Can a bulging disc close to nerves be helped w/out surgery?

[Loca]

I have been going through quite the ordeal since February. Bladder pain w/ mild, mild retention. Thought to be Pelvic Floor Dysfunction. Could still be...
Started to have pain around tailbone area...aching and aching for hours. Levator Ani Syndrome...maybe. Finally MRI last week reveals bulging disc at L4-5 in addition hypertrophy of the ligaments, thus making my spine canal look like an hour glass. All clear down the spine and then you see where the nerves are cinched together (almost) at this L4-5 area. Could this be the bladder problem since everything else has been ruled out?

My Neurologist is referring me to Neuro Surgeon for 2nd opinion. Afraid to consider surgery, but what choice do you have when nerves are involved? I seem to read only negative results from surgery.

Can email my MRI image if anyone has any thoughts on the matter.

Thanks!

[Mark N]

Loca, I can't really help you with your question other than to say that if your disk is compressing your spinal cord that much it may be the cause. I am one that has had successful surgeries. Both of my fusions did a great job and if my back had something that could be fixed by another fusion I would still be working. If surgery is the RIGHT answer then you can expect a big improvement but take your time and get tested so you know that it is the right choice for you.

[Jolene]

If the sciatic nerve is involved then it can deffinately affect the bladder. Some people it causes incontinence, others just the opposite. I would suggest you check out www.sciatica.com It sounds to me like if you have to have surgery selective endoscopic dysectomy would possibly work for you. But then, I'm not the expert. Just supplying info and trying to help.

[Loca]

What I did fail to mention was the sciatic pain that started only when I was in a certain position (laying back in bed and bending left knee to the side, left foot against right knee...you know?). I would get this hot, tingling, electrical feeling down the top of my thigh. Move my leg back down and it went away. Sometimes happened if I was standing and say cradling a baby in my arms.

A few chiropractic treatments a few weeks back and she (the doc) made the tailbone ache go away for several days in a row and the tingling pain reduced to a minor sensation. Now I feel it more in my shin area then the thigh, but not painful. Obviously she repositioned my spine and hips and it eased up.

I'll try to post the picture later, because when I look at it I have no idea how I would be able (without surgery) to open the space up.

This is not something I expected at all. I'm not a person who suffered from back pain in general other than the occasional pinched nerve and ache from period pain.

Thanks for your insight.

[Jolene]

I'm going to make a guess here... You say pinched nerves you have had? Well that was caused by your spine shifting. So you have had the problem longer than you realize. In my never to be humble opinion anyway...

[ncdude]

Loca-

I've had laminectomies 2 years apart for L3/4 and L4/5. No fusion since my spine stability was good. I definitely say you should speak with the NeuroSURGEON and bring your MRI films and written report with you. One possible option might be getting an epidural steroid injection (ESI) to the affected nerve. I've been about 66% successful with mine, with herniated discs.

The thing to think about when considering surgery is what will your life be without it. In my case, I was unable to walk 50 yards without the pain from the nerve forcing me to stop and sit down. So 2 successful lumbar surgeries was worth it in my case.

joe

[Loca]

Thanks you guys...

Pinched nerves, I 've had a few but only one in my lower back all the rest were always in the neck or shoulder blade area...but certainly nothing chronic, maybe 5-7 in 20 years (I'm 41).

My tailbone has ached all day, DMSO gel seems to help when ice pack has failed. I've stared at my MRI pictures on and off having myself a pity party. But turned out two people I work with had back surgeries and they were both successful (one is in her 60's and still plays a mean set of tennis and she had pins put in her back)... Turns out the Doc I was referred to is out of network for my insurance. I'm scheduled to see him next Thursday and my Neurologist picked him because he had recently operated on his daughter who had a tumor wrapped around her neck/spine area. She's perfectly fine.

He was the golden boy at UCLA and along came Cedars (hospital), paid him a mint and swept him away (my doc is still at UCLA).

Just looking at my pictue (scan) I can't help wondering how they can fix the narrowing of the canal without surgery. This just sucks.

I figured the only surgery I would be having in the future was another c-section or a hysterectomy...now this.

