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Chris_WebMD_Staff posted:
Any questions for Dr. Minchew this week? Ask them here.
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davedsel57 responded:
Hello, everyone. I have not posted in quite a while but do read very often.


I have a question for Dr. Minchew.


First, let me list my spinal conditions:


Hyperkyphosis, severe osteoarthritis throughout my spine, advanced DDD in all areas of spine, multiple herniated discs (4 C, 2 T and 2 L), several bulging discs, several bone spurs, advanced stenosis in all areas of spine. An MRI in 2004 showed that my spinal cord ends a few vertebrae higher than normal.


My question: How will the spinal cord ending higher and the other conditions affect me in the long term? I am 53 years old. I have been managing chronic back pain for over 30 years, and am now on SSD. Standing for more than 5 minutes is impossible, walking for more than 10 minutes does not happen. Mobility in general is difficult due to the pain and stiffness. and the only medication I can take for pain relief is a muscle relaxer (methocarbomol) and enteric coated aspirin. I have tried just about everything else available, and they either cause severe hives or do not work for me. My wife and I invested in a Sleep Number bed and a hot tub last year, and these have helped with pain management. In addition to all this, I do a strength training routine 3-5 times per week using 5 pound hand weights doing moves that strengthen the muscles in my back.


I was just wondering what your experience has been with patients having similar conditions as they grow older. A top area neurosurgeon has told me I will eventually have to use a wheel chair all the time, but no one can determine when. I understand fully that each person is different, but was wondering how soon I should put a down payment on a HoverRound??


Thank you very much.


Blessings and low pain to all,


-Dave
 
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smiles111 responded:
posted this separately,,but maybe i need to post it within this thread to ask the doc,, hope this is ok

my spine has a bump in the lower back area. not sure if it is getting worse or just more noticeable. i have been eating healthier, lost over 25lbs, (maintained same new weight for about a year now 120lbs at 5'6"), and have been trying to strengthen all my muscles as i start to feel the effects of aging (now 50). i know i have a vetebrae with missing wings (genetic) in that same area that i discovered probably 20 years ago after straining my back and getting xrays/mri. it has always been sore in the morning but nothing serious. i try to be careful but do everything i want. also my back started to click with certain ways i move, not all the time but often. i am looking for a doctor to be sure i am doing all that i can and that nothing needs work. what type of doctor would be best for me, whats going on with my back, and is there anything else i can do?
thanks for any advice or recommendations
 
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An_189500 responded:
I had a laminectomy, and a four level fusion (L2 - S1) Oct 2002. I have had severe chronic pain because L1 herniated and the fusion never fused.

I have had cortisone injections in my spine in 2002, 2004,and 2006, I have had some procedures, a psychologist, wear a tortoise shell brace, and do my PT exercises that the PT gave me besides being on strong pain management.

I have thought of going up another level - a five level fusion (L1 - S1) to hopefully be able to stop the pain meds. I am a senior citizen, and I have read that a second surgery does not have the success rate as a first surgery and that older people do not have the success rate of young people..

What are my odds for a successful surgery do you think? What answer would you give if your mother asked you that question?
 
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jszaradowski responded:
I have had scoliosis since 1994. One day when I came home from the school bus my mom noticed my neck was really messed up. My left ear was pratically touching my left shoulder. She immediately took me to the family chiropractor and they did xrays on my neck/back as well as straightened out my neck. After taking the xrays we found out I had scoliosis. I then went to the chiropractor for 2-3 times a week for 2-3 months for my back. They did manipulations on my back, pushed/pulled on my legs to correct the innequality and I would also lay on a machine that had rollers inside that would go up/down my back. I still have a leg length innequality where my right leg is appx. 2 inches longer than my left leg.Should I be getting this checked every few years or be doing nothing? I have done nothing since the 2-3 months in 1994.
Also haven't seen a MD for a regular physical, since my physical for 9th grade, only saw three different internal medicinists last summer for two seperate occasions, the first one was a plugged right ear( turned out to be an ear infection) had antibiotics(Ammoxicilion) and ear drops for that one, then a week later for a recheck, then about 1 week later for a plugged left ear which they cleaned out the wax.
One in a while, while at work I will get pain where it hurts to stand up in my left thigh( upper leg) after standing for a long time or sometimes I am unloading the wednesday or Sunday Truck order. The pain seems to come and go, after sitting for a while it goes away.
Any ideas on what can cause this?
 
