Lumbar stenosis- MRI help

Booksellergirl

Can y’all help me know how serious this MRI is?
An ortho spine surgeon told me I needed lumbar fusion. My primary doc advised against this and sent me to pain management. I got an ESI, but now I have tingling and pain in my legs, which I never had before the ESI.


TECHNIQUE: Routine multiplanar MRI of the lumbar spine was performed without IV contrast.
FINDINGS: Lumbar spine radiographs demonstrate the presence of a transitional L5 segment. There is a rudimentary disc space between L5 and S1. This differs from the nomenclature used on the radiographs. For purposes of the lumbar spine dictation, there are 5 lumbar segments.
Mild reversal of normal lumbar lordosis. Minimal lumbar dextroscoliosis. Multilevel degenerative disc desiccation, loss of disc space height and diffuse disc bulging. Superimposed disc protrusion at T12- L1. Degenerative endplate changes about the L3-4 disc space. No abnormal signal in an intradural or paraspinous position.
T12-L1: Diffuse disc bulge with superimposed 5 mm right paracentral disc protrusion. This impinges upon the thecal sac producing mild canal stenosis. No foraminal stenosis.
L1-2: Mild disc bulge. Mild facet arthropathy. No canal stenosis. No foraminal stenosis.
L2-3: Moderate disc bulge. Mild facet arthropathy. Mild canal stenosis. Mild foraminal stenoses.
L3-4: Prominent disc bulge, somewhat more prominent to the left of midline. Moderate facet arthropathy. Bilateral facet joint effusions. Moderate canal stenosis. Moderate left foraminal stenosis and mild right foraminal stenosis.
L4-5: Moderate disc bulge. Moderate facet arthropathy. Mild canal stenosis. Mild foraminal stenoses.

L5-S1: Rudimentary disc space. No canal stenosis. No foraminal stenosis.
1. Mild lumbar dextroscoliosis with associated multilevel degenerative disc disease and facet arthropathy. Degenerative changes combine to produce multilevel canal and foraminal stenoses. Most notably, moderate canal stenosis, moderate left foraminal stenosis and mild right foraminal stenosis at L3-4.
2. 5 mm right paracentral disc protrusion T12-L1 producing mild canal stenosis.

X-rays:

Radiographs:
Patient had 5 views of the lumbar sacral spine in the office today. Radiographs demonstrate minimal lumbar dextroscoliosis, 5 nonrib-bearing vertebrae noted with a rudimentary/transitional vertebrae sacralized to the sacrum. On the AP view patient is noted to have multilevel spondylosis, with bridging osteophyte of L3 over L4. Fractureno high-grade canal stenosis or foraminal narrowing. Trace retrolisthesis of L3 over L4. Facet arthropathy, SI joints appear patent.

The ortho spine surgeon recommended this:

Based off of patient's MRI, goal instability and handicapping pain we recommend namely, subtotal L3 laminectomy, radical L3 discoidectomy, transforaminal lumbar interbody fusion at L3, internal fixation with peek cage, L3-L4 posterior lateral fusion with local and iliac autograft, allograft, graft substitute and posterior nonsegmental spinal instrumentation from L3-L4 with intraoperative neuro monitoring



Patient inquired about interventional pain management injections-which at this time will not be beneficial due to the severity of her stenosis and her clinical instability and handicapping pain.



A note, I am not in HANDICAPPING pain. I can still walk and workout, but the pain is bothersome. The new addition of tingling and pain my legs is very worrisome.

Thanks for any help and advice!