Why does back surgery have such a bad rap? Stories through the ages?

[ChiroGeek]

Disc bulges can NOTbe helped with surgery (unless you're speaking of fusion).

A surgeon would be a fool to attempt discectomy on either a disc bulge or small contained herniation, for the outcomes are poor -- as pointed out by Stanford's Carragee [http://www.chirogeek.com/002_Carragee-HNP-Classifications.htm [

The other confounder regarding simple disc bulges, is that the false positive rate [i.e., MRI's showing disc bulges in normal non-pain-afflicted people] is extremely high. More explicitly, approximately 50% [Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373].

Therefore, if your pain level is over 55 on Oswestry, then consider SED, ADR, or IBF.

[Loca]

Chiro- Thanks for your input, but have to tell you I have no idea what your last sentence meant.

My nerves are being cinched together by the bulging disc on one side and hytropothy of my ligamnets on the other. As new as I am to this, I still can't imagine how else they would open my spine canal w/ out surgery. PLus it is effecting my bladder even though I am not losing control of my functions, I am still having issues with sciatic pain and bladder pain.

So- maybe you could go into more detail in your post as to other options. Please don't abbreviate as I have no clue what you are talking about.

Thanks.

[Jolene]

I'm not Chiro- but SED is Selective Endoscopic Dysectomy ADR is Artificial Disc Replacement and IBF is Inter-Body Fusion sciatica.com can give you decent details. SED I can give you major details as I've had two. PM me if you want the guts and gore version.. :D

ADR is self explanatory IBF is I believe where they go in and place a cage like device in the vertabrae to hold them stable.

Chiro has a lot on his adjusting table so when he get's along he can clarify. I just wanted to give you a little idea in case he's not around for a few days.

[the-last-dance]

If the MRI shows the problem area as L4/L5, then that would automatically rule out the source of your bladder problem. Reason - the nervi erigentes S2, S3, and S4 transmit the sensory nerves of the bladder. Jolene's statement that if the sciatic nerve is affected then it can transmit the pain from the bladder is totally incorrect. See Grant's Atlas of Anatomy Ch.3 pg. 72. Title of daigram: Diagram of the Nerve Supply to the Bladder and Urethra. Also, I might add, the statement that the spinal cord could be pinched is also incorrect. The spinal cord ends at the disc level L1/L2....Jolene: It is totally impossible to perform an ADR endoscopically. ADR placement is performed anteriorly ( the guts have to be pushed aside ), and also an endoscope is far to tiny to pass the large metal/polyethylene disc replacement structure through the tiny tube of the endoscope. It would be like trying to pass an elephant through your front door....

joe

[uvamomb]

Hi, Jolene. Sounds like you have an awful lot to think about. If your pelvic problem is a muscular problem, I have had great results (went from being incontinent to NOT!) by pelvic floor work -trigger point release and usuing some type of machine that measures muscle strength I believe. Also, did some dry needling. It has been wonderful to go from wetting myself to NOT!!! So, that would be a good, simpled fix for at least that one.
If you ned fusion surgery, I'm told you stand a much higher chance of success with the fusion "taking" if you follow surgery up with trigger point release (after surgeon says you can return to P.T). Only kept me away for 2 weeks since mine is passive type of P.T:) .
Whatever you decide to do, I hope you get the results you need and want.
Prayers and hugs,
Kathy:)

[Kathi49]

the-last-dance,

I believe you are correct in your assessment. I have problems with L5/S1 and I thought at one time it was affecting my bladder. Come to find out I have weak pelvic floor issues as does uvamom along with facet degeneration at L5/S1. The pain refers everywhere...so at times it is difficult to figure out what it what.

