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Lower back issues - neurosurgeon or ortho spine specialist


mlktwins
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If your MRI came back with disc issues and other things, which would you choose to go to?  A neurosurgeon or an orthopedic spine specialist?  I have MRI results from a podiatrist because I thought I had foot issues.  Come to find out, it really isn't my foot :-(.  He has recommended 2 neurosurgeons and 1 orthopedic spine specialist.  From my research, all are fabulous doctors in my area.  Just trying to choose which type I should go to.

2021 just keeps on sucking for sure!!!

 

 

 

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5 minutes ago, Jean in Newcastle said:

Depends on the issues. If at all possible, I would go for physical therapy first. (I realize that some things are not fixable that way but often it’s a neglected treatment option that can actually have good results). 

Yes, that is my plan!  I will not do surgery unless absolutely necessary and other options have failed.  I just need to pick one to start getting a thorough diagnosis.  I thought I maybe had sciatica, but it is more than that.  I need another MRI with contrast, according to the MRI results, but I want to have someone other than a podiatrist prescribe it (even though he is awesome) in case the specialist wants something else done.  

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3 minutes ago, mlktwins said:

Yes, that is my plan!  I will not do surgery unless absolutely necessary and other options have failed.  I just need to pick one to start getting a thorough diagnosis.  I thought I maybe had sciatica, but it is more than that.  I need another MRI with contrast, according to the MRI results, but I want to have someone other than a podiatrist prescribe it (even though he is awesome) in case the specialist wants something else done.  

My primary care doc is an Internal Med Specialist.  He ordered the MRIs I needed and gave me a referral for physical therapy.  I had to look around for a good physical therapist.  Bad ones do what I call a "cookbook approach".  They look up "lower back issues" in their book and then just do those exercises that come up.  My very good PT tailors her approach to my specific body and my specific problems.  In my case, some of my problems were because the wrong muscles were doing the work - I needed someone to be able to figure that out and then help the right muscles to kick in, which helped to take the load off from those muscles which were working too hard.

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4 minutes ago, Jean in Newcastle said:

My primary care doc is an Internal Med Specialist.  He ordered the MRIs I needed and gave me a referral for physical therapy.  I had to look around for a good physical therapist.  Bad ones do what I call a "cookbook approach".  They look up "lower back issues" in their book and then just do those exercises that come up.  My very good PT tailors her approach to my specific body and my specific problems.  In my case, some of my problems were because the wrong muscles were doing the work - I needed someone to be able to figure that out and then help the right muscles to kick in, which helped to take the load off from those muscles which were working too hard.

Sent you a PM.

 

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I have degenerative disc disease (aka arthritis) that causes pain in my hips, thighs and knees and sometimes my shoulders and elbows. My rheumatologist who treats me for RA handles those issues, too. But I'm not interested in surgery. If you want to go with PT your primary care doc should be able to refer you for that. Otherwise I'd try to get in with a ortho spine doc.

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2 minutes ago, Pawz4me said:

I have degenerative disc disease (aka arthritis) that causes pain in my hips, thighs and knees and sometimes my shoulders and elbows. My rheumatologist who treats me for RA handles those issues, too. But I'm not interested in surgery. If you want to go with PT your primary care doc should be able to refer you for that. Otherwise I'd try to get in with a ortho spine doc.

I am a little freaked out and wasn't planning to add this part -- LOL.  I just PM'd Jean about it.  But...maybe it will help with responses.

The MRI findings show a possible cyst/abscess on my spine and also in my hip.  Does this change your opinion?  I have bulging discs, some stenosis, and cysts???  All things I had not idea I had!  I thought I maybe had sciatica (lower ride side).  Apparently, not gonna be that easy of a fix.

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5 minutes ago, mlktwins said:

I am a little freaked out and wasn't planning to add this part -- LOL.  I just PM'd Jean about it.  But...maybe it will help with responses.

The MRI findings show a possible cyst/abscess on my spine and also in my hip.  Does this change your opinion?  I have bulging discs, some stenosis, and cysts???  All things I had not idea I had!  I thought I maybe had sciatica (lower ride side).  Apparently, not gonna be that easy of a fix.