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Joe T Minchew, MD replied to davedsel57's response:
Dave

First the simplest answer. The fact that your spinal cord ends at T10 and not T12 should not have any long term affect on your conditions unless you have some type of other cord abnormality like a teather of the cord to the lower spine or a fluid collection within the spinal cord. I assume that you do not as you did not mention those conditions.

The long term prognosis for your other problems is much more difficult to "predict". If I had that type of crystal ball I would have bought low and sold high and might be somewhere on an island right now. A lot will depend on the stenosis and if you develop pressure on your nerve roots or spinal cord due to the stenosis. If that were to occur surgery might be recommended to prevent you from needing that HoverRound for weakness. However, if you do not develop frank neurologic weakness, the impact on your function from the arthritic pain will be up to you to some extent. Certainly your x-rays will look worse as you continue to have birthdays (which we hope you do) but that does not mean that your pain or your function will by definition have to get worse. I would encourage to try to maintain as much of your ability to stand and walk as you can. You may find that exercise in a pool or use of stationary bike may be easier than walking for you to help maintain your cardiovascular capacity and endurance. A consultation with a physical medicine and rehabilitation sepcialist (physiatrist or PM&R doctor) may be useful to try and help you hold off on the HoverRound as long as possible.

I hope that this was helpful. Good luck and keep fiting the fight. You have a very tough problem.

JTM
 
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Joe T Minchew, MD replied to smiles111's response:
Smiles

Without the ability to examine you or see your back or x-rays, it is pretty impossible for me to give you any insight as to the "bump" on your back. It is clearly possible that you have just become more aware of a natural protuberance or prominence since you have changed your body shape. You sound like you are making fantastic life changes to improve your overall health as well as the long term health of your back. It is not uncommon for us to have some morning pain and stiffness in the lower back as we move from 20 to 50. This is common with the agin process and as long as it is mild and self-limited after your get going each day it is nothing to worry too much about. It is also common to get some "popping" or "clicking" wiht movement. This can affect the back as well as other joints and we really do not even know what makes the sound. Again, as long as it is not really painful or constant, it can probably chaulked up to a common albeit attention grabbing component of spinal aging. I think that a consultation with a physical medicine and rehabilitation doctor or physiatrist as they are called in England would be the most appropriate next step for you. You are already doing the right things but a PM&R doctor that does a lot of spine treatment can help you through the next steps of developing a core exercise program for your spine and a general exercise and conditioning program that will not negatively impact your lower back. If your PCP does not know of a PM&R doctor to refer you to, you can search for that type of doctor in your area on the website of the North American Spine Society, www.spine.org or you might searc the internet for a multidisciplinary spine center in your area. Those types of clinics usually have a rehab doctor.

I hope this was helpful. Good luck!

JTM
 
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Joe T Minchew, MD replied to An_189500's response:
Anon