[Jolene]

So let me make sure I get this.... Pressure on the sciatic nerve can't cause incontinence? Ok. So why in the blank is that one of the factors deciding how badly you need surgery?? For the record, yes, prolonged pressure on the sciatic nerve can causes bladder and bowel problems. It's rather ironic that whenever I got hauled to the Dr. the first question was, and I quote "you're not incontinent are you?? If you were that would require emergency surgery." Several Dr.s have explained to me about the sciatic nerve being the size of your finger in diameter and nearly every nerve in the lower half of the body either goes through it, or is affected by it. All my pressure was on the sciatic nerve. It can also cause your bladder and bowels to shut down, or "retain", which is what I had to deal with. So next week when I take all my Dr.s out to lunch I'll give them a copy of a few things from this forum. They always need a good laugh. :p :D

As for the ADR- If it is beyond people's capability to comprehend that that particular surgeon has developed an entirely new procedure that is their disability to overcome, not mine. I know full well about current ADR surgery, the methods as well as the parts available. I have even spoken to both Dr. Zeegers, and Dr. Bertanoli as in the future I will likely need surgery. I believe I said the words HI_TECH at some point?? Considering that the Dr. is a pioneer in endoscopic spine surgery, and were it not for him endoscopic spine sugery likely would not exist, or be years behind I doubt he would be worried if you believe it or not. I know he has developed it, has done the clinical trials, and has submitted it to the FDA for approval. I will ask him how that is proceding next week when I see him. I'm curious myself.

PS- I don't have time to go back and read if I said cord... If I did I meant nerve. Yes I know the spinal cord ends at level one. (lumbar) Anyway, I have a job to do. Have fun folks.
PsPS- I didn't say cord, someone else did. :D

[Kathi49]

Hey GJZH,

I don't have CES, that has been ruled out. But I do have a rectocele. The funny thing is, my Urogynecologist (after several tests) told me he thought the L5/S1 has more to do with the pain I am having and that rectoceles should not hurt. But I beg to differ with him LOL! Anyway, normally it doesn't but at times it does. He said I should go back to my spine PM, get a facet injection and then come back to him and go into PT. This is NOT fun! :eek:

[the-last-dance]

Pressure on the nerve root at L4/L5 caused by either rupture or bulging of the disc will sometimes bring about severe back pain near the belt line and radiculopathy;i.e., sciatica extending through the buttocks and passing down the outer portion of the leg ending at the ankle or crossing the foot and ending at the toes. However, IT DOES NOT AFFECTTHE BLADDER!!!!! Do your home work - look-up in an anatomy text to see the nerves that affect the bladder. It States specifically - The nerves affecting the bladder are S2,S3,S4.
So stop this debate. This is not about what you believe. It is factual knowledge. And again I must say, IT IS IMPOSSIBLE TO PERFORM AN "ADR" using the endoscopic approach. Such talk is simply gobbledygook.

joe

[Kathi49]

Joe,

You seem to know a lot about this. And I agree I was told the same thing about the S2/S3/S4. I am so new to this lumbar stuff so it helps to read these posts. I have also heard and read that the ADR has to be done anteriorly. But I am so far from even considering an ADR and my back is not all that bad yet that I am concentrating more on facet injections for the time being at L5/S1 because that is my main problem. And, well, the weak pelvic floor issue. Okay, so I have question even if a dumb one LOL! When I look at my MRI the L5/S1 and L4/L5 appear to be lying on a long nerve. Which is what my PM pointed out. Just what nerve is that?

[ChiroGeek]

If the MRI shows the problem area as L4/L5, then that would automatically rule out the source of your bladder problem.

This is not correct: since all of the nerve roots in question (S3, S2, and S1) hang together in the cauda equina, any severely compressive disc herniation (or tumor or anything else that may compress the delicate roots within the cauda equina) at any of the low lumbar levels may affect the bladder. Remember the spinal cord stops at the L1 level; past that, all nerve roots are fair-game for compression and injury.

In this patient's case, however, there is not severe compression of the thecal sac (which surrounds the cauda equina), so the L4 disc is not an issue.

