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MRI results show bulging discs: what are my options?
I recently learned I have some bulging discs again(past history of this 2 decades ago, HAD totally numb feet back then). I also have a vertebrae out of place. All are pressing on spinal cord(worse with the lower vertebrae). My one foot is tingly, one numb toe, and I cannot walk far because of my hip. Pain is severe lower back both side and right hip. Both legs take turns on weakness and pain. I just started with physical therapy and was wondering your opinions on if I should also see a chiropractor too. (A chiro helped decades ago with my first bulging discs. But years later I had to stop because I have fibromyalgia too and the chiro I had made EVERYTHING worse, I could barely walk for 3 months. I am doing whatever I can to NOT have surgery and to get that one lower vertebrae back in place before more damage happens. My spine specialist(physiatrist) also suggested injections since so many nerves are giving me grief. RFA helped with my neck, but not back(injections never really helped much) but to get RFA I had to get injections first(thanks to my insurance, ugh). He is thinking my sacroiliac joint area. OK, so my question is, can a physical therapist move my lower vertebrae back to where it belongs or should I just start seeing a chiro. I know they can adjust bones back in place.
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@saleha59 I would advise you to call your insurance and insist on seeing a spine neurosurgeon. They want to send you to a chiropractor to put off having to fix the spine issues you have to avoid spending money on your care. A chiropractic manipulation is very risky in your present condition according to many spine professionals and can cause permanent damage such as paralysis. One of the tactics to put off spine surgery is the spinal injections. You already have some instability and that will likely continue, and you have narrowing of the spinal canal in addition to all the nerve root compression at multiple levels. Anything that touches or compresses the spinal cord can cause issues which can be pain, spontaneous muscle contractions, numbness, and paralysis of body parts and even problems and disability with walking. It all depends where the damaged level is. With arthritis already there in the foramen, that will continue pressing on the nerve roots. The time comes when the only real fix is a spine surgeon who can clean out and enlarge the arthritic areas around the nerve roots, and remove discs that are too far damaged, and then replace that disc with a bone graft or an artificial disc. Injections only buy time by reducing inflammation with steroids or nerve blocks, and put off surgery, but there comes a point when spine surgery is the best choice. I have heard cases of patients who wait too long and live with permanent nerve damage and pain as a result. When discs collapse, the spine will try to stabilize itself by growing bone spurs near the disc, and the bone spurs can fuse the spine around a collapsed disc. That may be an out of alignment position that becomes permanent or causes spinal cord compression, and it may not be able to be operated on later; a surgeon would have to answer after reviewing your case. You can end up in a wheel chair with some degree of paralysis.
There are surgeons who will look at your MRI without charge to see if they would take the case. Mayo does that too. Spine surgery is very expensive, and Medicaid is not going to pay as much toward it, so many surgeons in private practice don't want to take the case. You really should insist on a spine surgeon to evaluate your imaging, then get their basic opinion on if you should seek an official surgical evaluation. It is your choice, and surgery is a big step, but it can give you your life back. That was my experience, and I knew if I let my spinal cord compression continue, that I would have become disabled. I didn't want that. The earlier you can fix a spine problem, the better your chance of a good recovery. You have to do it before nerve or spinal cord damage becomes permanent. I wasn't a patient who looked forward to surgery, quite the opposite, I feared it, but it was the best choice I could have made. I have done a lot of physical therapy which has helped my spine and my recovery, so don't overlook that. PT's can have a lot of knowledge about surgical procedures and relay their experience because they rehab surgical patients and they know the degree of success and the details of the patient's recovery.
The choice is yours. No one else can advocate for you. It is hard and you have to be informed so you can make your point. They can easily dismiss you if you can't counter their argument. I know my comments are pretty direct, and I learned my way through all of this by being denied help by 5 spine surgeons. It wasn't about insurance. It was because I had a case with an unusual presentation of symptoms and they were afraid to take it for fear of a poor outcome that could damage their ratings of successful surgeries. I was given different wrong opinions, and I figured out what was wrong after I found medical literature with cases similar to mine. I sent that to a surgeon at Mayo and he helped me. That is what advocating can do. I found what 5 surgeons missed, and then I had to move on because no one would help me address this with surgeon #5 and I didn't think he would listen to me since he had already disregarded the symptoms and clues that lead to the discovery. It would be pointing out a mistake to a highly respected surgeon, but that's OK, because my surgeon at Mayo was the best. I wish I had come to Mayo first and not wasted 2 years chasing surgeons who would not help me and playing along with every test they wanted to do instead of surgery. Again, more direct comments, but it is important to be truthful and it is not meant as criticism. I did not know medicine would be like this, and I didn't know how medicine could and should be until I came to Mayo. This is why I help patients on Connect and I want you to know that I do this out of respect for other patients to help them make their own choices.