Maybe? 

FWIW (sum total of my experience with spinal cysts) -- DS22 was diagnosed with one when he was around 12. He was diagnosed with scoliosis and the doc wanted him to have a MRI to make sure he didn't have a tethered cord or something like that (apparently that's not uncommon in boys with scoliosis). The only thing that showed up was a spinal cyst. We were sent to see a pediatric neurosurgeon, but he said it wasn't anything to be concerned about unless DS started having pain. He said he would feel it in his hip, and it would be a type of pain that would definitely get his attention. I guess where you'd feel the pain would depend on where the cyst is located? So maybe it would be a good idea to have a neurosurgeon take a look? DS has never had a problem with his.

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24 minutes ago, mlktwins said:

Sent you a PM.

 

 

18 minutes ago, mlktwins said:

I am a little freaked out and wasn't planning to add this part -- LOL.  I just PM'd Jean about it.  But...maybe it will help with responses.

The MRI findings show a possible cyst/abscess on my spine and also in my hip.  Does this change your opinion?  I have bulging discs, some stenosis, and cysts???  All things I had not idea I had!  I thought I maybe had sciatica (lower ride side).  Apparently, not gonna be that easy of a fix.

Since you posted here as well as the PM, I will post my PM answer to you here as well in case someone else has a similar issue:

Then I think that I would start with the ortho spine specialist just because they are specialists but a bit more general than the neurosurgeon.   I just think that neurosurgeons tend to go with the scalpel no matter what. 

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I have read the whole thread. Between my husband and I, we have experience with everything mentioned here except cysts. My husband in particular was advised to have surgery for a blown disc, and he was able to avoid it by committing to exercise. I was also able to turn around bulging discs through exercise. 

For the disc issues, definitely do physical therapy with someone who is actually a spine specialist. I agree with everything Jean says. Don't do 4-6 weeks and call it done. Rather, commit to this wholeheartedly for as long as you can, and then force yourself to keep doing the exercises. Consider checking back in with the physical therapist every couple months for a new "prescription" for continued work on your back. You will likely have to pay out of pocket for those tune-ups, but they are well worth it. 

My husband and I would both say it takes about two years of concerted work to really be strong and allow the discs to heal for real. You will get good results within three months, most likely. Keep going--avoid a roller coaster of ups and downs by committing to two years of back strengthening. If you want to avoid surgery, this is what it takes. 

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BTDT-- I would see an orthopedic surgeon who is a spine specialist. 

I tried PT but my issues were too complex and I needed surgery-- the MRI did not reveal the bone spur I had that was sticking INTO my spinal cord-- no wonder I had terrible headaches as well as back/leg pain!!  My disks were bulging but after 6 months+ of PT they had disintegrated...

PT can be VERY useful-- but it cannot always reverse damage.

I had to have shoulder surgery after a treadmill accident (I tried PT first then as well) it took 1 whole year of PT to get movement back in my arm/shoulder-- BUT in the end I now have more movement/rotation in the injured arm than I do in the un-injured  one.   So PT can work...

 

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My Dh is currently doing physical therapy. He found a spine specialist clinic within our medical group and they have their own physical therapists at the clinic. He’s also trying to avoid surgery and is seeing a little improvement this week. The physical therapists at this clinic are so much better than the random ones he’s been sent to previously. 

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18 months ago a disc ruptured in my neck the imaging showed osteoarthritis, spinal compression, and a bone spur on my vertebra about to poke into my spine, so the hospital transferred me to to a neurosurgeon at a different hospital for my surgery a day later where he got rid of the bone spur and put titanium cages in.

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Orthopedic spine doc reread my MRI and disagreed with original reading. So like others said start with Ortho and see what he thinks is priority (PT or surgery). My dad has cysts / lesions and no surgery is recommended only PT.

PT places vary so shop around. 

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I would start with ortho/spine and get a second opinion from a neurosurgeon. Do not do any procedures without a second opinion. A ortho will be more inclined to start with alternative treatments first before surgery. The surgeon will have seen when those ideas didn't work, or made things worse. Two different ways of looking at the issue is important.  Likely the surgeon won't see you unless they review the films and think it is operable tho.  The ortho guy will see you with just the abnormal films. 

