MRI results show bulging discs: what are my options?

Posted by saleha59 @saleha59, Oct 22 4:54am

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.

mri results

@saleha59 Welcome to Connect. I am a Mayo spine surgery patient and I have a biology science background and studied a lot about spine issues when I was going through the need for surgery. I understand your hesitation about surgery, but to help yourself have the best possible outcome, you need to take a different approach. Instead of asking how you can avoid surgical treatment, why not ask about what benefit you could have with surgical treatment and compare that to what your future will be without it?

You have multiple levels of involvement with spondylolisthesis which is the vertebrae slipping because the discs are not healthy, and retrolisthesis is the backward slipping. This instability is going to continue happening and it puts more pressure on nerves that get pinched in the foramen at the nerve roots and compression of the spinal cord itself. This misalignment also creates uneven pressures on the endplates of the vertebral bodies, and this pressure causes the bone to remodel which can generate bone spurs and further compress the nerves. You have a lot of symptoms now that can be spine problems, and a surgeon needs to make the diagnosis. For me, it took 20 years after a whiplash for my spine issues to compress my spinal cord and cause significant neurological issues.

The best thing you can do for yourself right now is to see a good spine surgeon who specializes in deformity cases. Both neuro-surgeons and orthopedic surgeons operate on the spine, but choose a surgeon who only does these types of surgeries. They are not all alike or have the same skills. Sometimes there are different procedures that can address the same problem. You have a lot of nerve root compression, but also at L1 L2, a central disc protrusion that is narrowing the central canal through which the spinal cord passes. If a chiropractor starts pushing on that with instability from the vertebrae slipping, that can directly impact the spinal cord, and this can also further narrow the foramen which is the space between the vertebrae where the nerves exit. You have significant disc bulges into the foramen which causes inflammation and arthritis bone remodeling there. I believe a chiropractor would cause you significant harm with your current condition. I know that isn't what you wanted to hear, but you can learn a lot from honest patients who have spine surgery experience. Surgery at the lower end of the spine is a longer recovery than my cervical surgery.

You choice of a spine surgeon is critical because spine surgery can make you worse. Often screws and rods are placed, and if the screws are not set at the correct angles into good quality bone, they can pull out with the pressure at the lower spine and twisting movements. I'm not trying to scare you, but this is why you need the absolute best surgeon who has good statistics of success with these procedures, and you should ask for their success ratings. You should consult a spine surgeon to see how they can help, and get several opinions because this is a critical choice that you can't undo after the fact. I was refused by 5 spine surgeons, and then came to Mayo in Rochester and had an excellent surgeon and care that was exceptional with great results. Do your research on ratings of medical centers and surgeons and find the best that you can. If I had understood this difference in quality of care, and that my case was unusual, I would have come to Mayo first and saved myself a lot of wasted time. If you are not able to come to Mayo, find a place with a good track record. Call your insurance company for recommendations as they may have ratings and you need to find one in your network. I can help if you have further questions. I would highly recommend my Mayo surgeon, Dr. Jeremy Fogelson who is a spine deformity expert. Here are some links about him and my patient story. Let me know if I can be of further assistance.

My patient story
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/
https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/specialized-expertise-for-spinal-deformity-surgery/mac-20469055
https://sharing.mayoclinic.org/2017/07/26/spinal-surgery-saves-teen-swimmers-mobility/
https://sharing.mayoclinic.org/2012/12/23/repaying-a-gift-scholarship-recipient-says-thanks-in-a-special-way/
http://www.startribune.com/in-second-term-minnesota-gov-markdayton-dealing-with-more-health-problems/361662931/
http://www.startribune.com/gov-mark-dayton-to-undergo-third-back-surgery/497015811/
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-scoliosis-screening/
https://www.beckersspine.com/spine-leaders/item/37080-spine-surgeon-leader-to-know-dr-jeremy-l-fogelson-of-mayo-clinic.html

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Thank you. I will check into all your info. I have one main issue….I cannot ever get a GOOD surgeon unless my state funded medicaid(I am on disability) will ALLOW it. I do not get the best care, I get the cheapest care.

