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Back Problems Message Board

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First of all I'm a 53 year old male. To try and summarize everything, back in the spring of 2010 I noticed my lower back tightening up and as I was a runner I would stretch before and after running and could tell that my right leg was not as flexible as my left (I think that it's probably been that way for years). I had been noticing that my running gait was off, in that it seemed like I was somewhat "dragging" my right leg when I both walked and ran. In early June of 2010 while running I stepped up on a curb with my right leg and it felt like I had been shot in the hip. I actually thought I had injured my hip at that moment. I tried to continue to run but the pain was too much and so I just walked the rest of the way home. The back of my leg and hip were not surprisingly very sore the next several days. I tried to run again maybe a week later and it was a no go. So, other than taking Advil and resting I just basically walked for the next month probably. I again tried to run in the middle part of July of 2010 and I was still having the pain, so I stopped again.

Fast forward to the fall of 2010 probably October maybe, and I finally decided to see a ortho doc about this as it wasn't getting better. I described my symptoms as the pain in my buttock and running down my right leg and how it was particularly bad when driving. He had me do X-rays and he stated that it looked like the disk at L-4 L-5 level had in his words "collapsed". He then had me do an MRI shortly there after. He stated that yes, the MRI showed more detail of what the X-Ray showed along with some stenosis around a disk in that same area of my back. He recommended I try physical therapy, which I did. That only did some good but I did really strengthen my core muscles, ha. My ortho then recommended a steroid epidural into that L-4 L-5 area to see if that would provide any relief for my sciatica. I then had two steroid injections from a pain management doctor fairly close together (I believe that one was performed then two weeks later another). And frankly that didn't help my situation much. My pain management doc recommended that I try physical therapy again after the shots and see if anything improved. And it really didn't. Went back to my Ortho guy and he stated that it really looked like I needed to have a fusion at that L-4 L-5 level as well as cleaning out the stenosis around the other nerve root. He seemed pretty quick to recommend that so that kind of worried me. Therefore, I decided to get a second opinion.

Went to Houston in early 2011 for another opinion from a neuro surgeon. He looked at my MRI's and he wanted me to have some x-rays taken with me bending my back to see if there was any slippage of the disk and also a myelogram which I guess he felt would provide better resolution. Well I did all that, and after meeting with Dr. #2 he DID NOT feel that I needed a fusion. But he did recommend another steroid injection and further phyiscal therapy. Well I did have another injection and did the therapy. Again, these were only temporary fixes. Dr. #2, felt that if I were going to have surgery that only cleaning out the nerve root obstruction with a Laminectomy or a foraminotomy. But, I think he was really conservative and rather see if I could fix my problem with PT and the additional injection. He was definitely not "knife happy" to coin a term used sometimes.

Well, after several more months I decided to seek a third opinion from a neuro surgeon who was closer to me. He was pretty highly recommended by my physical therapist and by a couple of doctors who I know in the area. So, I decided to see Dr. #3 and see what he thought. He looked at my MRI and myelogram film and agreed with Dr. #2 that he did not feel I needed to have a Fusion. But that the Foraminotomy to clean out the nerve root obstruction would probably work to either eliminate or to greatly reduce the sciatic nerve pain in my right buttock and down my right leg. In the mean time, while he was examining me he had me lie down and he was pressing on the top of my right hip area and he pressed on one particular spot and I nearly shot off the table. He stated that I was having a periformus muscle issue and he thought that maybe a steroid injection directly into the periformus might provide me with long term relief. Well I had that done. And yes, that seemed to work better than any of the steriod epidurals that I had. After having the periformus steriod shot my leg felt better for 2 or 3 months and was able to do some pretty aggressive physical therapy as a result. However, of course it eventually wore off and I was kind of back to where I was.

