I am happy to hear that your symptoms are currently much improved in comparison to what you were experiencing 2 years ago. Although you are are not completely asymptomatic, it appears to me that the decision to avoid surgery in your case was the right one for you. In the long term, I agree that a routine exercise program for stabilization, strengthening, stretching, and general conditioning is in your best interest. The key in your case is to avoid the extremes of the "no pain no gain" mentality on the one hand and the other extreme of being completely apprehensive about any activity the causes discomfort. My advice to you is to progress in a slow and steady pace while letting pain be your guide for your restrictions. You may also benefit from using over the counter anti inflamatories regularly during the initial couple of months of exercising to minimize pain and maximize the benefit from your program.
The symptoms of morning pain, stiffness, and radiation of pain to your leg are consistent with inflamation of the nerve root (sciatica most likely). Your spine arthritis is not the direct cause for your symptoms but makes you somewhat more prone to these kind of episodes. It is possible that you herniated a disc, but in the absence of real weakness in your legs, an MRI is most likely not necessary at this point.
I can understand your desire to avoid a doctor visit for this problem. In the majority of cases the symptoms you are describing often resolve on their own within 6-8 weeks even without any treatment. Stretching as you have done is very helpful in the long term. I would also recommend taking some over the counter anti-inflamatories such as Aleve, Motrin, Advil etc if you can tolerate them.
If you feel that your symptoms are not improving or are progressively worsening, you may choose to see the doctor after all. Most likely, all that you would need is a good course of physical therapy and some medications in the short term.
Coccydynia can be a very challenging condition to treat. As spine surgeon I do not encounter this condition very frequently, and fortunately, many of my patients have responded well to conservative, non-operative treatments including therapy, injections, medications, etc. Unfortunately, you seem to have had this quality of life limiting pain for 4 years and failed to improve despite all the appropriate conservative treatment options.
Although my personal experience with performing surgery for excision of the Coccyx is rather limited, it is a relatively quick and simple procedure to perform from a technical standpoint. As in many other surgical interventions for chronic pain, the predictability of success with this procedure is often limited.
Nevertheless, in your particular case, I believe it would be worth your time to consult with a spine surgeon in your area. A good consultation would help you weigh the relative risks and benefits of the procedure so that you can make a well informed decision based on quality of life consideration.
Based on the information you provided, it is not clear to me what your symptoms are at this point. You also did not mention a diagnosis if you have one at this point. Simply having had a discectomy/laminectomy in the past is not a diagnosis nor an automatic justification to be granted SSDI, even if you still have signfiicant pain.
Clearly, you have chronic back and possibly leg pain which appears to be currently somewhat controlled on narcotic pain medications. I can only assume that the judge may have concluded that you would benefit from an updated evaluation by a spine surgeon to establish whether you would be a potential candidate for curative rather than just palliative treatment. Granted, not all patients with "post laminectomy syndrome" are candidates for further treatment other than pain management. But those who have focal nerve compression or evidence of instability may benefit from focal treatment to address their spine pathology.
My suggestion to you is to consult with a reputable spine surgeon in your area so that at the very least you will know if you have options for treatment other than just pain management. If the spine surgeon will find that you are not a candidate for surgical treatment, his opinion will probably help you in your application for SSDI although you may need the help of an attorney regardless.
You are currently taking "industrial" amounts of narcotic and other medications for pain control as prescribed by your Physiatrist. I can certainly understand your desire to reduce your long-term dependency on these drugs, and I support it. As an orthopaedic spine surgeon, pain pumps are outside of my personal expertise, but it sounds like you might be a reasonable candidate having exhausted most alternatives. I am also in agreement witht the other surgeons who told you that additional spine surgery is not a good option for you.
Don't loose hope and please keep us updated.View Thread
Ankylosing Spondylitis (AS) is an inflamatory arthritic condition, generally best treated by Rheumatologists. Treatment needs to be tailored according to your symptoms and clinical findings. The good news is that over the past few years new medications have proven to be effective in controlling symptoms. As spine surgeons, we sometimes get to treat patients with spine related AS conditions such as unstable fractures or deformity.
Good luck and keep us posted on your follow up visit.View Thread
I was pleased to learn that you are scheduled to see a spine specialist primarily relatively soon based on your report of your "....leg feels generally weak."
First, you should know that in the majority of cases, symptomatic lumbar disc herniations are successfully treated without surgery. Surgery for disc herniations are typically considered a last resort option based on quality-of life considerations after failure of non-operative treatment (medications, therapyl, epidural injections)
In some cases, however, depending on the location and size of the herniation, and depending on clinical findings on your examination, micro-surgery may be recommended as the most predictable option for long-term relief of leg pain and numbness, and for restoration of strength and function. In general, micro-discectomy (the surgical removal of a disc fragment that is pinching your nerve) has a high success rate in relieving leg symptoms (85-95%). Relief of back pain can be less predictable, however. Therefore, your discription of predominance of leg symptoms is a positive prognostic factor should you be considered a candidate for disc surgery.
I hope you will find relief without the need for surgery, but if you end up having a micro-discectomy, be reasured that relief of leg pain is generally achieved with high predictability.
Thank you for welcoming us to the community. I have read your story and was glad to learn about the valube support you have received from WebMD over the past few years. As a spine surgeon I am looking forward to becoming an active part of the WebMD support community.