Unfortunately, this is a deceptively complicated question that appears as a simple question. There are many reasons why a surgery is not successful or why pain returns after surgery. Clearly one reason for contnued pain after a fusion is that the surgery was not technically successful meaning the spinal fusion did not occur at one or some or all of the levels. While this is a generalization, for those patients, they often have a period of significant improvement in their pain and then the pain returns. It is felt that the pain improves initially due to the "stabilization" of the rods and screws but then returns as the fixation of the rods and screws deteriorates with continued micromotion of the spine when the fusion does not heal. Unfortunately, like a paper clip that breaks when you bend it back and forth over and over again, the hardware will loosen from the bone or break or both if the fusion does not eventually heal. So if your pain did not ever get better, it may not necessarily be from the failure of the fusion. Unfortunately, even if you could know for sure that the non-union or non-fusion was the source of the pain, there is no guarantee that a solid fusion from a second surgery will relieve the pain. There are many patients with solid fusions that still have pain. With respect to an L1-2 disc herniation, it also may not be reasonable to blame persistent pain on that problem. If the L1-2 disc herniation is a new problem (developed after surgery), it is not logical to blame it for persistent pain after surgery. I assume that it is a new problem as opposed to one that was known about at the time of surgery but it was elected to not address it at that time for some reason. With a new disc herniation, the classic story is that the person again has a very good result from surgery, usually for an extended period of time, months to years, then develops new pain at a higher level as the new disc wears out. It does not sound like that is your story.

You are absolutely correct that the results of second surgeries are worse than first time procedures and that the surgical outcomes are not as good in the older population due to increased complications (due to scar tissue and increased surgical time), poor bone quality (osteoporosis) and more general medical issues. It is unlikley that if you have had chronic pain since 2002 or before that anything or procedure is going to relieve all of your pain. I would advise my mother to avoid any further surgery if at all possible for as long as possible because as hard as it is to believe, it can be worse. Clearly some type of nerve injury or infection could result in you feeling like you are worse off.

I hope that this was helpful. Good luck!

JTM
 
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Joe T Minchew, MD replied to jszaradowski's response:
jsaradowski

You did not indicate how old you are now but I assume that you are at least in your mid to late twenties if not thirties since you were diagnosed 16 years ago in 1994. I may be a good idea to get a baseline check of your spine and scoliosis now that you are an adult so that you can have a better idea of how this may or may not affect you down the line. The prognosis for adolescent scoliosis in the adult depends on many factors including the curve type and location, the curve magnitude and the cause of the curve (there are several reasons why you can develop scoliosis). The curves generally stop increasing in size as we stop growing but some curves can increase in size in adults, albeit, it is often very slowly like a degree a year. This is in contrast to increaseing 2.5 degrees a month in a growing child. If you are having pain, a specialist may be able to recommend some treatments to help strengthen your muscles to protect your back. The pain in your thigh could be some nerve pain due to narrowing around a nerve in your lower back but could be due to other things. A spinal specialist may be able to help diagnose this problem and recommend appropriate treatments and preventative measures. Finally, a specialist can assess your leg length inequality and try to help determine the source and determine if treatment (shoe lifts or build ups) would be potentially helpful or actually harmful. You may find a specialist in scoliosis and spinal disorders in your area by using the physician locator on the Scoliosis Research Society's (SRS) website. The SRS is the premire international organization of physicians dedicated to the study and treatment of scoliosis. The website url is: www.srs.org

I hope that this was helpful. Good luck!

JTM
 
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An_189501 responded:
Dr. Minschew, I have been diagnosed with DDD and DISH. My question is: do bone spurs just show up wherever and whenever? As well, do the calcification continue to grow and change shape? One more: why won't pain mgmt drs treat if one smokes marijuana? It helps so very much. I'm getting slated to see a new dr. but in the mean time I have to stop smoking so as to not lose this dr.
I'm confused, hurt all of the time and totally worn out.
 
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BrenBren30813 replied to An_189501's response:
Sorry to butt in here Anon, but your question about the marijanna is simple and Im thinking this doc won't be getting back with you very soon because this thread is old: It is illegal.

