I'm not a doctor but…
Cycling injury, recovery and health issues.
The information / discussion in the Cycling Health Forum is not qualified medical advice. Please consult your doctor.
Sequestration is serious, and this needs to be watched closely. It means part of the disc has broken away from the main body and is floating loosely.
If your symptoms worsen, then you need to tell your doctors immediately. If you cannot contact them, then it is worth having someone drive you to hospital emergency dept, or call an ambulance. You should clarify the significance of this with your doctors.
Crack on n get it tidied up... Jabbing it up might settle it down symptomatically, but won't be an effective long term solution given your functional expectations...
The plot thickens good luck its sounding not so good. I had to have an operation you maybe in the same boat by the sounds of it. Reading this thread has bought back a few memories, one being the use of a pregnancy belt over the top of my glutes to help the post op muscle spasms they work really well if symptoms continue in this area. I'm not sure how often they are used for this only one physio suggested it she even made it for me Worked a treat. The upside is your closer to being back on the bike now you know what is going on so you can get effective treatment.
"Discs can be unloaded by lying down more often, and wearing a lumbopelvic brace when sitting/standing/walking."
A lumbopelvic brace is more effective than a pregnancy belt, though ime, 2/3s of physios don't think of them, or don't keep them in stock for acute pain patients....but might order one in, or direct where to buy. And I've never heard of a chiro or osteo recommending them. Physios that don't recommend them argue if the pain is so bad, one should be confined to bed rest for 48 hours, and not attempting to carry on as usual.
What do you mean the plot thickens, it's sounding not so good
Just read the MRI report comments. The bad news is that you do have a hernia (rather than just a bulge) and some of the stuff that has leaked out of the disc has separated (ie sequestered). Surgery is more likely in this case than with just a bulge. I hope things start to get better for you. A couple of suggestions:
-if surgery is recommended talk through the options as there are differing extents of surgical work that can be done - from a microdiscectomy to a full on spinal fusion.
-if you've had the cortisone shot and start to feel better still take it very easy as the shot will not have healed this disc but treated some of the pain and maybe reduced any irritation / inflammation
Snagdog, sequestration means you have a loose piece of disc (often viscous material herniated rearwards from the middle of the disc) into the spinal canal.
Once this material is out, it can float around freely and randomly, until eventually lodging in a spot where it robs you of movement in your leg, or the ability to urinate/defecate. Sequestered disc material is generall removed by surgery, and usually in a hurry.
Re-read your MRI report:
"If there is motor, or significant sensory symptoms, urgent
neurosurgical assessment is recommended."
Talk to Peter Lucas about it, and don't leave his rooms until you are sure you understand.
YES. Its all too easy to come home and forget some if the facts you were told. Either take your wife/friend to have a second pair of ears, or record it!
And remember this. Yes it's better to avoid surgery if you can but that's not to say surgery is bad. Many have had positive outcomes.
Never underestimate the power of ignorance
Thanks again to all for members advice and thoughts.
Im taking my wife in with me because the way this Valium is affecting my cognitive processing I need all the help I can get.
I'll let ya know how I go
After quickly scanning this, i reckon
my fellow physio colleague winston from qld has a perfect reply.
not much helps bulges like that - mckenzie definatley worth a try though
facet joint injections dont work much - just a craze over the last few years to generate funds
core exercises are over rated (heresey you say!)
surgery isnt as bad as some people will make out
you WILL ride again
Too true....my brother had a fusion a few years ago and last year he road London to Paris in 24 hours, the 11th stage of the TDF and some other crazy thing in Vegas all for charity. So continue to see the positives.
Never underestimate the power of ignorance
Sorry snapdog but I see it from different angle as I've been there even where Winstow mentioned loss of bladder and a leg. Its a clear diagnosis so action can be taken as per your specialists recommendations. I had issues for years and lots of bad advice by health professionals this looks like a pretty clear diagnosis and appropriate action can be taken. Which is a great outcome.
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So you mean I need to tell the dr that I want this loose piece of disc out? I've been recommended to dr Lucas from 2 people under high recommendations.
I've also booked into to see another dr for a second opinion on Tuesday....... Worth doing ?
By the off chance does anyone know of any guru neurosurgeon in Brisbane ?
Snagdog, I have treated the patients of most Brisbane neurosurgeons. There's no guru.
A neuro guru would have to be conferred that rep by other neuros, and funnily enough they don't make a habit of talking their colleagues up that high.
I'd suggest you seek two opinions, even three.
And I'd suggest even more strongly you make a study of the spine and your condition, so you don't sit vacuously in front of the surgeons during your appt.
Absolutely no one cares more about the future use of your back than you do.
Thanks winstonw. At thi stage in booked into see 2 neuro's. I was just saying to the wife today that we'll prob just go with what dr Lucas says tomorrow but your are right and ill follow up with my other appointment on Tuesday with dr Dave Johnson.
It's all quite surreal I was only just thinking the other day how fit I'm going to be running around in my 50's still playing touch footy, riding and looking fit.
What's pissed me off about the whole thing is that it turns out the gp reckons I did it 5 months ago when I thought I tweaked my upper glute doing some post exercise stretching. Since then i have been to 2 chiro's and a physio who all told me they knew exactly what the problem was and how they could fix it.