[Gimpy]

Pressure on the nerve root at L4/L5 caused by either rupture or bulging of the disc will sometimes bring about severe back pain near the belt line and radiculopathy;i.e., sciatica extending through the buttocks and passing down the outer portion of the leg ending at the ankle or crossing the foot and ending at the toes. However, IT DOES NOT AFFECTTHE BLADDER!!!!! Do your home work - look-up in an anatomy text to see the nerves that affect the bladder. It States specifically - The nerves affecting the bladder are S2,S3,S4.
So stop this debate. This is not about what you believe. It is factual knowledge. And again I must say, IT IS IMPOSSIBLE TO PERFORM AN "ADR" using the endoscopic approach. Such talk is simply gobbledygook.

joe


The bladder can be affected by many different nerve levels. Cord compression in the neck can cause bladder problems. Be careful when accusing one of "gobbledygook" that you're not living in a glass house. I have compression at C7/T1, T8/9-11/12,12/1, L4/5, L5/S1 and I have intermittant bladder leakage among other things. My surgeon has determined that it is the T8/9 causing it. It takes testing to really determine what the cause of some of these problems are.

Gimpy

[caudaequinasyndrome]

[QUOTE= It takes testing to really determine what the cause of some of these problems are.
Gimpy[/QUOTE]
t8 and t9 can cause a cauda equina injury level.
cauda equina injuries will cause flaccid paralysis.
higher level sci are spastic paralysis.

i had l4/l5 l5/ s1 herniation which became cauda equina syndrome . i had a neurogenic bladder with retention for almost 2 years.

[Gimpy]

t8 and t9 can cause a cauda equina injury level.
cauda equina injuries will cause flaccid paralysis.
higher level sci are spastic paralysis.

i had l4/l5 l5/ s1 herniation which became cauda equina syndrome . i had a neurogenic bladder with retention for almost 2 years.

That's interesting. I looked up both forms, I should have copied and pasted them, sorry I didn't think to at the time. So it can happen, but with different etiologies.

Thanks for the info Yonkers!

Gimpy

[Kathi49]

Okay, after reading these posts I went and reviewed my MRI report.

My MRI regarding the L5/S1 says the following:

Disc space height and hydration remain within normal limits for age. The central canal and nerve root canals are unremarkable. There is moderate facet joint osteoarthrosis on the left, showing mild progression. The right facet joint remains unchanged. No foraminal stenosis is identified.

So, this just basically means that I have facet issues (also on the right at L4/L5) which are probably what is causing some of my pain from the buttocks down to my ankles. I will probably have a facet injection next which has never been done. I have had an ESI that worked for about two weeks and then quit. My PM mentioned an RF if the facet(s) is indeed the pain generator. What he really said was that the left side looked really chewed up. And that is the area that is constantly hurting. Has anyone had an RF or Rhizotomy in the lumbar area for facet degeneration? Thanks!

[Jolene]

As for the bladder issue I think enough people have posted their experiences to verify what I was saying. Also, what I went through was that I had SEVERE pressure on the sciatic nerve. This causes inflamation as your body automatically tries to protect the nerve by putting a cushion of liquid there. This in turn caused my bladder issue. There was never any pressure visable on film on the thecal area, not that that means anything as sometimes things don't show up. Esp in someone fat like me.

As for the endoscopic ADR. Thank GOD that people such as our Founding Fathers, Abraham Lincoln, JFK, Fred Smith, Sam Walton, Dr. Henry Kaplan and Edward Ginzton didn't listen to people such as yourself when their original idea developed in their minds.

My favorite of the stories is Mr. Fred Smith. In the 1960's he did a college paper on the idea he had. His professor scoffed at his idea, I believe even giving him a failing grade on the project. I have always wondered if that professor lived to see what Mr. Smith has built from his "idea that will never work". Mr. Fred Smith's idea was what is now a worldwide empire, that is one of the best there is in the industry. That idea was Federal Express.

Now, I never said this Dr. is going to be using the discs used in ADR as people know them today. What he has developed is an entirely new procedure using new technology and new materials. Just as when he developed the endoscopic procedures many spine surgeons use today people said they would never work. He developed endoscopic anterior fusion that was scoffed at. There have been so many things that people were told were "impossible" that if they had listened to uninspired nay sayers the world be be without many things.

What the procedure does is used a hi-tech material to replace the disc. The one thing I don't remember him saying was if he utilizes the patients disc casing or if that is removed and replaced. I would guess as it's done endoscopically that the material is put into the original disc, replacing the material removed through the selective endoscopic dysectomy procedure.

