physio actually made things worse at times by aggrivating the nerve (a bit too hands on at first), other things have helped too. Its the fact that I could have been referred onwards a lot sooner by them and I had to kick up a stink to get anywhere because we were getting no-where, and definately should have been once the MRI was done but wasn't.

Get to see the Neurosurgeon again tomorrow afternoon so will know whats the next step then

 

[guestofroom2002]

Paulgech's comments (post #12) echo my experiences about the use of X-rays and scans. These techniques can show up 'normal' abnormalities of the bones and discs which you have lived with for years without them producing symptoms. Only if the abnormality can be seen to produce the symptoms that you have should a surgeon consider operating.
So don't be surprised if the neuro surgeon declines to operate following the results of your scan - as Paulgrech says , research has shown similar results at 12 month follow-up with surgery and non-surgery.

 

[NMS HKG]

He has already put me on the list for surgery on the NHS, but I understand that following this scan he might change his mind about doing the operation privately, and take me off the list for the NHS op. I dont care as long as we can make some progress.

I also know that abnormalities are normal, but in my case (having seen the first MRI images) its blatantly this one disc thats causing the issues as all the others that were on the scan looked absolutely normal (very normal compared to this one which was bulging). Because it was so obvious I think this is why he could confidently make the decision about putting me down for the surgery.

At the moment, my back is feeling pretty good after the latest episode - still restricted in my movement but its not constant pain. Little discomfort in my right leg from time to time and my big toe is still a little numb (has been for a while really). Just need to keep moving about - Just over 3 weeks till our holiday

 

[catinhat]

Seen the Neurosurgeon again. As he thought, the MRI shows that there is a worsening of the problem compared to the first one. He asked when I walked (limped a bit) in if I was OK to which I replied I felt quite good. He asked if I was sure, cause he had seen the MRI He said that the disc requires surgery because its very enlarged and pressing on the nerve (I saw the MRI films which showed the disc is very enlarged).

Because we are going away in 3 weeks he is going to do the operation when we get back off holiday. He did ask if I wanted to cancel the holiday, but to be honest as long as it stays as it is now I am more than happy to wait till we get back (and not throw money down the drain). He is happy for this and is going to schedule me in for Friday 12th October which is the day after my little girls 4th Birthday.

There is another issue because I am due to TUPE across to a different company with the contract I work on currently before the procedure is due to be done, but the healthcare cover is replicated bt the new company and I have had written confirmation from them that the transition will be seamless (I checked with PPP too who confirmed that they both have the same cover with them).

All I need to do now is take it easy and not do anything that will put strain on my back until I have the OP to prevent another episode

 

[Sommer]

Thanks for the update. There is no doubt that surgery is the right thing for some people but the reputation has been tarnished by indiscriminate use. If there is a clearly prolapsed disc pressing on a nerve which fits in with the level of your symptoms, the chances of a good result are good. I hope it sorts out your pain.

 

[Spaumarach]

All the best to you Dave