Vertabrae And Disk Problem - Any Others Experince Similar

[kuma]

This was posted in the Health section but there was no replies so trying it here in general if mods allow as this string is much more visited......

So I have been diagnosed with a "forward displacement of the 5th lumbar spine" (last vertebrae has slipped forward out of place) - about 35% off now (grade 2) with "complete degeneration of invertebrae disc" - pretty much now at bone on bone.

Attached an x-ray.

I have been told here that I need to have surgery - which includes fusing the L5 to the L4, along with some other procedure ( I think) to help fuse the bone that seems to have broken off as well (not 100% clear on this yet).

This diagnosis occurred two weeks ago, I was at home and bent over to pick something up and ended up on my back on the floor for three days recovering, at one point had to go to the hospital and was given morphine for extreme pain.

Now things have stabilized. I have been doing my research to see what this is and what I can do. I see a lot of threads online that say there are non-surgical options you can try first - lifestyle changes, medication, exercise so I am enacting all those now - luckily I do exercise regularly so what I need to do there is adjust my workout, not start from a sedentary lifestyle.

The degree and severity of the degeneration is in their opinion because the condition was con genitive (born with it) - though I do wonder if it was from one of a number of major traumatic events I have had in the past which got it started and it has been degenerative since then....

While I get the non-surgical program going I was hoping to hear from the community on a few things:

1. Has anyone else had this and what was the result

2. Has anyone conquered this using non-surgical techniques?

3. Does anyone have opinion on Orthopedic vs Neurosurgeon approaches to a surgical solution

4. Does anyone have experience with surgeons here in Thailand that can do this type of surgery - either Neuro or Ortho?

Thanks in advance for any comments

[rubin]

You should make MRI scan to see what exactly you have. X-ray pic is not enough.

[Sheryl]

Actually, yuou posted this in Health so I am deleting your priopr post to avoid duplication.

Correct that an MRI is indicated. But X-ray does give some info.

Many TV members have had this or similiar problem and several have had surgery for it in Thailand. the most highly regarded place for this is the BNH Spine Center and while there are several extremely well qualified docs there, tops in the filed is Dr. Wicharn. he operated on my sister (fusion of lumbar vertebrae, similiar to what you may need) with excellent results and I would definitely trust him to operate on my spine in the need arose.

As you are apt to get all sorts of advise on this, please keep in min d that there are many types of back problems and many causes of back pain and that well-meaning people offering their experience may have had an altogether different problem.

if the disk has truly degenerated to the point that it is bone on bone (exactly my sister's situation) exercise is not going to help and may even produce excruciating pain. Pt won't help either. Exercise and PT are often effective for herniated (prolapsed) disks but that's an altogether other matter. And of course back pain due to strained muscles/ligaments will respond to conservative measures, but again. a whole other problem.

I suggest you bring your Xray to Dr, Wicharn or one of his associates at BNH Spine Center for an expert opinion. be prepared to be referred for an MRI there as part of the workup.

[BuckarooBanzai]

You might find this of interest . . .

http://www.spineuniverse.com/conditions/spondylolisthesis/spondylolisthesis-ray-spine-slippage-l5-s1

[kuma]

Hi Sheryl

Thanks for taking the time to respond.

Indeed, I have an appointment on Thursday this week for an MRI at the Urupong Medical Centre - I was delayed a week due to work.

I had been dealing almost exclusively with Sukhumvit Samitivej, which is a place I have visited for years and I appreciate their service, but the Spine Centre sounds like a place I need to visit.

In this case one of my concerns is if this condition appears often enough in the Thai population for surgeons to get proficient at it. From my research so far they mention that sports like football and weight training (two that I have and do participate in) are major drivers of this - and given they are not as prevalent here as activities I am unsure if there are surgeons with sufficient experience.

I do feel stupid that I did not even know of the BNH Spine Centre, I should have come across it by now. Thanks a bunch for that tip, I stay in Chonburi typically during the week and Bkk weekends, but as I have the MRI in Bkk Thursday I will be there a few more days and will look up the Spine Centre and see if I can get an appt.

With respect to the exercise, that is also useful advice, I will keep it very light and low intensity for now - stretching seems to be beneficial

Thanks again.

Actually, yuou posted this in Health so I am deleting your priopr post to avoid duplication.