However, I heard from an older gentleman a few weeks ago that the prescribed medication (maybe for only cancer patients??) that contains THC is Marinol. If I were you, I would treat my pain as prescribed by my doctor, then I would see the results I am seeking because an honest and trusting relationship with your doctor will do nothing but good, it won't harm you or get you thrown into jail. Best of luck, I know how it is to be in constant pain 24/7 my friend and you become desperate, but leave it up to the professionals to prescribe the meds, B
 
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confusedwildflower responded:
Dr. Minchew- Any advice of what to do next, what are my options, any kind of treatment you think would be helpful? Anything will help... I am 25years old and mother of two. I am almost 5'2'' (I have actually shrunk an inch) and maintain my weight, 120, I consider myself to be active as I hunt, fish, play w/ kids, etc. These things are getting more and more difficult to do as well as every day activity as my pain intensifies. After the birth of my 2nd child in June 2007, I had extreme pain that radiated down my right leg. I couldn't bend over the changing table to change my daughter. Then, I would wake up just to fall on the floor. My right leg was numb and tingling, I couldn't walk for 3 weeks (pinch nerve??). I saw a chiropractor, my PCP and finally a nuerosurgeon. Here are some of my different reports...some of which are still Greek to me. "Range of motion limited. True root-nerve tension signs on the right side w/ straight leg raising positive at 35 degrees. Weakness in the right gastrocnemius and soleus group. Right ankle reflex absent. L4-L5 and L5-S1 posterior buging measuring 1.8-2mm and, touching thecal sac and not touching at L5-S1." I also have DDD In the lumbar and also minimal sclerosis involving posterior elements of the lumbar and mild endplate sclerosis that is noted at the lower intervertebral disk levels and also a report from an MRI my PCP requested stating " a small Schmorl's node at the L1-L2 level". I have had therapy through the chiropractor and injections through the nuerosurgeon and nothing seemed to help. My lower back hurts, my tailbone hurts, and if I sit or stand a certain way for too long; it feels as if my hip is popping out of place and it often does pop; loud enough that others' around can hear. I am also starting to get muscle spasms that are mainly on the right side of my spine that go from the middle of my spine up to my neck? Could you please explain this to me the best you can of course w/out physically seeing me and what options do I have?? Thank you.
 
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davedsel57 replied to confusedwildflower's response:
Hello, confusedwildflower.

I just wanted to let you know that Dr. Minchew has not been on our community for the past 7 months. He must have a very busy schedule and has been unable to reply to posts. He may surprise us, though, and be back someday.

Read through the Tip at the top of this community that lists the steps for diagnosing and treating back pain. Read through the Resource at the top of this community that lists links to good spine sites. You can go to those spine sites and do research and get the answers you are seeking.

Praying you can get the answers and relief you need.
Blessings, -Dave
 
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blacy06 responded:
I am a 23 year old mother of 2 and was recently diagnoised with DDD phase1 almost 2 all down my spine. The bulk of the DDD is in my lower back and Neck. I have been in Sever pain for almost 6 years now due from a car accident several years ago. I am Starting treatment with my Chiropractor next week. Is there any way to correct the condition as well as preventing further damage? The Dr. seems very optimistic about the treatment but is there anything I can do on my own to help the progress along?
 
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davedsel57 replied to blacy06's response:
Hello.

This is a very old discussion and as I replied to the previous poster Dr. Minchew has not replied to posts in many months.

Have you been to a spine specialist such as an orthopedic surgeon or neurosurgeon and had a spinal MRI or CT scan for diagnosis? DDD does show in a regular x-ray as a narrowing of space between the vertebrae, but you really need to be seen by a spine specialist and have the right type of testing for a complete and accurate diagnosis.

I see a chiropractor on a regular basis, but I've been to many specialists and had several MRI's. My chiro would not adjust me until I had done son.

As far as I understand, DDD is not reversible. You can add some hydration back into your discs by drinking a lot of water each day. The extra hydration plus other therapies can prevent further damage.

Please read through the Tip that is at the top of this community that gives the recommended steps for diagnosing and treating back pain. You can also go to the Resource at the top of this community that lists links to good spine sites, God to those spine sites for further information.

Always be caution with your back treatments as any of them can cause more damage and more pain. Please do not go the the chiropractor before seeing a spine specialist and have testing done for an accurate diagnosis.
Blessings, -Dave


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