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Anyone w/S1 Joint, lumbar f. stenosis, DDD, L4 bulge, L5 herniation issues?

After approx. 6 mo's pain, went to Neurosurgeon for 2nd opinion - scheduled lumbar L5-S1 fusion for 10-15-15 - Insurance denied. Now meeting all insurance requirements to try to reschedule. However, saw pyshiatrist in meantime that diagnoses Sacroiliac joint dysfunction and doesn't believe Lumbar fusion will help. Also saw 2nd neurologist she supported surgery due to nerve compression showing in EMG, MRI & physical evaluation.

LUMBAR MRI - L4-L5 broad based disc bulge with osteophyte , minimal narrowing of spinal canal, mild right foraminal narrowing Disc degeneration. L5-S1 mild right & minimal left foraminal stenosis due to broad based disk bulge with osteophyte, foraminal disk protrusion and hypertrophy of the facet joints. Disk degenerative disease.

THORACIC MRI - Mild multilevel cervical spodylosis & disk degnerative disease

CT scan w/fluid shows: L4-L5 Grade 4 - contrast leakage along the outer third of the annulus - 45 degrees right posterior & lateral aspect, L5-S1 Grade 4 - contrast leakage along the third of the annulus - 75 degrees along the posterior right lateral aspect. Mild posterior bulging in conjunction with degenerative changes. Foraminal stenosis. Mild degenerative endplate changes along the right aspect of L5-S1 and mild L5-S1 height loss.

XRAY - min. disk space during L5-S1, mild facet anthrosis L5-S1, S1 joints are patent

Neurosurgeon still wants to do fusion of L5-S1 claiming I have bone on bone. He doesn't believe discectomy will solve butt & back pain. My Physiatrist & General Practitioner don't believe surgery will help at all and that source is joint pain. However, if source is join pain why would my feet by numb and have nerve compression in testing. Would appreciate any thoughts and./or suggestions.


  • But it would be very strange to have numbness from joint pain. A GP is not trained to know what surgery will help and won't, and a Physiatrist...which I assume is something like the equivalent of a Physical Therapist- well they always want to do more therapy, etc.

    I had a somewhat similar MRI scan with very large endplate changes. I was not walking well and had a lot of neurological symptoms. I also had a pars defect, which is essentially a small fracture in the vertebrae so...after a year of trying to heal after a microdiscectomy (which did improve some of my symptoms), I had a fusion about 2.5 weeks ago. I am personally pretty pleased so far as I'm walking better than before and in less pain. I'm struggling a bit with the restrictions and longer recovery time, but I can honestly say I wish I had done it a bit sooner....
  • dilaurodilauro ConnecticutPosts: 9,875
    is a well trained , multi-talented doctor.

    They are more than capable of examining diagnostic tests and determining if surgery would be a solution. They would indicate that surgery is the answer, but would also tell their patients to see a spinal surgeon to confirm.

    Most Primary Care Physicians and General Practitioner's may not have those skills.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Ive been off the site for a bit but came on and your post jumped out at me. I am not a dr so everything is my own educated suggestion from research speaking to other med professional and just trying to get better.
    I'm not sure of your age but most of what you are talking about from a radiologic reading of an MRI most is what just happens to us as we age, some happens to much faster, and others don't even know its happening. I myself never knew I had schmorls nodes, which sounds like a panic, but so common and usually doesnt cause or isnt the cause of our pain.
    You have bulging and osteophyte (bone spurs) which again make us panic when we see words that seem very foreign to us however, that is not always a cause to our pain, but in some cases can be numbness, tingling related...this site has great videos that explain many of what we are concerned with and in laymans terms.
    As for SI joint in my experience, I've had it, not had it, and had it and not had it, if you get what I'm saying. Did your MRI with contrast show inflammation in the SI? Also, if you have SI, I would continue to get your SI as healthy and strong as you can, because after a fusion, many patients end up with SI issues where its not on an MRI but symptoms make us "clinically" diagnosed. I personally think its a way of saying I don't know whats your real issue so lets call it SI dysfunction. Because it is real, just sometimes not detected on MRI.
    From my experience. I would say for me your nerve test is your best test....it is amazing that you can ask the neurologist and he can almost pin point where your level of pain is, acute, subacute, or chronic. Here is my suggestion:

    1. I actually would ask him before you have surgery...if there is a nerve issue that has hit a "chronic" point depending on the situation nerve ect, surgery may only make it worse. Nerves do grow back, but if its "chronic" and damaged and cant supply your muscle thats a whole different issue and I would get another opinion before surgery.
    There seems to be issues with l4 l5 as well as l5 s1 are they addressing both? A double fusion or single fusion
    2. Ask the neurosurgeon, do you have an annular tear at both levels? you dont want to have more fusions then you need but what if l5 s1 is not the source of your pain completely?
    Ask if they can give you a discogram. Most surgeons don't do a fusion with out this test for reassurance, if there is many areas like yourself that could be source of pain, this test will help determine rule out, its not nearly as bad as the nerve test comfort wise. But have a outside dr neurosurgeon, or ortho surgeon do it, in a clean facility have mild anesthesia so you can be responsive to the test

    This would be all the things I would do looking back....
    I started out as a simple micro and 18 months later hoping someone will just give me my life back....I never had back pain, I was a physically healthy individual, never took anything more then an advil maybe 2x a year. Ive had cancer and it was easier then this.
    Please. Ask questions, I had an annular tear for 11 months that they swore nothing was wrong but that that I researched and asked my drs to perform left me with only one fusion l4 l5, and a whole bunch of other pain and issues the test showed them I know my body and something was still wrong, I did every test from rheumatologist to neurologist to PM to injections to aqua therapy and land therapy.

    My GP was not educated in any of this he originally diagnosed SI I went to one PT and couldn't walk the next day. And I've never seen a Physiatrist but those who have seen them seem to say they are highly educated as Don mentioned..

    Good luck keep me posted. Again just suggestions before your life could possibly change and become irreversible.
    This can't be happening
  • Thank you so much for your replies. I naively expected an email if I got a response and din't realize I needed to keep checking back for responses. I've gotten an epidural in the S1 joint and that did help some also got a cortisone injection in right bursa and that helped. I'm between 30-40% better depending on the day. Also since gotten 2 additional neurosurgeon appointments and an MRI of thorasic, neck and brain. Neck has spondylosis but, nothing remarkable. So I've been passed back to a neurologist again to try to determine why my feet and toes are numb. Uggghh....
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