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MRI Lumbar Result Please Help


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Old 08-01-2017, 08:29 AM   #1
dustin76
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MRI Lumbar Result Please Help

Hi Everyone, I am new to this community. I am a 41 year old male with on and off back pain for 22 years. Over the past year I have been getting pins and needles down the back of my butt, outsides of my upper legs all the way down to the middle of my feet. Exactly one month ago I bent over to pick up my daughters toy and felt a crunch in my back. I went to the doctor and they ordered an MRI and this was the report I got. I never get a good explanation from the doctor on what is really going on. If you could please help that would be very helpful.

Lordosis of the Lumbar spine. My L1-S1 makes a sharp curve from the lateral view, 90% angle. I saw a neurosurgeon and Orthopedic spine doctors. They both said I have a very unique spine.
L3-L4 Mild annular bulge/spondylosis eccentric right. Moderate right forminal narrowing.
L4-L5 Mild annular bulge/spondylosis. Mild to moderate foaminal narrowing. Grade 1 retrolithesis
S1/L5 disc degeneration with disc space narrowing present at both levels, grade 1-2 anterolisthesis, bilateral par defects, severe left and moderately severe right foraminal narrowing.

My Symptoms are: Pain scale: 1-10
Pain in lower back at rest sitting: 5-8 - have to switch position every 10-20 minutes and have to get up at least once every 45-60 minutes.
Pain standing still: 7-9
Pain walking 10 minutes: starts at 5 and can end at 8-9
Sleeping: Wakes me up 5-15 times a night. Total sleep a night 3-5 hours.

The Neurosurgeon I went to see said that because of the curve of my spine he would not be able to help me other than non-surgical because he only operates thru the back and my L5-S1 disc at a 57 degree angle from level. The Ortho spine surgeon said PT and Injections, and also told me those are just Bandaids.

Any help would be appreciated.

 
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Old 08-01-2017, 09:15 AM   #2
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Re: MRI Lumbar Result Please Help

You definitely have some issues at all 3 levels. Most concerned about L4-5 to L5-S1.since you have a Pars defect at your lowest level & narrowing of the nerve open/exit points, causing nerve compression. It'll require the Dr to do both anterior/posterior (front & back) to repair the damage. Pars defect means a crack, at the Pars Interarticulis - making it vulnerable to further damage & instability if they do "minimally invasive" decompression, fusion, or left alone. I had scoliosis, a defective S1 Pars & herniated discs at the same levels as yourself. I was so desperate for relief, I agreed to a decompression to free up the nerve compression. A few months later I felt something go horribly wrong. I found a new ortho, and after doing a new MRI he found my S1 Pars defect turned into a complete break of my S1 Pars. He told me it was caused
from having the decompression surgery, and I shouldve had a fusion instead. From there I required a 360 fusion (font/back) to repair the Pars fracture, revise the decompression & fuse L4-5 to S1. Instability also increased because of the scoliosis. I had to go thru PT & injections, as a means of satisfying insurance requirements, before I had the 1st surgery. Drs have to justify to insurance company, that "all conservative methods failed, surgery is last resort". Even if the Dr thinks it won't help (band-aid). Stick with an Orthopedic, whether you stay with the same Dr, or go for another opinion (recommend). Down the road there's a risk of developing SI joint dysfunction (Hyper mobile or immobile Sacroiliac joints; the joints that connect the spine to pelvis), which is common after having S1 fracture and/or fusion. Neuro is limited on that front. Spondylolisthesis is a forward slippage of the vertebrae, and retrolisthesis is backward slippage of the vertebrae. I hope this helps in how you make the decision to move forward.

Last edited by lubear2003; 08-01-2017 at 09:26 AM. Reason: Add

 
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Old 08-01-2017, 12:02 PM   #3
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Re: MRI Lumbar Result Please Help

Welcome to the board. Please keep in mind that members are not doctors, but are people who share information based on their own experience with a particular issue.

The L5-S1 level is most likely causing most of your symptoms. Severe stenosis in the foramina (both sides) means the spinal nerves at this level are being badly compressed as they come from the central canal out to the area of the body they innervate. The spondylolisthesis at this level can also compress a nerve if it happens to slip and the nerve gets caught up in it. Sometimes this can create symptoms that come and go or change legs.

