[ExpatWarrior]

#10232

Hello,

I’m a 38yr old male and have had chronic back pain for approximately 4-5years. About a year ago, I started noticing numbness and weakness on my right leg. I’ve had shots, motrin, and physical therepy. No joy. In fact, my physical therapist says that I’m a “ticking time bomb.” The only thing that helps me is complete rest, sitting down, and bending down. I’ve had two doctors (Neurologist) dx me with spondy grade 1. One neurologist wants to do a leminectomy and the other a lumbar fusion (pedicle screws) with leminectomy (bilateral). What to do…thinking the latter. Anyway, below are my MRI results. What does it all mean?

“At L4-5 there is posterior loss of disc height and moderate loss of signal with a cirumferential annular bulge that touches the ventral aspect of the thecal sac and causes 50% foraminal enroachments.

At L5-S1 there is anterior subluxation of L5 is goes in severe posterior loss of disc height at severe loss of signal. Chronic irregularity to endplates. The circumferential annular bulge flattens the vetnral aspect of the thecal sac and causes complete right forminal encroachment and partial left encroachment.

Impression:
Moderate posterior desiccation at L4-5 with annulus causing mild spinal stenosis. Chronic subluxation at L5-S1 with severe posterior desiccation and annulus causing moderate spinal stenosis and severe right foraminal encroachment. No focal HNP.

Primary Diagnostic Code: ABNORMALITY, ATTN. NEEDED”

What does this mean? I’m thinking surgery is the best option, because I can’t walk and I have a physically demanding job.

Thanks.

[Donald Corenman, MD, DC]

#10239

Your imaging report is confusing. There are generally two disorder that can cause a slip-isthmic spondylolisthesis and degenerative spondylolisthesis. Normally at the L5-S1 level, the culprit is isthmic spondylolisthesis but this radiologist does not note this diagnosis.

Your history would suggest isthmic spondylolisthesis (“chronic back pain for approximately 4-5years. About a year ago, I started noticing numbness and weakness on my right leg”).

You could try injections and therapy as there is a possibility that this can improve your situation but with you long history of symptoms and now leg pain, I would assume that you would need a surgery. If you do have an isthmic spondylolisthesis, you would need a fusion by TLIF normally (see website). Do not do a laminectomy with this slip.

I cannot tell you what symptoms are generated by the level above (L4-5) but a workup might indicate what percentage of pain this level is contributing.

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.

[ExpatWarrior]

#10243

Thank you for your response, Dr.

My neurosurgeon (the second one) said the same thing about the laminectomy (by itself). Instead, he is going to do the laminectomy (L5-S1, bilateral) to free up the nerve and a lumbar fusion (with pedicle screws) to provide stability and avoid further slippage. I’ve decided to go with surgery with the hopes of being mobile (running) again. I have a physically demanding career, so I’m going schedule this as soon as I can.

I’ve tried injections and it does not help. I’ve lost weight and the numbess and tightness is still there. I need to be mobile and currently I can run. But when I do this, I pay a hefty price for a week or so. I can handle the pain, but my primary care physician says that I’m damaging myself (Back) through this cyclical run, rest, run, rest routine. The weird thing is while I’m running, swimming, or biking I don’t feel the pain. My doctors believe this is because of the endorphins kicking in. The only time I really feel pain and numbness is days afterwards and while walking or simply standing.

Physical Thereapy…I didn’t really take this seriously until a few months ago. My neurosurgeon said I’m past this and I could damage my nerves even more. My therapist also says that I should do the surgery because its better in the long run.

I’m writing because “mechanically” I know I need to be fixed. My pride is telling me push on. I’m nervous and hopeful at the same time. I’m 38yrs old with a lot more to offer to my family and career. I do find myself doing minimal activity to preserve my strength. Laying down all weekend is not me–but it has become me. Have I done all I could without surgery? Althought two MRIs (2012 and 2013) have shown progressive slippage, will it really get worse if I countinue my cycle of running? Am I really a “ticking time bomb?” Is it really better to do the surgery now versus later?

What do you think doctor or anyone else out there that feels or felt like me?

Thanks.

[ExpatWarrior]

#10244

I forgot to mention a couple things…

MRI Results:

“T1 and T2 images were taken in parasgittal plane and transzially from L3 to S1.

At L1-2, L2-3 and L3-4 the discs are normal in height, configuration and signal. The conus medullaris is unaffected.”

Neurologist #1 interpretation of MRI:
“Pinched Nerve, all you need is a laminectomy.”

Neurologist #2 interpretation of MRI:
“You have a spondy grade 1, pars defect. Laminectomy would cause further instability. So I recommend the Laminectomy with lumber fusion to stabilize your spine. Your pars defect could be congenital or possibly from an injury (I could not pin point an injury as I am active at work) or degenerative. If you wait, you could permanently damage your nerves and instability will get worse. You can continue to run, but if the leg starts weaking or numbing, STOP! I recommend you do the surgery as you will be back to activities as little as 4-6 weeks.”

Thanks for reading…

[SpinelessWench]

#10245

EW,

I happened to see your post regarding your current situation, and wanted to offer my two cents’ worth as a spine patient. I completely “get” your frustration, and have been at exactly the same juncture as you’re experiencing presently.

