Mr. J. is a 45-year-old man who has had three lower back operations. His history began 8 years ago when he injured his back at work and was diagnosed with a right L4-5 herniated disc. He had severe lower back and left lower extremity pain. After physical therapy and epidural cortisone injections failed, he underwent a discectomy. He improved somewhat for 3-4 months only to get worse. His surgeon ordered an MRI with Gadolinium, which demonstrated a small repeat disc herniation in combination with developing scar tissue around his left L5 nerve root and compressing the thecal sac. The surgeon performed another discectomy, which only made his pain worse. Four months later, the surgeon told him that he had an unstable spine and that he needed to be stabilized and Mr. J. underwent a posterior fusion from L4 to the sacrum. The fusion healed well however Mr. J.'s pain did not improve. The surgeon told Mr. J. that there was nothing else he could do, and he sent Mr. J. to a pain clinic.
That was 5 years ago and Mr. J. has now been in three different pain clinics. To date he has had 33 lumbar epidural cortisone injections which provide him with 1 day to 1 week relative pain relief and has been on a myriad of medications, including Lorcet 10, Percocet, Vicodin, Motrin, Tegretol, Dilantin, Prozac, Xanax, and Klonopin. Several of these medications made him sick while others provided him with little or no relief of pain or emotional distress. Right now he is on Oxycontin and Celebrex. He is able to tolerate these medications but he is never pain free, he is depressed, he has gained 45 pounds since his last surgery and 60 pounds since he first got hurt. With the above history, he presented to Georgia Pain Physicians, PC. Since his last MRI was 5 years old, an additional MRI with Gadolinium was ordered as well as X-rays and an EMG. After all studies were reviewed it was determined that his fusion remained solid however he had scar surrounding his right L5 nerve root and had a chronic right L5 radiculopathy (nerve damage). No new herniations or other lesions compressing nerves were identified. Since so many epidurals had been tried and had limited success, no additional epidurals were offered. He was prescribed Neurontin with an increasing dose schedule over a 4-week period. This mollified much of his burning and shooting pain, but the deep boring, aching pain remained. Spinal cord stimulation was discussed and, following a successful 1-week temporary implantation, he was successfully permanently implanted.
As of the time of this writing, Mr. J. was seen in the clinic today, 6 months following permanent implantation. Overall, his pain is 50-60% improved with his hip and leg pain having better pain relief than his back pain. He is walking 3 miles per day 3-4 times per week and is starting to lift weights and swim 1-2 times per week. He has lost 25 pounds and while he knows he has a long way to go, he is finally enjoying life again and sees a light at the end of the tunnel.