At this point in time, the only available solution to correcting a spondylolisthesis is through a fusion surgery. Anything less does not stabilize the segment. I am fused from L3 to S1 and my surgery was done from the back only. As you found out, every body is shaped differently, and different doctors approach the same situation differently, so it is smart to get opinions from several surgeons.

Did the ortho spine surgeon also say you were not a candidate for surgery? PT and injections will not create more room for the nerves that are compressed.

Last edited by teteri66; 08-01-2017 at 12:03 PM.

 
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Old 08-01-2017, 05:56 PM   #4
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Re: MRI Lumbar Result Please Help

Thank you both for your response. The Ortho spine doctor that I saw said he would remove the disc and put in a synthetic spacer and then 2 screws. That dies not seem to be enough to stabilize the area with so much pressure being placed on it. The bone growth should hopefully be as successful as my cervical fusion. That was from my C5-C7 with 2 spacers, 6 screws and a titanium plate. That was done almost 4 years and is doing great.

I just an my first injection today at the l5-s1. I choose to do it without sedation so I can be aware and not risk moving in a position that would hurt. I also have an issue I have to find out if it's related. This started right after my back issue started a month ago. I have been having issues with my bowels that is not nerve related. I took a closer look at my xrays and noticed that my S1 vertebrae might be pushing down on part of my colon which is causing me to get backed up. The only time I seem to be able to go is when gas builds up enough to push it thru the smaller space. Not sure who I should see to further look into this.

 
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Old 08-01-2017, 06:28 PM   #5
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Re: MRI Lumbar Result Please Help

I would have thought the ortho spine surgeon could advise you about the bowel issue. Sometimes people with L5-S1 spinal issues develop issues with bladder or bowel due to compression of the cauda equina. Are you sure your issue is not nerve compression related?

My L5-S1 vertebrae take a sharp angled turn as well, though probably not as much as yours. I have a cage at L4-5 and the fusions at L5-S1 and L3-4 were done without cages...where the discs are left in place and the bone graft is just laid in the "gutter." Then I have pedicle screws holding things in place. Everything grew together beautifully and my L4-5 spondy was just treated through the back.

 
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Old 08-01-2017, 08:28 PM   #6
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Re: MRI Lumbar Result Please Help

I will get in contact with my ortho spine surgeon and see what he thinks of my bowel issue. I am also going to look more into other Ortho's in my area for a second opinion. I have a lot more research to do tomorrow while I am at work for a second opinion. Well off to bed to try and get sleep. Thank you again.

 
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Old 08-02-2017, 06:59 AM   #7
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Re: MRI Lumbar Result Please Help

I would think that if the bowel issue were caused by the angled shape of the lower lumbar area, it would have been an issue before now. I doubt your spine suddenly changed shape one day when you leaned over to pick something up. Be sure to tell the doctor of the timeline...occurring a bit after the "injury."

Did the injection have any effect?

 
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Old 08-02-2017, 02:10 PM   #8
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Re: MRI Lumbar Result Please Help

Dustin,

I had an L5-S1 fusion to repair a bilateral pars defect four years ago. Your situation may well be worse than mine was at the time given the level of pain and the bowel issues. I had leg pain if I stood for more than fifteen minutes...but I could still do elliptical bike and things of that nature. I was led to believe that I would be able to return to athletic endeavors after the surgery. Unfortunately, I'm in far worse condition post surgery. I found some relief in an epidural injection for about two years...but only 1 of a total of 6 injections has made any difference. I experience a lot of neurological issues with twitching and pins and needles in the legs that never happened prior to surgery. I also have a lot of lower back pain that was not a problem prior to surgery. My surgery was done by a renowned neuro surgeon at Mass General...one of the best hospitals in the country...and I still ended up in bad shape. I would never make the same decision again, but I know that there are many people for whom the surgery is a great relief.

 
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Old 08-02-2017, 07:38 PM   #9
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Re: MRI Lumbar Result Please Help

The injection has helped some. It has made it easier to walk and stand. It still is hard to sit. Thank you for asking.

I am hopeful that I will get improvement from it but I know that surgery will have to happen at some point. The pars defects are full fractures on each side. My neurosurgeon said they were based on the MRI and X-Rays. Based on how my neck was with the severe bilateral stenosis and degerative disc disease, it's more like when I have surgery.