On more than 1 occasion on of these guys was poking me in the back, I'm thinking now where the slipped disc was, asking if it hurt there meanwhile I'm almost jumping off the freaking bench in pain with them looking at me like c'mon mate HTFU.
I just wish I wasn't a hero and showed more patience to get this sorted in the form of a X-ray or MRI instead of just getting on with it.
The time you have now is precious. I had no choice, no idea, nothing...just agony like never before.
I didn't have the luxury of doing some research and getting such fantastic advice online! Choosing surgeons? I was past caring. Correct diagnosis first, consider all options for treatment and know the risks with each.
See it that way and you might see the time you have now differently!
Never underestimate the power of ignorance
Snapdog, I can understand you being annoyed about the 2 chiros and physio. Any health clinician who uses confidence trickery is better avoided imo.
Even when a CT shows a bulge or herniation, that isn't always what is causing back pain. A large % of the general population have disc pathology with no pain or sciatica, and much back surgery does not resolve pain.
Even the most studied and experienced physio/chiro/osteo is not going to get it right 100% of the time, nor surgeon. Medicine just hasn't evolved to that point yet. Good luck with it.
Please let us know how your consult goes. I'll be interested in what physical examination the neuro puts you through. Some just look at your scans and don't touch you, though they have their reasons for that.
Dr Lucas seemed to be really good. He didn't come across as arrogant and was more than happy to Listen to what I had to say. He didn't touch me. He only got me to stand on my left, painful leg and to see if I could do calf raises.
He talked me through my MRI. Basically he believes that I have a loose piece of disc floating around, as you suggested, and that the main reason it's causing me all this pain is due to my thinner than normal spine canal?
He said that if this was to happen in a person with a wider or more normal size canal the symptoms would be greatly reduced.
He has said that there was a chance of this resolving itself but due to my canal it was unlikely.
He also showed me the horizontal view MRI where my s1 L5 disc or nerve on the left side wasn't looking in good shape --- to be honest I can't remember 100% what he said at this part.... Information overload
He has booked me in for a S1 guided nerve root sheath injection which is getting done at 2 pm today
If symptoms don't resolve within 5-7 days than he recommended me going for the surgery. I can't remember what he said this micro surgery was called but it was to basically remove the loose piece of disc.
He said that I'm going to really work hard on my paraspinal core strength - multifidus and will source me the necessary physio on the sunny coast who I can go through
We actually ended the consult talking about riding and he proceeded to tell me that he has a 12k Colnago..... Maybe I should have been a neurosurgeon. Hahahaha
Overall he seemed confident that I could get back on with life as long as I'm 100% focused on steady as we go and modify the gun ho behaviour all blokes are guilty of
If u progress to that it's not a big procedure (but still surgery)... Most people are up n going in a few days, and most without much of their referred symptoms... Then after the initial recovery phase, it's all about preventative maintenance....
Just got back from shot.
The worst part was that had to lie on my stomach and wait for the doc. The nurse put this wedge thing under my feet, apparently to help but I can't sleep on my stomach normally because it hurts my lower back but coupled with current situation I was in agony waiting for the doc. Sweating my ass off from the pain. The doc walks in and asks if I'm nervous. And I'm like mate get this freaking show on the road .....
So doc missed with the first go but reckons he nailed it with the second. That part didn't hurt at all. Straight away afterwards my leg was aching but I think that was because the nerve got all stirred up from when I had to lie on my stomach for 10 mins waiting for the doc.
30 mins now since i got back and leg feels ok. Time will tell
Going to bike shop to get my bike set up to a more relaxed position and general check with stem, seat position, cleats etc.... In the anticipation of jumping back on hopefully sometime this month.
If u couldnt lay on your stomach (prone) prior to this flare up then that would suggest you have a fair bit of work to do with lumbar stability and mobility work. Granted u have no hope now with the active pathology u have ATM
This increase in symptoms is quite common as the doc was injecting around the already compressed/compromised nerve root. If it reproduced your usual referred pain then this a good sign he hit the right spot.
Just stay away from the bike!!! There's no point changing any fit or setup until u can sit on it in a trainer and spin pain free. Knowing your luck u will aggravate your LBP wheeling the bike into the store!! Good luck with the next few days, hope it all settles well...
Thanks mutley, yeah there is no chance of me doing anything bike related until I'm well and truely ready. I was in the shop today just talking about what we can do, and they've been great, but it's more of a light at the end of the tunnel kind of thing. I even ordered a New Jersey. It's kind of a coping mechanism for me. Part of the healing process
It gives me something to aim for, some direction, without the goals / stages it kind of feels like I'm walking around blind / lost.
To be honest the whole,experience has been a real wake up / scare for me and with a 6 months old baby girl this is without a doubt process i need to get right for life....
And look it might be time for me to wind back on the Valium ....... I'm really spilling my guts hahahaha ha
There will be no cycling or ouch footy until given the ok from the professionals but the dr lead me to believe that these things will be ok soon just no moving house etc....
You lost me.... Soften up for me to pay his practice to carry out the micro ??? Knowing the injection was a waste of time?
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