Correct that an MRI is indicated. But X-ray does give some info.

Many TV members have had this or similiar problem and several have had surgery for it in Thailand. the most highly regarded place for this is the BNH Spine Center and while there are several extremely well qualified docs there, tops in the filed is Dr. Wicharn. he operated on my sister (fusion of lumbar vertebrae, similiar to what you may need) with excellent results and I would definitely trust him to operate on my spine in the need arose.

As you are apt to get all sorts of advise on this, please keep in min d that there are many types of back problems and many causes of back pain and that well-meaning people offering their experience may have had an altogether different problem.

if the disk has truly degenerated to the point that it is bone on bone (exactly my sister's situation) exercise is not going to help and may even produce excruciating pain. Pt won't help either. Exercise and PT are often effective for herniated (prolapsed) disks but that's an altogether other matter. And of course back pain due to strained muscles/ligaments will respond to conservative measures, but again. a whole other problem.

I suggest you bring your Xray to Dr, Wicharn or one of his associates at BNH Spine Center for an expert opinion. be prepared to be referred for an MRI there as part of the workup.

[kuma]

Hey Buckaroo thanks for that.

Funny how we all look the same a x-rays. In the case of that one there is still some light (disc) it looks like between L5 and S1 - more than is the case with me.

The surgeons I have seen so far say that if there was less disc damage then I could maybe avoid surgery - they feel it had degenerated so much that in combination with the slip I need to get cut - but I want to get some more opinions before just jumping on the table.

Thanks

You might find this of interest . . .

http://www.spineuniv...-slippage-l5-s1 - morr =

[shepsel]

I had severe back pain last summer and tried avoiding going to hospital, as I had a spinal twelve years earlier with several side affects during the first year of recovery. Eventually I was pain free and led a normal life. This past summer I tripped in a pot hole and my back started to give me a lot of pain. I went for a massage and it made matters worse. I feared going to the hospital because I remembered all the side effects I had from the first surgery. Eventually I had to go because I couldn't take the pain any longer.

I went to Chiang Mai Ram, and they did an MRI on me as they were checking me in. The surgeon, Dr. Preecha told me he wanted to operate immediately because I had shattered an adjoining disc, and I was reluctant and asked for a second opinion. I was given nerve blocks to try and lessen the pain, but it didn't hold more than twenty four hours. I agreed to surgery, and it went text book perfect without any side effects.

Everything was done to perfection, and the right dosages of medication were issued, the follow ups were fine, and I would have to say that the treatment here in Thailand was far superior than in my home country.

[Sheryl]

Hi Sheryl

Thanks for taking the time to respond.

Indeed, I have an appointment on Thursday this week for an MRI at the Urupong Medical Centre - I was delayed a week due to work.

I had been dealing almost exclusively with Sukhumvit Samitivej, which is a place I have visited for years and I appreciate their service, but the Spine Centre sounds like a place I need to visit.

In this case one of my concerns is if this condition appears often enough in the Thai population for surgeons to get proficient at it. From my research so far they mention that sports like football and weight training (two that I have and do participate in) are major drivers of this - and given they are not as prevalent here as activities I am unsure if there are surgeons with sufficient experience.

I do feel stupid that I did not even know of the BNH Spine Centre, I should have come across it by now. Thanks a bunch for that tip, I stay in Chonburi typically during the week and Bkk weekends, but as I have the MRI in Bkk Thursday I will be there a few more days and will look up the Spine Centre and see if I can get an appt.

With respect to the exercise, that is also useful advice, I will keep it very light and low intensity for now - stretching seems to be beneficial

Thanks again.

It occurs just as often in the Thai population as anywhere else.

And in any case the physicians recommended have all trained and practuiced in the West.

