I, like many others, have never posted anything online until now but I am in a position that has me wondering what is the right direction to take. It will be easiest to put the Impression section of my MRI report here so if anyone has or has had the same problems can share their story with me. The Impression is as follows:
1). L3-4 disc osteophyte complex with circumferential disc bulge and right paracentral/foraminal/lateral disc protrusion and bilateral facet joint hypertrophy. Findings cause right lateral recess narrowing and moderate right neural foraminal narrowing and likely touch the exiting right L3 nerve root.
2). L5-S1 disc osteophyte complex with circumferential disc bulge. Grade 1 anterolisthesis of L5 on S1 and geometric distortion of bilateral L5-S1 neural foramina raise the possibility of underlying L5 pars interarticularis defects. Findings combine with marked facet joint hypertrophy at this level to cause moderate to severe bilateral neural foraminal narrowing but no significant central canal narrowing.
I was going to my chiropractor for treatment but the treatments seemed to make the pain worse each time so he referred me to a Orthopedic surgeon who specializes in spinal surgery. This particular surgeon has operated on my Chiropractor's wife twice, once Lumbar spine, the other cervical spine. I feel that this is a good referral because of my Chiro's personal experience. The surgeon looked at my MRI and the report and basically said I need surgery to stabilize my spine... said I would need 3 pins. My wife and I are going to the surgeon tomorrow for a consultation. I also have an appointment with a Neurosurgeon on Wednesday. I am concerned about my condition because my Dad had degenerative disc disease and ended up in a wheel chair and also had a halo because his neck was so bad. I sincerely DO NOT want to find myself in a similar ending senario. I would appreciate anyones thought's on my condition. Thanks in advance!
The short lay man's version of what some of it says is that you have some narrowing of the openings that nerves exit the spine through, along with some facet arthritis. Each radiologist interprets things differently and what one will call mild another will call moderate, but the interpretation does sound like there is definitely something going on.
Hope that helps you some.
The Following User Says Thank You to peps90436 For This Useful Post: mainframer (04-09-2012)
"moderate to severe bilateral neural foraminal narrowing" - Because of this, I'd say your chances of conservative treatment giving you significant relief is unlikely (yet always a possibility). That being said, you'll likely need surgery if you're having significant leg pain.
If you have leg pain, where down your leg does it affect?
Also, I'd strongly encourage you to see more than one surgeon and pick the one you feel most comfortable with. Since you're already seeing an ortho spine surgeon, perhaps pick an neurosurgeon. In any case, make sure any spine surgeon you see has been fellowship trained. It's really amazing when you see two different surgeons with the same problem how different they would approach it.
Last edited by twohands; 04-08-2012 at 10:14 PM.
The Following User Says Thank You to twohands For This Useful Post: mainframer (04-09-2012)
I am at work now but I am going to put some of the findings in when I get a chance because there are a couple of things there that I'm not sure what they indicate. I do have pain, at this time the worst of which is to my right hip and my lower abdomen and groin. The pain in the back of my legs stops at my knees most of the time but I had an attack of sciatica two years ago down my right leg (I've had a knee replacement) that nearly had me in a fetal position a couple of times... I've had several kidney stones and can honestly say I think I'd rather have another stone than another attack of sciatica.
I think based on your MRI findings, and particularly due to your family history, it will be important to find a spine specialist to handle your case on an ongoing basis.
Disc osteophyte complex at several levels is an indication that the spine is weakening or that there are degenerative changes going on. It is important that someone with the highest level of schooling and training in the spine be involved in your care as you go forward. As you mentioned, this can be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back.
At several levels there is some narrowing of the foraminal openings which can result in nerve compression or irritation, which may or may not be causing pain. Perhaps of greater concern are the issues at l5-S1:
L5-S1 disc osteophyte complex with circumferential disc bulge. Grade 1 anterolisthesis of L5 on S1 and geometric distortion of bilateral L5-S1 neural foramina raise the possibility of underlying L5 pars interarticularis defects. Findings combine with marked facet joint hypertrophy at this level to cause moderate to severe bilateral neural foraminal narrowing but no significant central canal narrowing.
The anterolisthesis is a type of spondylolisthesis at the l5-S1 level. This is a condition where one vertebra slides or slips over the top of the adjacent vertebra. In this case, it is sliding forward and the slippage is anywhere from 1% TO 25%. Spondylolisthesis can be caused by several different things, but, in your case, the reporter is suggesting that there may be a pars defect at L5. Basically this means a crack in the pars which is allowing the slipping to occur.
