After two years of chronic back pain I have been diagnosed with 5 herniated discs and bilateral pars defect in my lumbar spine. How screwed am I? Will my bike fit change?
Consider this, a multi-level laminectomy and instrumented fusion will likely not relieve your back pain. I have a “surgical candidate” back and have focused on strength, flexibily-think yoga, it takes a while but a better option than going under the knife.
Best of luck
Here’s a good place to go for information:
I have three bulging discs in my lower back and four in my neck, but they are probably not as bad as your. First thing for you should be stretching and core strength, chiropractic, then steroid injections.
Good luck, you’re not totally screwed. It’s just a temporary setback!
Not a spine doc, but I’ve got HNP and DDD. Have been through MRIs, EMG and NCS. Was not considering surgery until had measurable motor deficits on clinical exam. EMG found chronic nerve denervation corresponding with nerve root compression at the HNP level. Nerve conduction studies were normal.
Every back is different so only you will know how screwed you are. For me, I have been unable to race for nearly a year and a half, unable to SBR for the past three months. Have a constant low level of pain, with acute episodes in between. Brisk walking can be painful, as is sitting or standing in place for more than 15-30 minutes. Have the green light to walk as much as I want, and just got the all clear to begin easy, upright biking (eg, road, not tri, position–so yes, my bike fit changed). It’s been a roller coaster ride, yet I remain more optimistic than not that I will be able to return to SBR.
Regarding treatment, I spent days reviewing published studies. My takeaways from that are:
–there are substantial methodological issues with many of the studies that have been conducted (so that’s the qualifier);
–if denervation is chronic, the damage has been done and surgery is unlikely to make a substantial difference
–if denervation is acute, surgery may prevent damage from worsening
–Most HNP resolves on its own within two years
–Short of emergency situations, such as onset of symptoms of cauda equina syndrome, surgery becomes a cost benefit analysis based on what level of pain and functional impairment one is willing to live with while the HNP runs its course
–the primary benefit/outcome of surgery is reduction in sciatic pain, ditto for steroid shots; the benefit of surgery and shots for motor deficits and generalized low back pain is questionable
–there is some evidence suggesting that shots may lead to poorer outcomes if surgery is done following
–volume matters; if you go the surgical route, find someone that does all backs, all the time, at the level that will be operated on.
At this point, my treatment plan is pain management (meds and acupuncture) and rehab (walking and PT). FWIW, my progress stalled in “traditional” PT. That PT supported referral to a PT that is certified in Functional Manual Therapy. Very painful approach (I’m told its similar to ART), but it seems to be progressing me.
Best wishes with your recovery.
Have you tried McKenzie? I am recovering from a herniated disc L4/ L5. I went from my wife having to putting on my socks and living with sciatic agony (about a month non stop) to basically pain free in about three weeks working with a McKenzie specialist. PT does not solve the problem and in my case created so much pain I ended up in the hospital and on a morphine drip for 2 days followed by about 5 days at home taking double hits of percocet just to crawl to the shitter. When I saw the spine surgeon and told him about all the streching and flexion they were doing (his own hospital group) he just shook his head and sent me to McKenzie. McKenzie seems too simple but it does seem to work if you give it a few weeks. I am cleared to slowly work back into run / swim (no bike) but I am going to continue just walking for a few more weeks before I start back up. If you want to do it on your own buy the book “Treat Your Own Back”.
Hope that helps!
Yes, my first PT used a McKenzie type approach. The second uses more of the “stretch and flex” approach, and that has helped. Like I said, each back is a case of n=1.
Thanks for the replies. I have been getting epi injections, but my main concern is the bi lateral pars defect; essentially it is two fractures on my spine. I have read that a lot of cyclists have it, and I’m curious if anyone out there has it and how they cope.
I want to buy a bike using my old FIST numbers but I am curious if they are the same…What felt good then doesn’t feel good now (I’m guessing anyway)
bump
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43 years spine mgmt. experience here
I have been getting epi injections, but my main concern is the bi lateral pars defect; essentially it is two fractures on my spine.>>
many people have - olisthesis and do not even know it. only signif if wrapped up in other LBP issues. such as recurrent or prolonged nerve root impingement (sciatica)
I remember reading somewhere that some amazing percentage of Olympians on the Italian team had it at OlyRome, so not necessarily preventing high level phys ex.
can be considered a developmental failure of fusion at the pars interarticularis during growth years, could have been an activity overload stress fx not recognized in teen years, or you could have damaged it jumping off the barn 
it causes a bit of atypical mechanical instability/extra movement at the segment which may be contributor to disc and/or facet joint degeneration over time,
management is basically same group of options as degen disc/joint dis.
a previous poster was asking about fusion surgery but that is only necessary in very very small %age
I’m a pain doc and treat spine pain, but not a surgeon. If your pain is pars/facet related, facet block and rhizotomy(ablation) may be useful for you. As was noted above, there are a lot of folks out there with asymptomatic pars defects, so simply having it doesn’t mean it has to be painful. You also said you had a bunch of herniated discs. Epidural injections can help, but won’t be curative. It would depend on your symptoms and activity . Good core strength and flexibility is key for you long-term. Surgery is a last resort. I’d be hard pressed to find any of my patients who had a major fusion and who still run. Cycling and swimming yes, but not any runners.