I keep walking everyday to keep my weight down and body in shape. I going to wait til my body tells me it's time.

 
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Old 08-03-2017, 06:58 AM   #10
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Re: MRI Lumbar Result Please Help

Daviday75: Have you consulted with any other surgeons to see what may be causing your pain and symptoms in the time since the surgery? Do you know if the bone graft fused? It took me three surgeries for my symptoms to finally be resolved...and visits to numerous specialists to determine why I was still having symptoms from nerve compression.

The surgeon who did the first fusion told me that sometimes people (like me) had to accept the fact that perhaps this was as good as I was going to get...and that I just needed to accept that "fact." For a variety of valid reasons, I could not accept that, and kept looking for answers. Eventually I was able to convince another spine surgeon that regardless of what the MRI showed, there was something wrong that needed to be addressed. Obviously not everyone is as lucky as I was, but I hate to see people give up without investigating their options.

Last edited by teteri66; 08-03-2017 at 06:59 AM.

 
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Old 08-03-2017, 07:29 AM   #11
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Re: MRI Lumbar Result Please Help

Dustin76~Just something to think about...

While I understand the wish to avoid surgery as long as possible, it is not always a wise choice to wait. You are experiencing fairly severe nerve compression that will not just bounce back to normal once surgery is done. Generally speaking, the longer nerves are compressed, the greater the chance for permanent nerve damage.

If the joint becomes more unstable, it may cause issues further up the spine and into the SI joints.

My surgeon basically told me the same thing regarding my spondylolisthesis at L4-5. I waited a couple years until it got to the point that I couldn't stand long enough to chop an onion and had to drive to my mailbox because it was too painful to walk down the driveway. I was afraid to travel as I didn't want to face having an emergency situation away from home and my surgeon, and have to take potluck at some unfamiliar ER. I finally decided this was no way to live...so I had the surgery. I don't know if the numbness in my feet and loss of ankle reflexes would have been less if I had had surgery sooner....

 
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Old 08-03-2017, 08:27 AM   #12
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Smile Re: MRI Lumbar Result Please Help

teteri66,

I dont think I would be able to make it years before having surgery. No amount of shots and therapy will relieve the pressure on my L5-S1 joint since it pushes into any seat I lean against. When i lay on my back on a hard surface I am actually only laying on the bones there. I just want to get a few more opinions from doctors in my area as I research them. I really appreciate all the ideas and sharing of your experience with me. It has helps a lot.

 
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Old 08-03-2017, 03:19 PM   #13
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Re: MRI Lumbar Result Please Help

Well, today has been one of the worst days I have had. Walking has been easier but sitting has been a nightmare. Nothing I do makes it feel any better sitting other than no putting any pressure on my lower back or tailbone which any seat I sit on pushes on it. Ofcourse I sit for work and it started this halfway through my day of work.

 
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Old 08-05-2017, 08:40 AM   #14
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Re: MRI Lumbar Result Please Help

I see what you mean about your spine being unique. Where the lumbar spine joins the sacrum, there is an abrupt angle, which is what mine does, too, but it also looks like the adjoining lumbar vertebrae are also kind of tipped so the one edge adjoins. Interestingly, they all appear to be aligned...as in no spondylolisthesis. I can see why the surgeon said he wouldn't operate on it.

I would still get a couple more opinions, probably from ortho spine surgeons, if you have some in your area....(they are more prevalent in some areas while neurosurgeons are more common in other parts of the country.). What type did your cervical fusion?

I'm sorry you are in pain....I can commiserate! I just found out yesterday I will be having more surgery, at L2-3 to open up the spinal canal. It will be easy surgery, esp. after my last one!

 
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Old 08-05-2017, 09:20 PM   #15
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Re: MRI Lumbar Result Please Help

I am sorry to hear that you need to have another surgery. I am glad though it will be an easy one. The surgeon who did my neck is a neurosurgeon, same one that said he could not do the operation since he has never done one with a curve like mine, and he mainly operates through the back.

I have seen one ortho who said he would just do a fusion with a spacer and 2 screws. I am seeing another one on Thursday. All I know is that i need the stablization since I can feel that it's not. I am curious what hos approach would be. I just hope that my i health insurance company does not drag there feet with the approval if they deside that I need surgery.

 
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