Anyone is allowed to believe anything they wish. However, it is very unhealthy to discount something simply because it is beyond one's capability of comprehension. Again thank GOD that people such as Neil Armstrong, John Glenn, Harry Truman and others had broader visions and better forsight.

[the-last-dance]

Jolene. I think you got it all wrong. The first utilization of the endoscope being inserted into the human body was done by Dr. William Beaumont at Macinac Island, Michigan, in 1822 - yes, before the invention of electricity. Do your homework. The history of the endoscope and its continual developement of improvements can be found at http://en.wikipedia.org/wiki/endoscopy Also, I did my reasearch carefully on the consideration of the 'Nerves That Control Bladder and Bowel Function.' Those nerve are as I have stated the 'Sacral Nerves' not the lumbar nerve roots as others have voiced. All you need to do is Google ' nerves that control bladder ' and you will find a wealth of info plus anotomical diagrams showing explicitly the nerves that control bladder and bowel function. If you can prove me wrong, please let me know of the website(s) and/or Grey's Anatomy page or Grant's Atlas of Anatomy page since I have both texts on my shelf. I will be more than happy to recant what I have said with acknowledged apology for gross errors. I'm not an expert on any of these subjects but I always do my research and state what the experts have said.

joe

[Jolene]

I said nothing of the first time an endoscope was used. I said endoscopic spine surgery that many Dr.s utilize today. Do your research and I know you will eventually figure out who I mean if you haven't already.

Also, as many others are posting it doesn't matter what every book in the world says. What has happened has happened to us. There are even people who when they feel pain, feel it in a different part of the body that it was applied. Also, I know a man with a totally severed spinal cord whose legs ached. How I know they ached was he was taking Motrin for it. I thought he was imagining it, so without him knowing it I replaced his Motrin with a placebo. He started complaining that his legs ached after about a day. To this day he doesn't know I did this test. Luckily in time they quit so he was able to quit the meds. So you can quote every book in the universe and it won't matter because these things have happened. They may be outside what experts consider "normal" but who cares. They happen.

[the-last-dance]

Jolene. Please, if it's not too much trouble, give me the website url so that I can update my knowledge on Drs. Bergnatoli and Zeegers Hi-Tech novel approach of performing an ADR endoscopically. It seems I have searched the entire internet and cannot find any info on that subject. You said you talked to them over the phone. Do they have any website that I can visit that contains HI-Tech endoscopic ADR ?

joe

[Jolene]

First I apologize for spelling Dr. Bertagnoli's name wrong. Your spelling of it caused me to look it up so that is one thing that has been accomplished. I went back and re-read my posts. At no time did I say that Dr. Zeegers or Dr. Bertagnoli were the Dr.s doing this. I mentioned them when I was discussing ADR as it is done today and the parts (better term would have been materials and devices) used. I haven't tried to find this on the web. The Dr. who's doing it only submitted to the FDA about 10 months ago. I've had no reason to look it up as he told me he's doing this in person. I'm not doubting what he said. He has done amazing things before and hopefully this is just another to add to his list.

Now, as I said what you believe doesn't matter. I believe what he told me, I believe in him and the work he does. So that's what matters. If he fails to get it approved at least he's trying to improve people's lives. Believe me, the man is in his 60's and already more wealthy than most of us will ever experience. So I will continue to believe him and in him until he gives me a reason not to. I am now through discussing this.

[Jolene]

LOCA--- I'm very sorry your thread turned into a three page debate that a big portion had NOTHING to do with your question.

[caudaequinasyndrome]

Also, I did my reasearch carefully on the consideration of the 'Nerves That Control Bladder and Bowel Function.' Those nerve are as I have stated the 'Sacral Nerves' not the lumbar nerve roots as others have voiced.joe

any
damage to the cauda eqina, which is the horses tail bundel of nerves below l1 can cause damage to bowel bladder and sexual function, plus the motor and sensory damge to the legs.
it s surgical emerency and well documsented. a l5/s1 that severly herniates can cause cauda equina syndrome. i stuck straws inside me to pee for over 2 years 8 to 10 times a day , i am very lucly i got it back

[uvamomb]

If you have surgery with fusion, I've read that having trigger point release post op (when surgeon says you can) can increase the chances of the fuson "taking."
I hope you find answers soon. That's one of the hardest parts of this chronic pain thing, not knowing what to do. If you have diabetes, you take your sugar readin and inject insulin. If you have leukemia, you do chemo, bone marrow transplant, etc. But, if you have chronic pain, it's always a shot in the dark as to what to do, and you never know if you're going to end up better or worse for having done it....maybe one day!

