[Kellevax]

#9422

Hello Dr. Corenman. I have just returned home from an appointment at the local VA hospital that my fiancee had with a neuro surgeon. A neurology doctor referred him to consult with a surgeon after he had updated MRI scans completed. I am very upset and frustrated as the doctor we consulted with today made very contradicting statements and became quite insulted when we discussed consulting with other doctors. We are not educated or versed in the spine and did not understand what the doctor was telling us even when we could make out what he was saying with his very thick accent. Bottom line: We are confused and he continues to be in pain with no recommendations other than pretty much to deal with it. My fiancee, John, has been through physical therapy, acupuncture, and has received many many injections. Most recently they have done a procedure whereas they put him under general anesthesia and injected into both sides of his lower back. He had no relief from this. They are now looking to do another procedure whereas they put an injection directly into his spine. He will be turning 44 years old in a few months and this injury occurred in 2007. He is in constant discomfort and has learned to tolerate the pain, but more recently- his mobility is being limited and he is having much trouble doing daily tasks and performing his professional job. I am hoping you can offer some insight as to what these MRI findings mean bc it is foreign to us and these doctors aren’t offering much assistance. I will type verbatim this report in my possession-
Findings: For purposes of this dictation there are 5 lumbar type vertebral bodies and the lowest well-formed disc space is the L5/S1 level. The conus medullar is terminates at the L1 level and demonstrates normal spinal cord signal intensity. There is some imagine artifact is noted at the T12 level which mildly limits evaluation.
There has been interval worsened loss of disc space height L4/L5 with new heterogeneous elevated and low T1 and T2 signal intensity in the L4 and L5 vertebral bodies adjacent to the disc space level. No acute fracture or listless is seen.
At L1/L2 there is a broad-based posterior disc bulge with mild canal narrowing and no neural foraminal narrowing.
At L2/L3 there is a broad-based posterior disc bulge with moderate canal stenosis and mild right neural foraminal stenosis. Previously noted annular fissure is no longer identified at this level.
At L3/L4 there is a broad-based posterior disc bulge and facet arthrosis with no canal narrowing and with mild to moderate right and mild left neural foraminal stenosis.
At L4/L5 there is a broad-based posterior disc bulge and facet arthritis producing mild canal narrowing and severe right and mild to moderate left neural foraminal stenosis. Loss of disc space height is worsened compared to the prior exam (April 2011). There has been interval decrease in the amount of extruded disc material posterior to the L4 vertebral body compared to the prior study.
At L5/S1 there is a mild posterior disc bulge and facet arthritis with no canal narrowing and with moderate bilateral foramina stenosis.
Impression:
Multileval degenerative disc disease and facet arthritis of the lumbar spine as described, with interval worsening of disc space height at L4/L5 and with multiple level with foramina stenosis, right worse than left.

Today we were told that there are too many damaged discs and that they aren’t “bad enough” for repair by surgery and that because there are more than two discs damaged that surgery would not give him any relief anyway. We are concerned because years ago there were only two herniated discs and this same surgeon told him to wait it out as a third disc was damaged too and it was senseless to repair two and have the third then give him problems. Now, this same doctor is saying that now there is too many and the damage isn’t severe enough for any corrective surgery and that he will never get releif and surgery will only make him worse. He then went on about his 30 years if experience and became very upset when we honestly said that we will be looking for other opinions.

Please help us!! Any insight would be wonderful. Thank you in advance for your time and concern.

Sincerely,
Julie.

[Donald Corenman, MD, DC]

#9433

Welcome to the wonderful word of spine surgeons. There are some great compassionate surgeons, some that do not want to give you the time of day and some in the middle. You found one on the wrong end of the spectrum.

You do not describe your fiancee’s symptoms. Is it back pain or leg pain? If both-what are the percentage differences? Read the section under “Conditions”-“How to describe symptoms” to better convey what he is experiencing.

He does have multiple levels of degenerative changes which can be off-putting to some surgeons but there is one level that is much more remarkable than the others. He has IDR (see isolated disc resorption) at L4-5 which can cause significant lower back pain. See the section “Causes of lower back pain” right under the section “How to describe symptoms” on the website.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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