By jonbean on Saturday, November 22, 2003 - 07:56 pm:

I just got my MRI results (I had a special dynamic/kinetic MRI that detects ligamental tears done):

"you have a partial rupture of the interspinous ligament
at the L5-S1 level [I also have a bulge there]; this results in some degree of sagittal plane hypermobile intersegmental instability at this same level. . . this
dysfunctional intersegmental motion in turn causes some degree of
accelerated intersegmental degeneration because of the underlying internal
'auto' trauma occurring progressively over time...."

Doesn't recommend surgery. So, I asked some questions (below) and he said
see a treatment specialist. Well, my pain MD is running out of
options and wants to boot me to a neurosurgeon but I'm not a candidate for
surgery so I am basically Screwed. There are a few articles on ligament
ruptures recently indicating that this may be a major cause of back pain and
lead to disc herniation (duh) but no discussion of treatment options.
Basically, according to his report: wait until your spine really crumbles
and you are screaming for surgery.

I'm trying prolotherapy now, which has helped SI, iliolumbar but not the lumbosacral (L5-S1) area.

Is there a danger of totally rupturing the interspinous through prolo? How successful is prolo at reaching this ligament at this common trouble spot?


**************************************** ********************Dear Dr. J

It is finally good to know what is wrong with my back. Before I meet with my
M.*. next week I had a few quick questions, if you don't mind. I UNDERSTAND
that any advice you give is _unofficial_ and that I should consult my M.*.
before taking any further medical action. Thanks again. --

**************************************** ***************
NONSURGICAL OPTIONS

a. Suture? Why can't doctors simply suture torn or ruptured back
ligaments?

b. Nucleoplasty (as described above) to relieve pressure on torn
ligament.

c. Prolotherapy: it has helped elsewhere--perhaps more attention here?
I know its semi-unorthodox.

*. Steroidal injection: only in acute phase? My pain M.*. is generally
leery of them. Would it help in this case?

Or, Rush Limbaugh Pain Pill of the Month Club for the foreseeable
future? (I'm on tramadol and topamax, which do an OK job).

6. ACTIVITY AVOIDANCE: I was a VERY active person who ran 5-6 miles/day,
lifted weights, etc. I suppose with a ruptured ligament running and
vigorous activity is permanently out of the question?

What should I avoid? Is stretching good or bad? It's good for muscles?
But bad for ligaments??

By Greg on Sunday, November 23, 2003 - 07:45 pm:

jonbean,

I really feel for your situation. In my opinion, prolotherapy will be the only and best thing that will help you. I have not had this injury, but I do know that prolo is the ONLY treatment that can heal this ligament. Being an interspinous ligament, which is found on the posterior of the spine, this should be a very easy ligament to reach with a needle if the doctor knows prolotherapy sufficiently. I have had the interspinous ligaments of my neck treated and they all tighetened right up. With the severity of your injury, it may take quite a bit longer.
How many prolo treatments have you had in the area? How long have you been getting treatments for? And with which doctor?
I would strongly urge you AGAINST any steroid injections, as these are only for pain relief and corticosteroids actually weaken connective tissue, and could lead to a worsening of your pain and instability.
I would avoid any surgical procedure until you have exhausted a number of prolo doctors, and have their advice that prolo is not an option anymore. Good luck to you

Greg

By hoops on Monday, November 24, 2003 - 12:05 pm:

Jon,
Genetic hypermobility is totally different than an injury. I have the same type of injuries in my neck and have no luck with prolotherapy. Nothing tightened up. If you read Dr. Hauser's book, one reason that it does not work is that the ligament is completely torn. Make sure you choose someone that is not in it for the money. They will just keep injecting you even if it does not work.