Please let us know what you decide and how you're doing.
Hugs and prayers,
Kathy

[Maggie]

Medical studies have also shown that the dermatones, and/or pain pathway mapping can be overriding and are not exact. The only time I've had bladder difficulties was when my cervical disk were in a flare.
It is not exactly correct when it comes to the nervous system to state that something "can not, does not, etc."
Maggie

[Kathi49]

Maggie,

Interesting point. I was told originally that my cervical disc would not or could not cause bladder spasms; nor that the radiculopathy could cause symptoms in my ankles and feet. Well, since I just had the C5/C6 fusion; the bladder spasms have stopped and my ankles, legs and feet are feeling a little better. Anyway, not to get into a huge debate here. But my Neurologist told me "anything compressing the spinal cord can shoot pain throughout the whole body." My NS would disagree with her though. :) Makes sense to me even though I still have lumbar issues. I just notice that the bladder spasms are completely gone and that my legs feel stronger and that the PN and/or radiculopathy in my ankles and feet have subsided somewhat. I am no doctor but if the neck is where the "spinal cord lives" and considered the "fusebox" as I have been told; then, yes...anything goes! My own opinion anyway.

[Gimpy]

Maggie,

Interesting point. I was told originally that my cervical disc would not or could not cause bladder spasms; nor that the radiculopathy could cause symptoms in my ankles and feet. Well, since I just had the C5/C6 fusion; the bladder spasms have stopped and my ankles, legs and feet are feeling a little better. Anyway, not to get into a huge debate here. But my Neurologist told me "anything compressing the spinal cord can shoot pain throughout the whole body." My NS would disagree with her though. :) Makes sense to me even though I still have lumbar issues. I just notice that the bladder spasms are completely gone and that my legs feel stronger and that the PN and/or radiculopathy in my ankles and feet have subsided somewhat. I am no doctor but if the neck is where the "spinal cord lives" and considered the "fusebox" as I have been told; then, yes...anything goes! My own opinion anyway.

It amazes me how Doctors can make such uneducated statements. If a neck injury cannot cause bladder problems, then I suppose all the quads and paraplegics that are bagged are just holding it in. Any injury or disease affecting the spine, can cause problems at any level below that injury or disease. It's not rocket science, but it is basic anatomy and any doctor should know that.

My entire neck is now stenotic, and I can hardly walk a straight line. It looks like I'm drunk. I don't understand how it's happening, but I guess it's the same thing when I try to pick something up and instead I knock everything in sight on to the floor. I'm losing control of ALL my fine motor skills, great.

Somebody made the comment in this thread about if it's the nerves causing the problem then we should get it fixed. I never looked at it that way. I just thought more surgery, great, I'll live with it. I've already had 2 cervical fusions. But I suppose it does have a better outcome if the nerves are involved vs. doing it to relieve pain from a compressed disc.

Interesting thread, thank you for starting it and tolerating all the side bars.

Gimpy

[Kathi49]

Gimpy,

Precisely my point! No wonder we all get confused from time to time! :) I know what you mean by not being able to walk a straight line. That was happening to me before the first fusion in 2004; it cleared up. And then started in again when the C5/C6 started acting up. Had that fusion and now my gait has cleared up as well. But, yep, I was dropping things and could barely write. That has all cleared up now.

I looked at it pretty much the same way you did. And I know people will disagree with me. But...I did NOT want to take med after med after med while everything was going to pot. So, I got 'em done. I just figured I would rather correct the problem then deal with any pain issues later. Do I still take meds? Yep, but not anywhere close to what I was originally taking. :)