DR. WICHARN YINGSAKMONGKOL

Specialty : Spine surgery

Language : English,Thai,

Education Medical school :

MD- Chulalongkorn University

Certification :

-Certified Thai Specialty Board of Orthopedic Surgery

-Certified Surgical Spine Fellowship (2-years programme), University of Missouri-Columbia, USA

-Fellowship in Spine Surgery, Columbia Spine Center, USA

-Fellowship in Pediatric Orthopedic and Spinal Deformity Surgery, Delaware, USA

Academic title : Associate Professor

Office Hour :

Special clinical interest : Spinal surgery, Spinal deformity, Scoliosis, Total Artificial Disc Replecement (Lumbar & Cervical Regions)

Monday, Tues, Thurs, Fri 17:00 - 19:00

Saturday 09:00 - 12:00

http://www.bnhhospital.com/index.php?name=search_doc

As you will note above, Dr. Wicharn also does artificial disks. Seriously expensive, though. How much advantage it provides depends in part on the number of vertebra being fused and also the lifestyle/occupation of the individual patient. In my sister's case we decided that the loss of flexibility from fusing only 2 vertebra would be minimal and not worth the added cost to get an artificial disk. She doesn't notice any problem from the fusion. But if several vertebra are fused, or perhaps in someone involved in certain sports or activities (e.g. yoga) it might be noticeable. Anyway Dr, Wicharn can advise on that. I found him to be quite frank.

[Sheryl]

Forgot to mention, Dr. Wicharn is also available at Bangkok Christian Hospital, Sundays only

It is a less expensive hospital so there would be cost savings on the hospital side of things (tests, room if inpatient etc. His surgical fee (if it comes to that) likely the same at either hospital, and higher than average (with reason).

If you are uninsured and cost is a constraint might consider this option. if so have your initial consultation with him at Bkk Chrisitan as BNH, like most private hospitals, takes a dim view of docs sending patients to other hospitals.

[kuma]

Thanks again Sheryl for the additional info and insight.

I did look up Dr Wichan and the BNH spine clinic and have an appt with him this week to go over my case.

I get your point about the surgery and costs but so far I have been advised by my insurance that it is 100% covered if I decide to go ahead, so I will see if that is the case with him as well.

Cheers! I do have persistent non stop low level pain now in the small of my back - which has become an annoyance and major distraction in just these two or three weeks so I hope this has a possible out!

Forgot to mention, Dr. Wicharn is also available at Bangkok Christian Hospital, Sundays only

It is a less expensive hospital so there would be cost savings on the hospital side of things (tests, room if inpatient etc. His surgical fee (if it comes to that) likely the same at either hospital, and higher than average (with reason).

If you are uninsured and cost is a constraint might consider this option. if so have your initial consultation with him at Bkk Chrisitan as BNH, like most private hospitals, takes a dim view of docs sending patients to other hospitals.

[kuma]

Thanks for the reply

Glad to hear you had a positive experience and have recovered - as the state i find myself in now is not something i want to be long term.

it sounds like you are in CM, which is not where i am - figure i will stick to what is available in Bkk for Thailand

Cheers

I had severe back pain last summer and tried avoiding going to hospital, as I had a spinal twelve years earlier with several side affects during the first year of recovery. Eventually I was pain free and led a normal life. This past summer I tripped in a pot hole and my back started to give me a lot of pain. I went for a massage and it made matters worse. I feared going to the hospital because I remembered all the side effects I had from the first surgery. Eventually I had to go because I couldn't take the pain any longer.

I went to Chiang Mai Ram, and they did an MRI on me as they were checking me in. The surgeon, Dr. Preecha told me he wanted to operate immediately because I had shattered an adjoining disc, and I was reluctant and asked for a second opinion. I was given nerve blocks to try and lessen the pain, but it didn't hold more than twenty four hours. I agreed to surgery, and it went text book perfect without any side effects.

Everything was done to perfection, and the right dosages of medication were issued, the follow ups were fine, and I would have to say that the treatment here in Thailand was far superior than in my home country.

[FBN]

Apologies for such late response but work sort of got in the way..

The X-rays show quite a severe listhesis and I do not see an alternative to surgery here. It needs to be confirmed if there is a spondylolysis (fracture of some of the stabilising bony elements at the back of the vertebral body) as this will also be a guide to the severity and the chances of getting worse. It seems so from the current X-ray.. The problem here is that the "slip" of the vertebral body is bound to get worse over time because of the mechanical pressures on the joint. The L5/S1 disc is normally a lot "thinner" than the rest of the lumbar spine discs but this can also be fixed in a L5/S1 fusion.

Dangers here going forward without a fusion is progressive nerve and spinal nerve column, which at this level forms the "cauda equina" with loss of sensation and motor impairment in the groin area. (Look up "Cauda Equina Syndrome").

Fusion at this level will not have a major impact on mobility of the lower back at all; it is, in fact, the best of a bad situation..