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Disc space narrowing

RwillRRwill Posts: 300
edited 06/11/2012 - 8:44 AM in Spinal Stenosis
Background in a nutshell. I'm in my mid 30's I've had 6 lumbar surgeries involving L3-4 to L5-S1. My most recent surgery was in Oct they removed a large sized free floating disc fragment. I was doing better until Jan. then symtoms started to return and are getting worse. After a new MRI in March Dr wanted to try Steroid injections, after much thought I have decided against it(prior failed injections). I am considering having a L4-5 fusion. Looking at my MRI results I am wondering if the other discs around the L4-5 could be causing problems also. I am seeing my Dr next week but I wanted to get some "other opinions" on this before I bring it up. MRI shows L3-4 moderate degree of disc space narrowing. L4-5 broad based posterior bulge w/ disc space narrowing, epidural contrast enhancement seen anterior to the thecal sac as well as along the lateral to right postlateral aspect of the sac. Also seen is enhancement within the right lateral to foraminal aspect of the disc. Mild to moderate bilateral foraminal narrowing as well as mild spinal canal narrowing. L5-S1 Bilobed posterior disc bulge is seen resulting in mild to moderate bilateral foraminal narrowing. Multilevel DDD is seen. The Drs. have been avoiding spinal fusion due to my age. I have to say that I have had a lot of surgeries but they have been very successful. I am normally free of pain meds and I'm able to live a fairly normal life. Current symtoms: difficultly walking both legs feel like jello, severe pain in both legs, toes feel like they are going to sleep, severe burning at times in feet, occsional shooting pain in feet. Some lower back pain but my legs are the biggest problem. Sorry this got so long!!


  • I am not exactly sure what your question is. We're unable to interpret MRI results on this forum, best left up to your surgeon. Has your surgeon suggested a fusion?

  • Rwill,

    Howdy! Like was just said by Marianne, we don't understand what or if there is a question? 6 surgeries since 17? Wow! Did you have an accident that precipitated this? It seems from your post that you are very well versed on MRI and spinal issues in concern with your own body. That is the unfortunate education all (or most) spineys gain over time!

    We are all here for support if needed. Questions can sometimes be answered as well. :-) Please let us know what you decide, and how it goes!

    Welcome aboard Spine-Health!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Well oops is all I have to say. Dr seems most concerned about L4-5 but I am concerned a L3-4 and L5-S1 as well. I know you can't diagnose but doesn't it appear that some attention needs to be addressed to the other levels? Should I be more adament that he look at my whole lower spine and look at the whole picture? Unfortunately I wasn't in any accident. It seems to be a genetic issue. I started having aching in both legs and finally after 6 months of hell my mom cornered our physician and made him order an MRI. The diagnosis before that was growing pains. MRI showed 2 large ruptures on L4-5,L5-S-1 and a bulge on L3-4. One yr later L3-4 ruptured and it kind of went back and forth between levels since then. This is actually the 5th time that my L4-5 has ruptured. Amazingly enough I've led a pretty great life I am active and I've managed to have 3 wonderful kids. I just want to take care of this as best as I can. I know I may not be 100% but I have faith that I can walk more than a few feet and not want to curl up into a ball and disappear. I have tried every "conservative" treatment under the sun. I know that once a fusion is done you can't go back but I feel I'm running out of options. Sorry if I've been confusing, I guess I'm just a confused person. I just want to do the right thing.
  • I don't think your post was "confusing" Rwill :-)

    MRI's and EMG's and CT's etc., are great tools in ones diagnosis. Physical exam, doctor's experience and YOUR symptoms make the full puzzle! What is creepy about ruptures, hernia's, bulges is one person can have all manner of nasty on an MRI, but feel fine, another can have small hernia's bulges etc., and be in misery! With your insurance, is there a way that you can seek another opinion via a Neurologist or Orthopedist that specializes in the spine?

    Being genetic, that might be why they are leery too, as this condition I am guessing is progressive more so than "most" who have DDD over age and life's abuses? Due to other nerves issues that have come up with me, my NS has put my back surgery on hold. My MRI is much "nicer" than yours in that my disks are protruding into L2 and L3 nerves, and not ruptured, but affecting my back and legs. If these other issues had not come up, a 2 level fusion was going to be on the table. Each patient and doctor are different. Best shot might be to get another opinion. At a minimum, it would be great to at least know what the possibilities are. 6 surgeries in the same area might also be of concern due to scar tissue and maybe stability of that area? Can you get another opinion? Remember, 6 surgeries in that area can be of major concern for complications?