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And surgeons, dentists, etc aren't all about getting money.  This year, i had a plastic surgeon tell me  he really hopes I won't need his services for a skun graft. And my dentist told he doesn't think I should choose getting my front teeth the same color (I can't use whiteners) so only putting 4 crowns on for cosmetic reasons would work and he thinkx I should very seriously.  More importantly, I would need braces first (and he doesn't do orthodontics) and I definitely may pursue the orthodontics (invisalign) because it would help my RA in my jaw.

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22 hours ago, Harriet Vane said:

I have read the whole thread. Between my husband and I, we have experience with everything mentioned here except cysts. My husband in particular was advised to have surgery for a blown disc, and he was able to avoid it by committing to exercise. I was also able to turn around bulging discs through exercise. 

For the disc issues, definitely do physical therapy with someone who is actually a spine specialist. I agree with everything Jean says. Don't do 4-6 weeks and call it done. Rather, commit to this wholeheartedly for as long as you can, and then force yourself to keep doing the exercises. Consider checking back in with the physical therapist every couple months for a new "prescription" for continued work on your back. You will likely have to pay out of pocket for those tune-ups, but they are well worth it. 

My husband and I would both say it takes about two years of concerted work to really be strong and allow the discs to heal for real. You will get good results within three months, most likely. Keep going--avoid a roller coaster of ups and downs by committing to two years of back strengthening. If you want to avoid surgery, this is what it takes. 

Thank you!  I'm thinking this is God's way to get me to start exercising and taking care of me 🤣!  I will do what I have to do to avoid surgery if at all possible!

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22 hours ago, Jann in TX said:

BTDT-- I would see an orthopedic surgeon who is a spine specialist. 

I tried PT but my issues were too complex and I needed surgery-- the MRI did not reveal the bone spur I had that was sticking INTO my spinal cord-- no wonder I had terrible headaches as well as back/leg pain!!  My disks were bulging but after 6 months+ of PT they had disintegrated...

PT can be VERY useful-- but it cannot always reverse damage.

I had to have shoulder surgery after a treadmill accident (I tried PT first then as well) it took 1 whole year of PT to get movement back in my arm/shoulder-- BUT in the end I now have more movement/rotation in the injured arm than I do in the un-injured  one.   So PT can work...

 

I am sorry you have been through so much!!!  Big OUCH on the bon spur sticking into your spinal cord!!!  I don't think my the bulging discs are too bad yet, but I'm being careful until I see the doctor.  

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19 hours ago, Homeschool Mom in AZ said:

18 months ago a disc ruptured in my neck the imaging showed osteoarthritis, spinal compression, and a bone spur on my vertebra about to poke into my spine, so the hospital transferred me to to a neurosurgeon at a different hospital for my surgery a day later where he got rid of the bone spur and put titanium cages in.

I am so very sorry!!!  That must have been a shock!  And...to have no time to plan or get things in order at home before surgery and recovery?  Are you doing ok now?

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19 hours ago, PeterPan said:

Orthopedic spine doc reread my MRI and disagreed with original reading. So like others said start with Ortho and see what he thinks is priority (PT or surgery). My dad has cysts / lesions and no surgery is recommended only PT.

PT places vary so shop around. 

Thank you.  The podiatrist is not a back specialist and he just went off the results without looking at the actual MRI pics.  I will be talking those to the new doctor with me!

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5 minutes ago, mlktwins said:

Thank you!  I'm thinking this is God's way to get me to start exercising and taking care of me 🤣!  I will do what I have to do to avoid surgery if at all possible!

Honestly, that's what it has been for us. 