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5 ReactionsInteresting, because I have read and been told that one reason for certain cysts to develop - I had developed one in my spine/lumbar region, years back - was the body’s own attempt to protect parts from pain. Example was where my cyst was (L4?) is where my stenosis and spondylolisthesis was “the worst”. My body was trying to prevent further aggravation by “padding” (my understanding) the area so it wasn’t rubbing. Sort of like getting a blister on your foot where a shoe is rubbing it, if that makes sense? So, you have hip pain, a hip cyst and you have trouble walking any distance. Most people will demonstrate “degenerative” changes (another word for degenerative joint disease, aka osteoarthritis) on XRays after a certain age. So I have been told both as a patient and when I was a nurse. The issue is whether it is bad enough in whatever joint to cause constant pain not relieved by OTC medications, PT, and interferes with activities of daily living (ADL). If it does and there is a way to relieve it (joint replacement or other surgery), then that is something that may be suggested to said patient. Anyway, so saying you have arthritis in “ALL my joints” is still not defining a specific problem with that (side) hip of yours. So it seems to me, you need to be seen by a doctor who can help figure out all these conditions of yours and determine what part is causing pain precisely where. That I cannot help you with. You need to keep things very specific for the doctors you see and again, take notes, write things down very clearly, etc.
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2 ReactionsI have 3 bulging disks. I've started physical therapy. Am I going in the right direction?
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1 Reaction@anr Hello and welcome to Connect. Having a bulging disc isn't always a problem nor does it always need surgery. That all depends on what other symptoms it may be causing, loss of nerve function, or if it has been several years and the bulging has progressed to a herniation and spilled the jelly like contents of the disc outward. That is when a disc begins to loose height and vertebrae bones get closer together, and the inflammation from that spilled jelly causes bone spurs to grow next to it. That is when you can get into trouble by closing down the space where nerves exit the spine between the vertebrae, or by impinging on the spinal cord if the disc has ruptured into the central canal. That is what happened to me, and only surgery could fix that. It took about 20 years for my bulging disc to herniate. A bulging disc represents an injury, and it can have small cracks in the outer fibrous layer of the disc. Over time and with aging, discs naturally dry out a little bit, and the cracks can open up weakening the outer layer and leading to a herniation.
Bulging discs can change the direction of the curve in your spine throwing it off or by straightening a curve that is supposed to be there. The neck should have a graceful backward curve and often it becomes straight like a pole when cervical discs are bad.
I am a believer in physical therapy because it can correct postural and functional issues of weakness. Posture is very important to maintain a healthy spine and to prevent spine injury. My spine surgeon told me maintaining core strength is the best way that I can keep myself from needing his services again. Physical therapy can help people avoid surgery. Will you pose this question to your physical therapist? That is a conversation they would want to have with you and to better your chances for normal functions and to help avoid surgery. They should be asking you how you feel and what symptoms are improving and sometimes measuring movement ranges with their tools are charting your progress.
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2 ReactionsMy experience with many, different physical therapists is that they have you do a series of exercises with or without the use of equipment. When I compare the sheets of exercises from different PTs is that they all begin to look a lot alike. I would say that there is no "one size fits all" solution to back pain, especially in regard to physical therapy. Most pain specialists that I have seen over the past 6 years tell me things like, "There's nothing else that can be done"; (2 orthopedic surgeons) to multiple injections, multiple nerve ablations, spinal fusion surgery, spinal cord stimulator surgery ( 2 different types), chiropractic intervention (2); a "chiropractic neurologist" who claims that he can heal everything bad in my back through patented spinal decompression. But he would need $6000 cash because the process is not covered by any kind of insurance. (hard pass). Just had a morphine pain pump surgically implanted last week (4/12). This will require several adjustments to get the right level of pain mitigation. I am already feeling a little better.
I have learned a few things over the past 6 years: Don't take the first diagnosis/treatment as gospel truth. Do your research. Be prepared to be disappointed. What works wonders for others may not work so well for you. Doctors are well-trained people who are often following a set of guidelines to try and find a solution to your problem. Unless they are really passionate about helping you, they may stop short of going the extra mile to help you. Who has been the most up front and caring for me? A chiropractor. His 12 week program of different treatments provided no help after 6 visits. He sat down with me and we agreed that this course of treatment was not going to be of any help. The program was not covered by insurance, so I had to foot the entire cost upfront. He refunded the money for the remaining treatments that I would not be using.
You have to learn to be your own best advocate.
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3 ReactionsHello @anr and welcome to Mayo Clinic Connect. I see that @jenniferhunter has joined you already.
You will notice I have moved your post into an existing discussion on bulging disks that you can find here:
- MRI results show bulging discs: what are my options?: https://connect.mayoclinic.org/discussion/mri-results/
How long have you been doing physical therapy?
Thanks for your insights Jennifer. Yes medical healthcare is a business. Opinions galore.
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2 ReactionsDr. Tom Jesson is a physician who decided to become a researcher on sciatica and cauda equina syndrome. He teaches physicians how to diagnose and treat patients with these conditions, and interpret MRI results like yours . I can't recommend highly enough.
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1 ReactionI so very strongly agree with everything Jennifer has said. Especially avoid the chiro! which can cause you further damage. Be careful with some PTs who can be overly aggressive and also put you in more pain and issue. They try to strengthen your muscles to support your spine better. Some do Neuromodulation therapies ,which helps me alot. Depending on your age and health, surgery may be a difficult choice. There are different types of injections. For me caudal and intralaminar injections never worked, but a transforaminal injection helps alot. Try and get to Mayo for your surgical opinion there are alot of Drs elsewhere recommending fusions and implants and procedures that dont help. Try and do alot of research about your conditions online at Pub Med , NIH, Becker Spine and Spine Health.com , Sending Prayers 🙏
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2 ReactionsThank you for the information
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