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thanks Brenda for your comments it is definately food for thought. I consulted another Physician and he was ready to fuse at the time of my last surgery. I went with the more conservative approach and just removed the fragment. I know that re-entering so many times is putting me at risk so that's why part of me is like "lets stop fooling around". I will have my husband with me at my next appt which makes me more comfortable. For some reason I tend to get intimidated by surgeons and my mind goes blank. He'll help me keep on track. :0) Once I hear what he has to say I will see how I feel about looking for a second opinion.
  • You're very welcome Rwill. :-)

    I am not intimidated per say, but when "surgery" comes up (even if I know it is coming), my brain starts focusing on that word, and I do miss a lot that is said! When there is big decisions likely to come up, I too bring my hubby. I find that he is a great set of extra ears, and too he tends to come up with his own "observations of my wife" questions to question him with! I also feel that there is a bit more free and open discussion when he is there - dunno, might be a "guy" thing or something?

    Glad to see you are open to a second (or 3rd etc.) opinion. My NS is sending me for a '3rd' opinion before we come up with the next plan of action. I gained a lot of respect for my NS in that his specialty is "direct" from the spine issues and on the spine, and whatever is going on with me is now possibly extending past his specialty areas. Gotta call this new NS tomorrow for an appointment as a matter of fact! (G) Please let us know how it goes!! :-) Support *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I saw my Neuro last week. Thankfully my husband was there to really ask him some tough questions and it made us have good discussions. Due too my DDD he is very cautious about doing a spinal fusion once it is done there is no going back as many of you well know. He is actually recommending trying a Spinal Cord Stimulator and he would also like to have a EMG test. If the EMG shows a problem he then might recommend a fusion or decompression. From all the postings about the EMG test I am a little nervous about it but I know I'll get through it....
  • The EMG is usually not to bad. I think you are confusing that with the mylegram maybe. EMG is just needles stuck into your skin to see if they get an electrical signal between points. You feel like a pincushion but its not too bad. The mylegram is where they go into your spine area and try to recreate the pain. That can be everything from uncomfortable to outright agony.

    Brenda is right about diagnosing. The tests are just a starting point most of the time. Docs only treat what is causing pain or other symptoms. Or if there is something that would cause more damage. I've got crap all over my c-spine and l-spine but no one cares about that now.

    I kinda agree with staying conservative. If a microD can do the trick why do a fusion? If there is something else that is causing the pieces to break off then you should address that. But if it ain't broke dont fix it.
  • I'm glad to hear you say that about the EMG...I've seen a few other postings some say it's horrible and others say it is tolerable. I had a Mylegram many years ago that was a horrible procedure that can still bring me to tears thinking about it. I've had 3 natural child births and have been through 6 back surgeries so I keep telling myself I can handle whatever needs to be done.
  • Rwill,

    Glad to see you got in for your appointment, and plans are still in the works! :--) My NS on my last fusion sent me for the NCV/EMG to confirm if the issues caused by the disk material on my nerve root was affecting things as bad. It was, fusion occurred a few weeks later.

    Fast forward, sent for NCV/EMG for upper extremities and spine, lower extremities and spine - surgery stopped! Mine was that the EMG portions indicated a new problem that is now overshadowing spine surgeries in his expertise. So the EMG can be a tool to either go forward for surgery, or find something else, or just add something to what is already wrong? Me speaking here...on the needle portion, I only allow the Neurologist to conduct it, NOT the tech. I've had much more consistent results with the Neuro doing it that way.

    EMG's - I am one that normally has no problems with needles. On this last series, the needles inserted into the sides of my spine, those buggers got my attention! Otherwise the "prick" feelings aren't that bad for most.

    Spinal Cord Stimulator. I am just learning of this tool of late due to future need possibilities for me. *My* understanding of its use though is that it is used as a 'last resort' when there really isn't anything more they can do to relieve your pain. I am hoping from what you've described, that you find they can still fix, or get you a lot better before that step is needed. We all look forward to see how this goes for you Rwill. Support *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Sorry for some reason I didn't see your post. My Neuro actually referred me to a specialist that he does these tests all the time. For me it is looking like the SCS would be the last resort if we are avoiding surgery due too the fact he's not sure it would help me and or cause more issues down the road. Thanks for your support!!
  • Rwill said:
    Sorry for some reason I didn't see your post. My Neuro actually referred me to a specialist that he does these tests all the time. For me it is looking like the SCS would be the last resort if we are avoiding surgery due too the fact he's not sure it would help me and or cause more issues down the road. Thanks for your support!!
    Glad to hear the Neurologist will do the test. Techs do pretty good with the NCV, but the EMG - night and day! I was thinking about all your prior surgeries after I posted concerning the SCS, so (lol), yeah I guess that might be a high item of possibility for you. Fingers crossed for ya. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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