Expert: Dr. J. Shawn Leatherman - 12/16/2006

Question
In 2001, I had a microdisketomy of L5. No problems went right back to work.  In 2003, I started having the mains down my leg (SCIATICA) and went back to the doctor who did the microdisketocmy.  He did an MRI and said it all looked good and sent me to a Pain Specialist.  This pain specialist injected me several times with no relief. He referred me to a physical medicine doctor.  She said she could tell my examining me and by looking at the MRI that my SI Joint was "out of whack".  She sent me for therapy where I was manipulated but when I would go back for therapy two days later, the therapist said your joint is out of place again.  We did this 8 to 10 times.  Finally he called the physical med. doctor and said I can't keep her SI Joint in place even with a belt.  So I called my internist who I really trusted and she sent me to an orthopedic surgeon.  He did an Mri AND a discogram and said my L5 was fractured and needed to be replaced and fused because the area was unstable.  He did not think I had an SI Joint issue.  After 4 weeks, I was back at work.
2006 - Same sciatica pain, went back to ortho doc who rain another MRI and discogram and he said L4 was blown and needed to be replaced and re-fused with L5.  He replaced the disk with bone from my left hip.  I went back to work after 6 weeks and proceeded to go down hill with terrible groin pain.  Was put back on disability and after 6 weeks of water therapy, I asked the doctor to let me see if I could go back to work.  I lasted 6 days.  I could not concentrate because of the intense stabbing pain that came up from my right groin, spreading into my buttocks and thighs.  I also have chronic bursitis in both hips.  The doctor put me back on disability and sent me to the pain center.  They have done an SI Joint injection (Doctor said he had a real hard time getting into the joint and he also said I was very sensitive to the pain), I had intense pain for a few days after the injection but no relief.  Then he did facet joint injections because the MRI showed arhritis from L2 to L5.  Had the injections and no relief.  Now I'm back on disability and I hurt in the 9-10 range EVERYDAY.  I can't do stairs at all, the pain wakes me up at night and the right groin is always hurting like I'm being stabbed.  

With everything I've told you, what do you think?  My orthopedic surgeon said I have degenerative disease and a narrowing of my spinal column.  I just turned 50 and feel like I'm 80.

Any thoughts on this. I appreciate any information you can pass on to me.

Sincerely,
Shirlee M. Smith

Answer
Dear Shirlee,

It sounds like you have been through the ringer!!  Any time you have a spinal surgery, especially a diskectomy or fusion, the adjacent vertebral levels will undergo degeneration at an accelerated rate.  It is obvious from what you have described that you have multiple areas of degeneration and that surgery and pain management has been ineffective to this point at ameliorating any of your complaints.

I am really at a loss for words, and I only wish you had tried chiropractic care before the initial surgery, or at least after the second bout with symptoms.  I think you have few options left.  

Pain management:  
You could still try epidural injections.  They are similar to the facet injections, but are placed at the outer covering of the spinal cord.  This is very similar to the type of epidurals given for pregnancy, only it is not left in for hours...rather just a 5 minute procedure.  

Radio frequency neurotomy (nerve ablation) is another technique.  Again this is done with a needle under a flouroscope (special x-ray) which allows for precise placement of the needle.  When the nerve/nerve root is found, a radio frequency is sent down the needle which destroys the nerve and eliminates the pain.  The nerves will grow back over time, but I have seen patients get pain relief for up to a year at a time with this procedure.

There is also the possibility of having a pump placed at the spine for continual pain management.  Some have reservoirs of medicine that is time released, and that can be refilled.  I have see the use of implanted electrical stimulators on the spine as well, but these usually lead to pumps, so why bother.

Prolotherapy:  
A possibility, although you may be past the effectiveness of this emerging treatment.  The basic premise is that an injection is made at the tissue site with a minor irritant which jump-starts the natural inflammatory reaction of tissue healing.  There are cases and reports of actual cartilage regeneration with this technique.  It is a newer therapy, but worth exploring.

I am not an expert in pain management, although I used to work with a certified pain management anesthesiologist and I am very familiar with the techniques. I am neither an expert at Prolotherapy, but both techniques are worth exploring.  Discuss this information with your doctors, and check out this website:  http://www.prolotherapy.org/

Good luck Shirlee, I sincerely hope that you find an effective resolution to your recurrent pain.

Respectfully,
Dr. J. Shawn Leatherman