In my dh's case, he had been slacking for a while. Used to jog regularly and just found it really hard to keep up after an interstate move--the move, the teenagers, the crazy-busy work life. Ended up with three major back episodes in two years and a diagnosis of various squished and herniated discs. The first episode happened six weeks before a major backpacking trip he'd planned with ds for a year. He was scared of missing the trip or having an emergency during the trip and he threw himself into PT. Was able to do the trip. Thank God! But then more back problems until finally an MRI was approved and the diagnosis resulted. This man loves to play hard, and there is no quality of life for him without soccer and volleyball and camping and all the things. PT turned the whole awful situation around. No surgery, just continued hard work, and we are thankful he can play and garden and everything.

In my case, I had a double whammy. Bone spurs and squished discs and an underlying connective tissue condition have pushed me into therapy numerous times. I was maintaining some basic exercise with the intent to escalate asap--I knew from the cycles of PT that I was on borrowed time to ramp up my exercise regime. A life-threatening abdominal infection and sepsis caused a steep slide down. My pain skyrocketed. My joints basically fell apart in the aftermath of that ghastly infection. I was having trouble with balance and weight and so much pain and exhaustion. Finally when I was told I would need knee replacement surgery, I said enough is enough. I made the singular focus of my life exercising. I hired a health coach to keep me accountable and help figure out next steps along the way (my condition was complex)--she was such a support. I did PT for months, and I paid for quite a bit out of pocket when insurance ran out. I progressed to working with a gifted trainer. It was 100% worth every penny and every minute of hard work. 

For both of us, we felt that these were a wake-up call. Surgery is something we thank God for when it's needed, but it's also invasive and tough to work through and we wanted to try other routes first. The only way either of us would have any quality of life is by doing the hard work no matter what. And thank God we did. Just this past weekend we went canoeing for 2 1/2 hours, something that would have been impossible four years ago. We camp. We bike. Dh plays his beloved sports. This has been a life-giving journey of restoration, and we praise God for it. 

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1 hour ago, Harriet Vane said:

Honestly, that's what it has been for us. 

In my dh's case, he had been slacking for a while. Used to jog regularly and just found it really hard to keep up after an interstate move--the move, the teenagers, the crazy-busy work life. Ended up with three major back episodes in two years and a diagnosis of various squished and herniated discs. The first episode happened six weeks before a major backpacking trip he'd planned with ds for a year. He was scared of missing the trip or having an emergency during the trip and he threw himself into PT. Was able to do the trip. Thank God! But then more back problems until finally an MRI was approved and the diagnosis resulted. This man loves to play hard, and there is no quality of life for him without soccer and volleyball and camping and all the things. PT turned the whole awful situation around. No surgery, just continued hard work, and we are thankful he can play and garden and everything.

In my case, I had a double whammy. Bone spurs and squished discs and an underlying connective tissue condition have pushed me into therapy numerous times. I was maintaining some basic exercise with the intent to escalate asap--I knew from the cycles of PT that I was on borrowed time to ramp up my exercise regime. A life-threatening abdominal infection and sepsis caused a steep slide down. My pain skyrocketed. My joints basically fell apart in the aftermath of that ghastly infection. I was having trouble with balance and weight and so much pain and exhaustion. Finally when I was told I would need knee replacement surgery, I said enough is enough. I made the singular focus of my life exercising. I hired a health coach to keep me accountable and help figure out next steps along the way (my condition was complex)--she was such a support. I did PT for months, and I paid for quite a bit out of pocket when insurance ran out. I progressed to working with a gifted trainer. It was 100% worth every penny and every minute of hard work. 

For both of us, we felt that these were a wake-up call. Surgery is something we thank God for when it's needed, but it's also invasive and tough to work through and we wanted to try other routes first. The only way either of us would have any quality of life is by doing the hard work no matter what. And thank God we did. Just this past weekend we went canoeing for 2 1/2 hours, something that would have been impossible four years ago. We camp. We bike. Dh plays his beloved sports. This has been a life-giving journey of restoration, and we praise God for it. 