So, finally by the spring of this year, I decided to go ahead with the foraminatomy that Dr. #3 recommended. He performed the procedure June 12th and I spent the night in the hospital and went home the next day. Before being discharged from the hospital my doc mentioned that in addition to the stenosis that showed up on the MRI and myelogram, he had to remove a bone spur from the same area around the nerve root. Me not being a doctor asked how could something like that not show up on all the tests I had done. My doc stated that it is very rare but sometimes it happens and that he doesnt actually know what he's dealing with until he opens the back up and looks inside. So, I guess my surgery was a little more involved than he orginally anticipated since he had to deal with the spur in addition to the stenosis. He wanted me to take about 3 weeks off of work and either lay down or walk. He gave me Soma and instructed me to take it every night before I went to sleep and also a combination of two drugs (Valium and Ultram). I was to take the combination of those two drugs up to 4 times per day as the pain indicated. At first it seemed like the surgery had solved my problem. As I layed around recovering I could tell my pain was either gone or "different" than before. It was more around my hip area if I had any. I had a couple of post surgery visits with him of course and at the first one the nurse cut the stich out of my incision but everything looked good according to her and him.

I went back to him a month after surgery and he recommended I start a physical therapy program. So, I go going with that. It was not taxing. All they did was massage my hip area with my sciatiac nerve was giving me problems. They also did electrical stimulation on my low back and they had me do some stretching exercises with bands, etc. In the mean time I returned to work for half days after about 2 1/2 weeks after surgery (I know a little earlier than my doctor recommended). But I work in banking so I am in a sedentary job and I don't exert myself. Although I know that sitting is probably the worst thing for back issues. After about a month of PT they had me add stationary bike riding and some squat exercises. Well after adding those too I noticed an increase in pain. By quite a bit in fact. So the PT backed off of those and I just continued with the stretching, massage and electrical stimulation. But frankly I seemed to be regressing in my recovery. That had me worried since I was about 6 weeks out from my surgery. Then one day after physical therapy I was in a lot of pain and I called my doctor from work and he called me in a script for Loratab. At this point I'm still taking the Valium & Ultram combo at least once per day, sometimes twice as well as still taking the Soma before bed. The Lortab maybe once per day. Also, he wanted me to have a CT scan on my lumbar area to see if there was possibly something else going on.

So, I did have the CT scan and just saw him this past Wednesday (August 22nd). He asked me how my symptoms were. I'm still in pain post surgery but it's a "different" pain than I had before. He examined me and had me lay on my back and raised my legs and asked if I felt pain. I said no for each one. My doctor commented that he could now raise my right leg to a higher degree than he could when he first examined me. So, that was a good sign about my sciataic nerve. He showed me the CT scan results and he pointed out the difference in the forma of the nerve root where he performed the surgery was much more open now, so that now the nerve was not being impinged as it was before. In fact, he said my spine now looked, in his words "very good". Well I asked him why am I having this continued pain around my hip area, especially my right hip "girdle" area (hip flexor) and down the front of my right leg? He thinks that I am having an SI joint issue which is causing my current pain. He thinks that I probably had this issue in conjunction with my sciatiac nerve problem, but that the nerve impingement in my lower back was causing me to notice that more than the SI joint problem. He thinks I could have developed the SI joint problem while I had the lumbar nerve problem which caused me to change how I walk (and run in particular, remember at the beginning of this long story I explained that I ran and how it felt like I was "dragging" my right leg as I walked and ran). He recommends that I have a steriod shot into my SI joint. He thinks that might help me enough so that I can get back into physical therapy.

So, I guess after that long, long story my question is should I go ahead with the steriod shot into the SI joint? At this point frankly I wish I had not had the foraminatomy as I seem to be having more pain now (especially when sitting at my desk at work) than I was prior to it. I know that it sometimes takes nerves a long time to heal from these things and it's been less than 3 months for me at this point. I guess if anyone who might have been in a similar situation or may understand what might be going on given my long and hopefully not too convoluted story please give your two cents worth. If anyone needs any further information please ask.

Thanks in advance. This board has been a great help to me over the past few months.

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