Thanks for clarifying that Dr. Corenman. Now with that, may I present you the findings of an CAT scan and MRI to get your comments?
In November 2012– an XRAY of the lumbar spine showed 5mm grade 1 spondolythesis at l5 on s1. There are small osteophytes noted at t12-l1 and l1-l2.
In December 2012, an MRI of the Lumbar showed the following:
L3-L4, L2-L3, L1-L2- no significant disc protrusion or formanial stenosis.
L4-L5- There is moderate facet arthritis seen. Mild to moderate bilateral neural foraminal narrowing is seen due to disc bulge, facet disease and ligamentum flavum thickening.
L5-S1- Moderate to severe facet arthritis seen. Broad based disc bulge effaces the ventral aspect of the thecal sac. Disc dissecation is seen. Mild bilateral neural foraminal narrowing is seen to due to disc bulge, facet disease and ligamentum flavum thickening.
Impression: Spondolytic changes of the lumbar spine at l4-L5 where is disc bulge formation and acting in concert with facet disease and ligamentum flavum thickening to lead to mild-moderate neural foraminal narrowing at L4-L5.
2. There is subtle anterolisthesis of L5-S1 due to facet arthropathy.
3. No acute lumbar compression fracture deformity, or abnormal fluid collection or mass collection with the lumbar spine canal is appreciated.
In May 2013, I had at CT scan of the lumbar:
L1-L2, L2-L3, and L3-L4- mild hypertrophic facets and ligamentum flavum. Possible minor disc bulge. No significant spinal stenosis.
L4-L5- Disc bulge and mild hypertrophic facets and ligamentum flavum. These produce bilateral moderate foraminal stenosis. Central canal is borderline in size.
L5-S1- Promninent disko-osteophytic bulge and extensive bilateral vacuum facet arthopathy. These produce mild central and severe bilateral formainal stenosis, worse on the right.
Impression: Lumbosacral degenerative disc disease and worse in the lower lumbar spine.
2. Disc bulge and hypertrophic arthropathy at l4-l5 and l5-s1.
Resultant moderate bilateral formaninal stenosis at l4-l5, and mild central and severe bilateral foraminal stenosis at l5-s1.
In October of 2013, I had an MRI. I thought I would be having surgery in a few weeks, and this was done for an update:
l1-l2, l2-l3, l3-l4- Minor disc bulge. Hypertrophic facets and ligamentum flavum. No significant spinal stenosis.
l4-l5- Disc bulge with a mild left foraminal disc protrusion. Borderline right and mild left foraminal stenosis.
l5-s1- Substantial hypertophic facets. MInor disc bulge. These produce bilateral moderate foraminal stenosis, worse on the right.
1. Lumbosacral degenerative disc disease.
2. Disc bulge with a mild left foraminal disc protrusion at l4-l5. Mild left foraminal stenosis.
3. Hypertrophic arthropathy and a minimal disc bulge at l5-s1. Bilateral moderate foraminal stenosis.
I had an EMG done in January 2013 which showed acute denervation in left mid lumbar roots and acute left lumbar radiculopathy mainly l4-l5.
I have had 2 spinal injections which did not give me any relief. But just a few months ago, I had a nerve root block at s1. This has calmed down the nerve significantly. Whereas pain was a 7-8. It has lowered it to 4-5. Have to be thankful for such improvements. But I still experience plenty of pain and weakness.
Now in analyzing the spinal changes, what I see are the mention of a disc bulge higher up and mild stenosis at l4-l5, which is not seen in the MRI in December 2012.
Given these findings, what procedure would be best to correct these issues? I am very concerned that one back surgery would or could lead to another down the road. It has been suggested by 2 surgeons that I have fusion. One suggested ALIF and one suggested PLIF. What I have heard regarding fusion is that although it stabilizes that area, it causes the other levels to break down in years to come requiring another surgery.
If I would have fusion, I’m not sure if I’m correct in my feeling that ALIF is better because it does not disturb the back muscles which has been suggested to help in preventing destabilazation of the spine at other levels in the future. I have heard it’s an easier recovery than PLIF. Although, the advantage to PLIF is that the nerve roots are easier to see and correct. But I have been assured the same is possible with ALIF. One downside to ALIF, is that it works better only on one level not more. That later results show stenosis at l4-l5, is ALIF an option? I look forward to hearing your thoughts.
What has been so remarkable to me Doctor Corenman, is that I never had any back issues prior to this. I was involved in 3 car crash in April 2012, resulting in us being rear ended. Besides for stiffness and a back sprain, I made nothing much of it until 3 months later, while dealing more achiness and stiffness than I ever experienced, it became difficult and painful to walk. Not long after I had to get a cane. And within a few months I was unable to walk more than a block without a wheelchair. I do get around and usually after an active day, I am in excruciating pain at night. I take some pain medication and sometimes wake up feeling better in the morning, and sometimes the pain lingers.
If this needs to be fixed surgically, what can give me the best possible outcome to be thriving and active as I am only 45?
Thank you so much for your time and direction.