I had an L4-L5-S1 fusion in 2004. I was in a lot of pain after the surgery and could not sit up without pain for five years. Things got somewhat better, but I have not been working (on disability) and putting stress on it since 2010. Then in the last year and a half I started getting a lot of pain around L3-4 and more recently I am walking slowly and cannot pull up with my right foot against pressure.
My surgeon suspected that the L5-S1 fusion might not have occurred (even though the doctor in 2004 said everything fused fine). According to my recent CT-Scan impression:
1. Redemonstrated postsurgical changes of anterior posterior L4-S1 fusion. No evidence of hardware fracture or loosening. Clear osseous Bridging across the disc space at L4-5 but not at L5-S1.
2. Stable grade 1 anterlisthesis at L5-S1. Moderate right neural foraminal narrowing at this level.
3. To clarify, prior reports describe laminectomies but we do not see evidence of this. Rather, there is hypoplasia and incomplete fusion of the posterior elements at L5 as well as the upper sacrum. This includes hypoplastic isthmic portions and articular masses at L5, which may be related to the spondylolisthesis.
There are several parts of this I don't understand, and clarification would be helpful. I am trying to prepare for my followup with the doc which is over a month away.
First, could the moderate right neural foraminal narrowing be pinching a nerve and causing the weakness in my right leg/foot?
Second, could the incomplete fusion at L5-S1 and the upper sacrum or the anterolisthesis explain the pain at L3-4? The report also mentions a mild, stable disc bulge at L3-4. Could this be the reason for the pain?
Does it make sense to have an additional surgery to fix the unfused vertebrae as my doctor has suggested? Will this relieve the pain at L3-4? How? Given this information, is physical therapy likely to help or make things worse?
Right now the pain is such that I cannot work because I cannot set for very long and it is very important that I be able to go back to work. Any help would be appreciated.****************************************************
No on one the Spine-Health patient forums is medically qualified to provide any advice or
or recommendations on any diagnostic test. However, the following key words can always be applied.
MILD Treated with conservative measures such as Physical Therapy and mild medications. Many times these situations can be cleared up and the condition can be resolved.
MODERATE Some more treatments may be needed, ie Spinal Injections, Ultra sound and stronger medications. Always a possibility of more aggressive treatment if the conservative measures don't help
SEVERE Need for stronger medications. The requirement for surgery may be necessary