You will notice that there is also a problem with the facet joints at this level which is also an indication of the degenerative or arthritic process. The facet joints are the synovial joints at each level of the spine that allow for movement; they make it possible to bend forward and backward and to twist, without allowing the spine to go too far, which would result in us falling on our faces!
The anterolisthesis combined with the facet joint issues result in "moderate to severe" narrowing of the foramen. The foramen are the openings from which the spinal nerves exit the spine at this level. Another term for this narrowing is stenosis. One way to picture this is to think of a lead pipe that becomes filled with gunk (mineral deposits, etc.) through the years, becoming more and more filled in until water can barely flow through. In this case, the opening becomes overgrown with bone spurs and other gunk that reduces the size of the opening until the nerves get scrunched and pinched and can no longer function freely.
One option to treat this condition, is for the surgeon to go in there and do a "roto-rooter" process where he/she cleans out all the bony overgrowths and makes room for the nerves. This "un-pinches" the nerve which usually results in the pain symptoms resolving.
The spondylolisthesis is a bit more difficult to treat. If it is causing instability in the spine, and conservative measures are not helping, the surgery of choice is to fuse the segment so there is no more movement. However, I would caution that just because a person sees the word spondylolisthesis (or arterolisthesis or retrolisthesis) on a MRI report, it does not automatically mean that he/she will need surgery. Many situations are stable and do not require treatment.
A MRI is just one piece of the diagnostic puzzle. The spine surgeon will correlate it to information he gathers from the physical exam, basic neurologic exam and your history and report of your symptoms and how it is affecting your daily activities. So we can't tell you if "it is really all that bad." But you do have some issues that are of concern and you should be under the care of a talented spine specialist.
Last edited by teteri66; 04-09-2012 at 07:15 AM.
The Following User Says Thank You to teteri66 For This Useful Post: mainframer (04-09-2012)
I wanted to put the Findings from my MRI in here so you can make any comments if you want.
Straightening of the normal lumbar lordosis. There is grade 1 anterolisthesis of L5 on S1 secondary to degenerative changes. Bone marrow signal is diffusely heterogeneous. Thpe 1 Modic endplate degenerative changes are present at L3-L4. Scattered foci of T1 and T2 hyperintense signal within the L2 and L3 vertebral bodies may represent focal fat versus hemangiomas. There is diffuse desiccation of the lumbar interverebral dis with moderate loss of height at L3-4 and L5-S1.
Conus medullaris terminates at the L1-2 level.
L1-2: No significant central canal or neural foraminal narrowing.
L2-3: Circumferential disc bulge and infolding of the ligamentum flavum. No significant central canal or neural foraminal narrowing.
L3-4: Disc osteophyte complex with circumferential disc bulge eccentric to the right with superimposed right paracentral/foraminal/lateral disc protrusion which measures 3.7 cm ath the base X 5 mm AP. Findings combine with bilateral facet joint hypertroghy to cause mild central canal narrowing, right lateral recess narrowing and moderate right neural foraminal narrowing. Findings likely touch the right exiting L3 nerve root.
L4-5: Circumferential disc bulge and bilateral facet joint hypertrophy cause mild bilateral neural foraminal narrowing.
L5-S1: Circumberential disc bulge and bilateral facet joint hypertrophy. Geometric distortion of the bilateral neural foramina raised the possibility of underlying bilateral L5 pars interaticularis defects. Findings combine with anterolisthesis and uncovering of the posterior disc to cause moderate to severe bilateral neural foraminal narrowing. No signigicant central canal narrowing.
Can anyone explain to me what 'Type 1 Modic Endplate Changes' means? Also I started with Re-hab today, it was mostly an evaluation, but the therapist did show me some exercises to start doing to see if therapy can delay or remove the need for surgery. While my therapist was working with me, as I was laying on my back, my right foot got pins and needles. It didn't last very long but it was weird. Alternating therapy sessions will be working in a pool so I am looking forward to that!
Thanks in advance for any information anyone can share about the 'Modic Changes'!! Hugs to all who are in pain!
If you are wondering if this is connected to the tingling you felt in PT today, it is not. Modic vertebral endplate changes are a finding that is fairly common in MRIs of the spine. It is named after Dr. Modic who first wrote about the finding in 1988, and it signifies a variation in signal strength in the marrow of the vertebra. This is more of a technical issue that I am not prepared to go into, dealing with the way the technology works...I can tell you what the words mean, but not really what significance it has to your case, other than it is another clue to the degenerative process that is going on.