From 15 years of age until age 25, I powerlifted, did some non-professional bodybuilding, ran, played sports, and was in excellent physical condition. Although I’m female, I lifted considerable amounts of weight (405 deadlift, 195 bench), which in hindsight, likely contributed in part to my situation now.

At age 18, I ruptured a disk in my lumbar spine (L4-5) after sneezing one morning. I wish the whole thing could’ve occurred while saving kittens from a burning building, or from fending off an entire battalion of enemies in combat with my bare hands, but in the end, it was a simple sneeze, and hurt like h***. I waited 7 months to see a neurosurgeon, who yelled at me for 30 minutes because of the time lapse. I was 18, however, and had no clue as to why this guy was so angry with me. He had me in the operating room within a few days, and I underwent a laminectomy and diskectomy with no complications. He warned me, though, that 18 year old teenagers don’t usually rupture disks, and that I should prepare for this to happen again.

While serving in law enforcement, I engaged in a fight with a suspect whose entire 300lbs of bodyweight landed on top of me. When the adrenaline finally wore off the next morning, I felt the same tell-tale symptoms of ruptured disk #1. I had yet another surgery on two more ruptures (age 23), then finally had to undergo an L-3 to S1 fusion with plates in 1991 (age 26). That ended my law enforcement career, which affected me on 100 different levels that I won’t bore you with here. Suffice it to say I was mad at the world.

Since 1991, I’ve had 10 additional spine surgeries, including 5 on my cervical spine (C2 – T2), and a complete reconstruction of L-2 to S1. I just underwent bilateral fusions of my SI Joints in 2012 and 2013, which were needed after years of displaced kinetic energy affecting my pelvic/sacral joint spaces, and was diagnosed with severe bilateral sacroiliac joint dysfunction (SIJD&D). Although I never consult forums (such as this one) for advice on my health (or anything else), Dr. Corenman provided me with some great pre-operative information, including results of research studies on SI joint procedures and causes of the condition, possible complications from surgery, benefits, and so forth.

I can honestly tell you that while some would see my situation (and yours) as a “no brainer”, it’s never easy when it’s YOUR spine, and YOUR life. Yet, I can attest to the fact that had I not had these procedures, I’d likely be wheelchair-bound…. or, worse, I suspect. For me, it simply filtered itself down to this: quality of life. In your current physical condition, every sudden move or surge of kinetic energy (like that rogue sneeze in 1982) is placing strain on your disk spaces, your L5-S1 region, and the neural foramina that are impinging on nerve roots. Your comment that, “I don’t hurt while I’m active, but I feel pain afterward” is COMPLETELY understandable. This happened (and still does) with me as well… cleaning house, shoveling snow, riding my Harley-Davidson… I’m somewhat OK while I’m in motion, but as soon as I stop, I’m beyond miserable. My lower spine simply can’t take the movement and loading required to accomplish those otherwise simple, everyday tasks. Your spine can be equated to an Army… when the weak parts start to give out, the ones above and below try to pick up the slack to keep going… this constant redistribution puts a ton of strain on the surrounding disk spaces, bony structure, and peripheral nerve outlets. Thus, you end up like me… with everything wearing out simply by process of elimination. Hence, the “degenerative” nature of many spine conditions.

Finally, my ego has likely taken the biggest hit of all. If you could X-ray a person’s self-image, mine would have dents and scars all over it… It’s a pride thing, especially with Type-A personalities that hate to admit weakness, failure, and a loss of autonomy. I’m also coming to the realization (ever so slowly) that I’ll be under pain management care for the rest of my life, and will occasionally have to choke out the question, “Can you help me do….?” to my friends and family. Your alternative, however, is what you should spend time thinking about right now. There are pros and cons to every situation, and when it comes to one’s health, those are extremely important to consider.

Just keep a positive attitude, and view your current situation (and your body’s current condition) as a temporary setback that can, and will be corrected by a competent surgeon and post-operative care team. Grab the bull by the horns now (as I had to do 13 times) and try to stay in front of it. Your body will respond according to your mental state, and you’ll be just fine if you keep your head in the right place. Just don’t make the mistake I did and assume you’re ready to lift the family car off the ground a week after surgery… give your back time to heal, and follow the surgeon’s directives to the letter. A fusion / bone graft in the spine takes at LEAST 6-8 months to firmly set (just like concrete around rebar). Don’t compromise the integrity of the fusion by being stubborn. Easier said than done.

Good luck. I hope you don’t mind that I tossed out my experiences as they directly relate to your current situation. Again, it’s temporary, and can be managed (and corrected). Go get ’em.

Take care.

[Donald Corenman, MD, DC]

#10248

Spineless Wench: thank you for that heartfelt discussion of your spine experience. Even though your surgical experience is highly unusual (most people who need spines surgery have 1-2 spine surgeries in their life), your understanding of this disorder and ability to comprehend it is wonderful.

To ExpatWarrior: I take surgeon number two. With an isthmic spondylolisthesis, this level has become somewhat unstable as the nerve root is now involved. A “laminectomy” without fusion will take any instability you have and magnify it. The laminectomy will also remove the posterior elements and throw them away (lamina, facet and spinous process).

These elements are essential for bone graft to allow the fusion to take place and you “can’t go back” if you have the laminectomy first. If you undergo the fusion, make sure you have a TLIF or PLIF that goes along with your posterior fusion.

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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