I am in the middle of this.  Though fibro, which includes exercise intolerance, makes it a rather frustrating endeavor.  But I do what I call my Xena workouts (I embrace my inner Xena Warrior Princess).  I do daily Epsom salt soaks to try to help.  And I'm now on DHEA to hopefully help me actually make muscles because it's so frustrating to work out harder than all my friends and still have muscles the size of toothpicks.  (My goal is not big muscles - it's to have muscles big enough to support a mobile active lifestyle.)  I have literally trained my dog to help me to get up from a chair.  Standing up without help is a goal.  I did PT for 9 months straight.  Now I've "graduated" to a personal trainer who works out of the physical therapy office.  I had tried going from PT to a "regular" personal trainer at a gym and immediately was injured.  They just don't understand the baby steps that I need to make. 

Anyway, OP, I hope that you find the right doctor.  And I hope that they can come up with a treatment plan to help the root problems. 

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1 hour ago, Jean in Newcastle said:

I am in the middle of this.  Though fibro, which includes exercise intolerance, makes it a rather frustrating endeavor.  But I do what I call my Xena workouts (I embrace my inner Xena Warrior Princess).  I do daily Epsom salt soaks to try to help.  And I'm now on DHEA to hopefully help me actually make muscles because it's so frustrating to work out harder than all my friends and still have muscles the size of toothpicks.  (My goal is not big muscles - it's to have muscles big enough to support a mobile active lifestyle.)  I have literally trained my dog to help me to get up from a chair.  Standing up without help is a goal.  I did PT for 9 months straight.  Now I've "graduated" to a personal trainer who works out of the physical therapy office.  I had tried going from PT to a "regular" personal trainer at a gym and immediately was injured.  They just don't understand the baby steps that I need to make. 

Anyway, OP, I hope that you find the right doctor.  And I hope that they can come up with a treatment plan to help the root problems. 

I love the Inner Xena Warrior Princess! I am adopting that for my own. I adore Lucy Lawless in her Acorn series, My Life is Murder. If you enjoy mystery shows, it's a winner.

I can absolutely relate. I, too, graduated to a trainer who also works as a physical therapist. Her expertise makes a huuuuuuuge difference. She knows about baby steps and she is incredibly creative in finding workarounds for my shifty joints and weak hands/wrists. I am so grateful for the effort she put into figuring out how to help me.

I remember when you started off trying to do more "normal" movement throughout the day--you have fought through so much! GOOD FOR YOU!!! 

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I'll add my vote for ortho/spine specialist. I've had back issues for years and had been seeing an ortho doctor who specializes in back issues. I have degenerative disc disease which, as @Pawz4me pointed out, is basically arthritis. 

I've had years of physical therapy, injections, and pain meds. At one point I even had a spinal cord stimulator. It doesn't reduce pain but is really just white noise for pain. Eventually I had it removed because as long as it was in my body I couldn't have an MRI of my spine to determine if things got worse. 

 

 

23 hours ago, Jann in TX said:

BTDT-- I would see an orthopedic surgeon who is a spine specialist. 

I tried PT but my issues were too complex and I needed surgery-- the MRI did not reveal the bone spur I had that was sticking INTO my spinal cord-- no wonder I had terrible headaches as well as back/leg pain!!  My disks were bulging but after 6 months+ of PT they had disintegrated...

PT can be VERY useful-- but it cannot always reverse damage.

I had to have shoulder surgery after a treadmill accident (I tried PT first then as well) it took 1 whole year of PT to get movement back in my arm/shoulder-- BUT in the end I now have more movement/rotation in the injured arm than I do in the un-injured  one.   So PT can work...

 

This is similar to my story. None of the things I was doing would have worked and surgery was the only option for relief. I had L4, L5 discectomy, minimally invasive.

This January I finally had surgery. It was actually several years in the planning but doctor changes, insurance changes, and then the pandemic were all working against me. I was lucky in that I didn't need fusion. I had arthritic bone pressing on my sciatic nerve and the surgeon cleaned it out. When I went for my first follow up with his PA she told me there had been "significant nerve impingement" (she was present at my surgery). None of the non-invasive things I was doing would have worked so I was just going in circles trying to avoid surgery.

My point is, try everything non-invasive because a lot of people do get relief with PT or injections. However, don't be afraid of surgery if it comes to that. It was the best decision I made in a long time. I'll always have some pain due to my arthritis but cleaning the bone off my nerve has reduced it significantly.

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