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@saleha59

Thank you. I will check into all your info. I have one main issue….I cannot ever get a GOOD surgeon unless my state funded medicaid(I am on disability) will ALLOW it. I do not get the best care, I get the cheapest care.

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I am a bit puzzled by your statements about Medicaid, cheapest care, etc. I don’t know where you live and yes, you may not have the option of going anywhere you want, especially if your care is limited by the confines of an HMO or similar. But just because you have Medicaid does not automatically equate to a poor quality of surgical care. I worked as a hospital RN and just by general percentages, know that some of our patients were receiving disability, on Medicaid, Medicare, private insurance, HMO, PPO, etc. It still was the same surgeons doing the same surgeries, the same OR team, nurses postop, etc. Patients weren’t treated differently that any of us were made aware of. Nor did us staff have time to worry about who was paying for or covered by what! One of my nursing coworkers had 2 children with congenital disease who had extensive spinal surgeries; I know they were covered by SS Disability, etc. Perhaps I am not understanding your question/comments? I myself had a very unusual condition that needed to be fixed surgically (extensive surgery). Because my HMO could not provide what I needed, they were mandated to provide me with appropriate care by law. They weren’t happy about it. I had to keep pushing! But they did it!

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Also, another question. You mention hip pain. Do you think it is spine related or have you had regular hip XRays looking for signs of arthritis? The hip and spine pain may (or may not) be two totally different issues.

Liked by migizii

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@wisco50

Also, another question. You mention hip pain. Do you think it is spine related or have you had regular hip XRays looking for signs of arthritis? The hip and spine pain may (or may not) be two totally different issues.

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I have arthritis in ALL my joints. My last CaT scan of hip showed a cyst. Not one single Dr. cared about it or my complaints of not being able to hardly walk any distances.(the hip issue started in 2017) Also, the hip issue could be related to spine and sacroiliac joints. The vertebrae that is misplaced is lower so that could affect my hip too. Lots of pinched/compressed nerves. As for being treated different because of my insurance, I have always been limited on what Dr./surgeons I can see. Many times they could could not do the things they wanted to do because they were limited because of my insurance. Many things were not done.

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The health insurance racket has to be stopped! Corporations and their profits should not have any say in our health care.

Liked by saleha59

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@saleha59

I have arthritis in ALL my joints. My last CaT scan of hip showed a cyst. Not one single Dr. cared about it or my complaints of not being able to hardly walk any distances.(the hip issue started in 2017) Also, the hip issue could be related to spine and sacroiliac joints. The vertebrae that is misplaced is lower so that could affect my hip too. Lots of pinched/compressed nerves. As for being treated different because of my insurance, I have always been limited on what Dr./surgeons I can see. Many times they could could not do the things they wanted to do because they were limited because of my insurance. Many things were not done.

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@saleha59 You need to advocate for yourself. Call your insurance company and ask for approval to see a surgeon. The squeaky wheel gets the grease. There is enough on your MRI report to warrant medical care. That diagnostic test was ordered by a physician and have they given you a response to the results or a recommendation? I know it can be frustrating and scary at the same time, but you have to imagine yourself having a good recovery and the journey begins with a single step. Speak up for yourself until they listen to you. This insurance problem isn't the doctor's fault, so be careful about voicing frustration to the doctor. I'm sure they hear a lot of it and it just makes their job stressful.

Liked by wisco50

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@jenniferhunter

@saleha59 You need to advocate for yourself. Call your insurance company and ask for approval to see a surgeon. The squeaky wheel gets the grease. There is enough on your MRI report to warrant medical care. That diagnostic test was ordered by a physician and have they given you a response to the results or a recommendation? I know it can be frustrating and scary at the same time, but you have to imagine yourself having a good recovery and the journey begins with a single step. Speak up for yourself until they listen to you. This insurance problem isn't the doctor's fault, so be careful about voicing frustration to the doctor. I'm sure they hear a lot of it and it just makes their job stressful.

