Introducing myself - considering L5-S1 ADR

[badfish8]

Hello all,

I wanted to introduce myself for the first time on the forum as I am considering and having a one-level replacement at L5-S1. I’m 25 years old and have had disabling lower back pain for the past 3 years after an injury lifting weights.

I was once a fairly competitive athlete and played soccer year round growing up and in college. In 2013 I had to stop playing because of an injury to my hip, and also around this time got heavily involved in weight training. At the time of my injury I was lifting hard and fairly heavy - 350+ and 400+ pounds on the squat and deadlift respectively. My back was always sore and I had some minor pain but ignored it and pushed on as I always had. Then in April 2014 I was doing a twisting exercise when I felt a pop in my lumbosacral area and shooting pain in my right lower back and right glute. Ever since I have had chronic LBP.

About a month after the injury I graduated from college. I continued to have back pain for several more months at which point I had an MRI which showed a small herniation at L5-S1. Around this time I also had my hip problem diagnosed as FAI with labral tear. I decided to have arthroscopic hip surgery in October 2014 the hopes of being able to play soccer again. My outcome from this surgery was not great and I honestly regret having it. Little improvement in the pain and stiffness in my hip and also more back pain when standing and walking.

Over the two years following that surgery I tried many different treatments for my back - physical therapy, massage, chiropractic, prolotherapy, epidurals, walking - to no avail. Static positions were the most difficult especially sitting. It became difficult to work and maintain relationships. I became very depressed. Moreover it was not exactly clear what was causing my pain as the pattern was not typical of discogenic. Also other than a small bulge/herniation at L5-S1 my spine looked very healthy on MRI. SI joint dysfunction and referral from the hip were suspected but a myriad of diagnostic tests (including a discogram) provided no answers. A second MRI of my spine also showed no change from the prior one over a year earlier.

However there is a silver lining in my experiences as a patient over this period in that they inspired me to pursue a career in medicine. So in January 2016 I began a pre-med program at my local state school. Things were going well for a little. My pain was not improving but I was managing. My classes were going well and I moved out of my parents house. In the fall semester I increased my course load and began a part time job tutoring biology and chemistry.

Then around a month into the semester I experienced a severe and rapid increase in my pain. Excruciating 10/10 pain in my lower back, glutes, and thighs. I could barely move without feeling like I was being stabbed. It was a nightmare. This continued unabated for some two months before calming down after much lying on the floor and avoidance of pain triggers.

This episode prompted a third MRI which actually provided some answers! In less than 1 year my L5-S1 disc had become dehydrated and had collapsed by almost 50%. Both cartilaginous endplates were damaged allowing disc material to leak out and corrode the vertebrae, creating painful cysts and inflammation in the bone. Every doctor I have talked to said they had never seen a such a rapid deterioration - lucky me! You can see the progression in the image attached below. The first and second images are about 17 months apart while the second and third image are about 11 months apart.

With the new MRI, I consulted several local surgeons - three neuro and one ortho. The neurosurgeons (who did not offer ADR) did not want to treat me surgically. The orthopod recommended ADR with the prodisc. And he recommended doing it within the next 6 months as he was concerned about the rapid deterioration evident on MRI. However this doctor had only done around 20 lumbar replacements so I decided to consult some doctors who had more experience with ADR. I sent my films to Dr. Yue at Yale and Dr. Zigler at TBI both of whom said I was a decent candidate for disc replacement BUT that there was also a small possibility that I might need a fusion (Yue because of the damage to the vertebrae, Ziger because lack of disc space, I suspect it is a combination of the two).

I did not decide to have surgery at the time because I was managing my pain with lifestyle modifications and also wanted to try some alternative treatments. Dr. Yue also advised to wait and have another MRI in 5 months. In January of this year I had a stem cell treatment involving an injection of bone-marrow concentrate and adipose-derived stem cells into the disc. I have not noticed a huge improvement since this treatment. Although I have been able to maintain a relatively low level of pain over the past few months with a very restricted lifestyle. Also my fourth MRI earlier this month appeared to indicate that things have stabilized somewhat after the rapid deterioration over the year prior. So maybe the treatment had something to do with that.

But recently I have been giving some serious thought to ADR. I spoke with Dr. Yue again - he thinks I would have a good outcome with the surgery and said that it is up to me to decide if I want to go through with it. Some days I really want to have the surgery. I am sick and tired of all of this. It’s been 3 years now and things have only gotten worse. Although I am not in constant pain and do not take pain medication I heavily tailor my lifestyle to accommodate my back. I avoid sitting more than a few hours per week, never bend over, lift, or carry, and generally avoid many other movements that I know might trigger a flare up. I have to lay on the floor 4-5 hrs/day as I cannot tolerate any other static position for extended periods to time. I am finding it very difficult to advance my career. I have no social life and am incredibly lonely and depressed.

I am convinced that with ADR I would most likely have a good long term outcome. But I am also terrified about what could possibly go wrong. I am a very analytical person (to a fault some might say) and am fairly risk-adverse. So I have been obsessing over various complications and poor outcomes, reading literature and trying to determine how likely they might be. Some of what I have found has not been particularly comforting. There are also some other treatment that I might try including another stem cell treatment and an injectable hydrogel nucleus replacement. I am still not sure what I am going to do.

Anyways that is my story so far, thanks for reading!

[Harrison]

Jacob,

Welcome but sorry you are here. You are among new friends who will support you in your journey.

Thank you for your eloquent introduction. I am sure others will reply soon. Please PM me next week.

Richard (AKA Harrison)

[Big_A_2246]

Jacob, what a story. Seems like you have been through a lot! I think everyone on here has pretty much the same story including me. I was in pain for almost 3 years and tried everything I could think of. Except the ones insurance wouldn't cove (stem cells, prolotherapy, etc..). I had my L5-S1 done February 28th and I am doing great. I return to work next Thursday. I too was apprehensive about going under the knife but was pretty much at a dead end with no options left. I'm so happy I did this, I get to move on with my life! If you read some of the stories on here I'm sure it will give you some motivation!
Good luck! Keep us posted on what you do.

[perepere8]

From the MRI from 2016 you can clearly see disc degeneration. There is also Modic signs (differend colors on vertebrae above and bellow disc) what indicates degeneration is there some time. I have that too. I am not doctor but have pain for about 15 years so i learned realy alot about the spine. I thing ADR will help you. I will get mine in autumn or winter. Greetings