Modic broke his observations down into three groupings....Type I concerns an increase in the T1 signal and a decrease in the T2 signal. People that have Modic changes almost always have lower back pain.
It is important to know that the "vertebral endplate" is a part of the disc and not the bony vertebra. When Modic changes appear in the vertebra near the endplates of the disc it confirms the diagnosis of DDD.
The pins and needles were caused by the way you were lying on the table -- something about the position was causing a nerve to be "pinched."
The Following User Says Thank You to teteri66 For This Useful Post: mainframer (04-19-2012)
Location: San Francisco, California, United States
Re: Is it really all that bad?
Hi -- just dropping in to add a couple of things. If lying on a table causes discomfort/numbness/radicular symptoms, you might try putting a pillow under your stomach to change your spinal alignment. Your physical therapist will probably need you on your stomach for certain massage and modalities, but you don't want to aggravate your condition. The physical therapy may not change the need for surgery, but it might make the surgery more successful or make for an easier recovery. So, if you do need surgery, don't consider the PT to be a waste of time or energy.
If chiropractic care makes your condition more painful, please discontinue. Chiropractors can really help some conditions, but they can make others worse. I am guessing that you are now passing all care through your spine specialist, but I wanted to add this in for folks who read but don't post.
If you get several different surgical opinions and can't decide on your own which one to go with or whether to have surgery at all, you might want to contact a physiatrist to follow your case and help you make a decision as to which option will work best for you. Physiatrists often have more time during their appointments and since they won't be performing the surgery, they don't have a vested interest in selling you their version of surgery. Of course, you might end up with three or four identical opinions and just choose the surgeon with whom you are most comfortable.
The Following User Says Thank You to SweetPeainSF For This Useful Post: mainframer (04-19-2012)
It's been a little over a month since I last posted but I have been reading most everybodys posts and replys. I have finished Physical therapy, at least for the time being, and am now pondering what I am going to do now.
I went to see my Physiatrist after my last therapy session and he told me that all he can do is 'put band-aids' on my problem, he can't fix it. He gave me several choices of what to do next: 1). Have an Epidural to basically confirm what they already see on the MRI and X-rays. 2). Try Neuronton (Gabapentin) to see if it would at least calm down the pain in my behind and Legs. 3) Live with the pain and take pain Meds to get me through life and 4). Get it (the spondylolisthesis and compressed nerves) fixed.
The first 3 choices are of course, Band-aids. All of which keep me out of surgery at least short-term but do nothing to help or 'cure' the problem and allow further deteriation to occur.
The 4th choice is scary but is probably the right thing to do. My Physiatrist's big selling point for that was that I'm healthy and should get this taken care of while I am not suffering from any 'old age' problems! I'm only 59 but I feel like what I thought it would be to be 80....
I told my Physiatrist that I needed some time to think about what to do and would appreciate it if he could give me a prescription for some pain Meds. He said to take as much time as I needed but he couldn't give me a prescription because of new laws in Ohio, that I needed to see my Primary to get any pain meds.
So.... I go to my primary for pain meds and he says "sorry, I can't do that, you have to go to a 'Pain specialist' to get a prescription for pain meds" because the State of Ohio chose to restrict and punish all Doctors and honest Patients instead of going after the few Dr's that were writing prescriptions like there was no tomorrow".
I am now waiting to here from the pain specialist. I have pressure in my lower back and pain in my behind that is running down my legs but no Pain Meds.
Regardless, I am doing okay. Happy to be alive and thankful that Heavenly Father is in control of the situation. I, like many other's I'm sure, can't figure out why I am going through this particular trial but I know "This too shall Pass"...
I'll let you all know what is going on in the next week or so. May God bless you all!
If you pain is "nerve pain" I would think you would want to try the gabapentin or Lyrica first. Your PCP should be able to prescribe that because it is not a "pain medication." I put this in quotes because I'm not sure how Ohio is defining pain medications. It seems to me that Aspirin could qualify as a pain medication, unless they are only further controlling the opioid class of drugs.
In any case gabapentin is a drug that was developed to treat the seizures of epilepsy.
Do you know what type of surgery the spine surgeon is proposing for you?
I'm not sure how the law has changed in Ohio but from my perspective many people are being inconvienenced due to the short comings of others. I do think the issue in my situation is that they wanted to put me on Vicadin or Percocet.