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Correct. Even try a different primary provider if you feel like you are not getting proper attention. Doctors are rushed these days and it is not their fault – it is who they work for (clinic, hospital, insurance). You need to have all your ducks in a row before you are seen. WRITE down specific questions to take with you. You may wish to specify you need a longer appointment time. But you must be your own advocate or have someone help you figure this out ahead of time.

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@jenniferhunter

@saleha59 You need to advocate for yourself. Call your insurance company and ask for approval to see a surgeon. The squeaky wheel gets the grease. There is enough on your MRI report to warrant medical care. That diagnostic test was ordered by a physician and have they given you a response to the results or a recommendation? I know it can be frustrating and scary at the same time, but you have to imagine yourself having a good recovery and the journey begins with a single step. Speak up for yourself until they listen to you. This insurance problem isn't the doctor's fault, so be careful about voicing frustration to the doctor. I'm sure they hear a lot of it and it just makes their job stressful.

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I was referred to the Neuro Spine clinic. I ended up seeing a physiatrist. He was only one who accepted to see me. (the clinic has all necessary Drs., orthopedic surgeons, neuro surgeons, etc. ) He ordered the MRI. He recommended physical therapy, injections and possibly a chiropractor. I am going to call a chiro. today. I cannot see how a physical therapist can move my vertebrae that is out of place, let alone help with all bulging discs. I do know my entire spine is BAD, especially my neck but I am only allowed to address ONE area at a time. I have so many pinched nerves and bulging discs. I personally do not want to rush into surgery though. Hoping I can get help before it gets worse. Decades a go, a chiro. did help me when I only had 2 bulging discs. But once I got fibromyalgia, a chiro makes EVERYTHING much worse. But willing to try it again.

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@wisco50

Correct. Even try a different primary provider if you feel like you are not getting proper attention. Doctors are rushed these days and it is not their fault – it is who they work for (clinic, hospital, insurance). You need to have all your ducks in a row before you are seen. WRITE down specific questions to take with you. You may wish to specify you need a longer appointment time. But you must be your own advocate or have someone help you figure this out ahead of time.

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My rheumatologist is who referred me to the Neuro Spine clinic. They only specialize in the spine.

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@saleha59

I was referred to the Neuro Spine clinic. I ended up seeing a physiatrist. He was only one who accepted to see me. (the clinic has all necessary Drs., orthopedic surgeons, neuro surgeons, etc. ) He ordered the MRI. He recommended physical therapy, injections and possibly a chiropractor. I am going to call a chiro. today. I cannot see how a physical therapist can move my vertebrae that is out of place, let alone help with all bulging discs. I do know my entire spine is BAD, especially my neck but I am only allowed to address ONE area at a time. I have so many pinched nerves and bulging discs. I personally do not want to rush into surgery though. Hoping I can get help before it gets worse. Decades a go, a chiro. did help me when I only had 2 bulging discs. But once I got fibromyalgia, a chiro makes EVERYTHING much worse. But willing to try it again.

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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.

Liked by starfirey2k, migizii

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@saleha59

I have arthritis in ALL my joints. My last CaT scan of hip showed a cyst. Not one single Dr. cared about it or my complaints of not being able to hardly walk any distances.(the hip issue started in 2017) Also, the hip issue could be related to spine and sacroiliac joints. The vertebrae that is misplaced is lower so that could affect my hip too. Lots of pinched/compressed nerves. As for being treated different because of my insurance, I have always been limited on what Dr./surgeons I can see. Many times they could could not do the things they wanted to do because they were limited because of my insurance. Many things were not done.

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Interesting, 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.

Liked by migizii, ga29

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