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Back Problems Message Board

Back Problems Board Index

Thank you all for sharing in my good news :). It’s quite a change to feel upbeat even though my back is screaming at me today. I wanted to share a few more thoughts and try to figure out this epidural stuff as well. Even though this whole process has been agonizingly slow and frustrating, it has produced some pivotal lessons. Probably the most important lesson I have learned is that everyone with a chronic back problem should hear from many different experts before deciding on a course of action with life changing consequences. Two of the doctors I have seen felt I would be having NO pain from the degenerated disc if not for this recent herniation. In stark contrast, the other three doctors felt the entire disc was “bad” and wanted to remove it. It is so important for us to educate ourselves and insist on thorough explanations. I have looked at my MRI films with 5 different doctors, but it is only after this last visit that I truly understand what they show and how this relates to my symptoms. I could now show my films to someone who know nothing about the spine and thoroughly explain what they show.

The second important lesson I’ve learned is that everyone with chronic back pain should be seen at a pain management clinic. If I had been sent to a pain mgmt clinic earlier, I could very well be out of pain now. Now I must wait another 4-6 weeks to get into the UCSF pain mgmt clinic. Enough with the damn waiting! In Feb. 2003, I had two epidural injections two week apart. The first was done by an orthopedist who came in with the needle through the sacral space (don’t know the technical term, but he came in from below the disc). This had no effect. The second epidural was delivered via catheter while I was in recovery from arthroscopic knee surgery. This catheter was place in the disc space at L4/5 because they needed to do a complete nerve bock on my legs for the surgery. I had one blissful week of no pain, but once I started moving around again it returned.

What Dr. Saal was recommending was that I have a total of 4 transforaminal epidural injections. Two of these injections would target the L5 nerve root and two would target the S1 nerve root. Here is a helpful description of why this targeted “blitz” approach might work better than more conservative approaches:

"One of the major concerns about lumbar and caudal epidural steroid injections is that the medication is not reaching the target. Most interventional pain medicine specialists advocate the use of fluoroscopic guidance and the injection of contrast to ascertain the correct positioning of the needle and spread of contrast in the epidural space. Additionally, many interventional specialists are performing transforaminal ESIs. These are target specific for the exact nerve root(s) involved. The goal is to deposit the steroid between the nerve root and the prolapsed disc. This is in the ventral epidural space. The majority of the time a well executed interlaminar ESI does not reach the ventral space. Therefore, it is not that epidural steroids do not work but the medication did not reach the correct area where it is effective. Caudal injections have the same problem."

Regarding the PT, the exercises that bothered me the most involved "bridging" (laying on your back with bent knees & squeezing your butt muscles while raising your pelvis. A similar exercise involved laying over a physio ball and walking my hands out while tightening my butt muscles so that eventually only my calves are on the ball & my back is straight, then walking my hands back in. This is probably a bad description. Dr. Saal knew of my PT and thought he was a good choice for some patients. But he also said that the PT only had an "on/off switch" and had no volume control. I am still not sure about what stabilization exercises I should be doing, but am getting a referral to a new PT. Will share info about recommendations as I get it.


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