Regarding the proposed surgery: I haven't spoken with my surgeon since our initial meeting but I am working with the Physiatrist of his chosing who tells me they are thinking to do a Fusion at L5-S1 and (he actually used your term from an earlier post) 'Roto-Rooter' the foraminal openings at L3-L4.
I did want to ask if the 'time off work' suggested by my Physiatrist is realistic. I asked him for a 'ball park estimate' so I could begin planning for myself as well as letting my employer know what to expect. He told me I would be off work approx. 3-6 weeks since I sit most of the time at my job (Information Systems). Teton, most of what I have seen on this board suggests 3-6 months versus weeks. Is there a procedure which might allow a quicker return to work than normal? I do know they are planning an open incision on my back, some 5 or 6 inches long.
Location: San Francisco, California, United States
Re: Is it really all that bad?
I had a one-level ALIF (as opposed to the PLIF it sounds like your doctor is proposing). I took four weeks off work, then worked part-time for the following eight weeks, gradually increasing my hours and days at work. I have found from multiple surgeries that regaining stamina is much easier if you don't go from zero to forty right away. You should also plan to have plenty of appointments for physical therapy and surgeon follow-up.
One thing to keep in mind is that your ability to return to work will greatly depend on your work set-up. You should not sit for more than 20 minutes, so you should make sure that you are able to stand periodically. I have a work station that allows me to sit/stand/sit in a saddle chair. I also have some reading I can doing while pacing the hallway to get my walking in.
I started taking neurontin recently for another condition, and it has helped my radiculopathy. I am titrating up to 3600 mgs per day, currently at 2100 mgs. I don't know if you need to titrate at the low dose prescribed for you, but your doctor or pharmacist may be able to help. The idea with titration is to allow your body to adjust to some of the side effects -- mostly fatigue.
Thanks for the Info. I will check with my Dr. and see if that is what he wants me to do. I took Neurontin several years ago for my neck and I was up to 1200 mg/day and you are so right about the fatigue!
I probably have told you this already...if so, sorry! It is hard to give you a specific time frame as we all heal so differently. I had a rough time with my first surgery, which was a L4-L5 PLIF. This surgery was with a cage and BMP with rods and pedicle screws. Looking back, knowing what I now know, I think I was over-medicated, and would have done better with less medication. But I had been told repeatedly from people like me (on forums!)to take meds as prescribed by the surgeon...so, I did, religiously.
I had a second small surgery (a foraminotomy at L5) that was a piece of cake, then I had what I considered the final attempt to get it right, a 3 level posterior fusion from L3 to S1. This surgery did not involve cages and was much easier than my first fusion.
The surgeon went in over the same incision line for the third time. That third surgery was much more complex as the surgeon had to rebuild the facets at L3. The hardware at L4-5 turned out to be incompatible with the new hardware, so the surgeon had to remove the rods and screws, and then he put in new rods and pedicle screws to hold the three levels together. He left the discs in place at L3 and L5-S1, and I already had the cage at L4-L5 and was already fused at that level, so he used my bone from the surgery that was ground up and mixed with a biologic bone product to make a slurry that is laid in the "gutters." So the surgery was fairly complicated and recovery has taken a long time because we did it in teeny baby steps.
However, compared to the first fusion, which was textbook and easy in terms of the surgery itself, I felt good after the 4th day. My family had to really restrict my desire to do things as I was feeling energetic. If I had an office job, I think I could have gone back to work well before 3 months...taking precautions to move around every half hour (max) and taking it easy after work.
From being on this board and reading on others for many years, I think one problem people make post surgery is not pacing their activities. When they return to work, they also have the mental attitude that they should resume ALL their other duties as well. So they spent the day at work which has already exhausted them...then they go home, drive the kids to soccer, piano lessons, etc., then return home to make dinner, maybe do the dishes, pick up the house a little, and throw in a load of laundry too. In reality, just putting in a day at the office was sufficiently strenuous, but then they pile it on after work hours, too, and end up in pain, usually with a return of nerve pain, and then think the surgery "didn't work."
I realize that most people do not have the luxury of pacing themselves and regarding recovery as their full-time job...as I did. But it is really important for everyone to decide going in that fusion is a big surgery and even though recovery can take up to a year, in the scheme of life, that isn't such a very long time if you don't have to repeat the surgery again.
If you have a PLIF I personally think three weeks is not enough time to recover to the point that you could return to work full-time. Could you arrange to work from home for awhile? That would make it much more manageable.