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New MRI results in - Is fusion on the near horizon?

BrihtwulfBBrihtwulf Posts: 69
edited 06/11/2012 - 8:32 AM in Back Surgery and Neck Surgery
Quick history of my condition:
- Disc rupture 7/2007
- MRI in Feb 2008 showed severe herniation with spinal stenosis at L5/S1
- Lumbar Discectomy at L5-S1 March 2008
- Slight improvement for a few months, then downhill
- Physical therapy failed to help
- 2 ER trips in a month without meds
- Current treatments:
-- 10mg Vicodin
-- TENS unit

So, I got the results of my MRI from last week. I haven't had an appointment with my doctor or the new neurosurgeon I'm being referred to yet, but I always pick up a copy of any reports from the hospital for my own records. Here's a rundown of what it reported:

- Discogenic degenerative changes involving the inferior endplate of L5.

*** I'm really not familiar with the "endplates" and their significance. Anyone have some clarification for me? ***

- Moderate disc space narrowing at L5-S1 with central disc protrusion at L5-S1. The Axial images show central disc herniation at L5-S1. Again condirmed with Post Gadolinium images, also showing herniation is slightly exxentric to the left.

- Mild enlargement of the right SI nerve rootlets but the disc fragment does not abut this nerve rootlet.

*** I don't quite understand this part either. Why would my SI nerve rootlet be enlarged? Anyone able to help clarify? ***

- Spinal canal stenosis at L5-S1. Some of which is caused by this disc herniation with an AP spinal canal diameter of 8.6 mm.

... So, can this be helped by injections? Is there no point in just leaving my treatment up to a pain doctor? I have a referral to a neurosurgeon now, and I'm guessing they're going to tell me I need a fusion. Thoughts?


  • Brihtwulf,

    My MRI is similar - the enlargement they mention might be inflamation due to the herniation and the endplate talk could be arthritic changes in the bone. The NS will be able to explain everything to you - force him or her to do that. I went to both an OS and NS, neither said I needed a fusion, but offered it as an elective procedure. As of Dec 08 my L5 disc was 70% herniated and I could see a moderate loss of disc space on my MRI and Xray. Repeat MRI and Xrays in May 09 and WOW the disc is shrinking big time and L5 and S1 are much closer to each other. Since this has generated increased back and leg pain I've decided to have a TLIF on 24 Aug with the OS. The NS was going to do a PLIF - since there are so many different types of Fusion do your research now so you can you understand the different risks of each and can ask the surgeon's rational behind it. I tried hard to avoid surgery and could probably pop some more pills and feel fine, but I also have a stability problem with a grade 2 spondylolisthesis of L5 over S1. Do you have more leg or back pain? Keep us posted. All the best, Mike
  • Do not assume the neurosurgeon will recommend fusion. They are more reluctant to recommend fusion until other options have been explored, as there is no turning back!

    Here is a link to a good definition of end plate:

    End plates can degenerate, fracture and can be damaged when a disc herniates. Damage to an end plate can be a source of lower back pain.

    There are a number of reasons the S1 nerve is irritated. One could be the chemical reaction that occurs when a disc ruptures. It could be caused by the stenosis that is mentioned. When there is central canal or foraminal stenosis, nerves often end up being compressed. An opening that the spinal nerve needs to pass through is narrowed. This can result in irritation and/or inflammation of the nerve.

    I would suggest you go to the neurosurgeon for an accurate diagnosis of your current problems. Then you will have a better idea of your options.

    From what you have said about your MRI it doesn't appear to have anything that screams out "surgery." But that is a totally non-professional opinion, OF COURSE. If you can get the swelling to go down (with an ESI or oral steroids), things may be able to quiet down and allow the disc to heal up.

    Let us know what the NS has to say!!
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  • I already had a discectomy in the affected area a year ago, and my condition has continued to deteriorate. 1 year ago, there was no arthritic degeneration in my lumbar spine. Now in April there is. In April, there was no spinal stenosis from the disc at L5-S1. Now there is and the narrowing of the disc space is worsening. I also have narrowing on both sides of the lateral foramina at L5-S1. The April MRI also showed edema in the vertebra.

    My back pain has been increasing in severity for the last 8-9 months, and the discectomy didn't effectively get rid of all the pain in the first place. It also left my right heel, ankle, and outside of the foot permanently numb. Without meds I end up in the ER, and it takes at least 3 10mg vicodin a day to keep my pain to a tolerable level most of the time.

    The severity of my pain is focused in my back. Depending on certain factors, like level of activity, the pain also radiates into my rear and down either or both legs (typically the right leg). Now, I have tried physical therapy (numerous times and methods), anti-inflammatory meds, and one brain-dead pain doctor's poorly-placed injection. Haven't tried oral steroids, but I hear those have TERRIBLE side effects. I don't know what options exist apart from fusion surgery, but I'm not exactly content having my vertebra and disc deteriorate down to nothing until I'm paralyzed. This whole thing just "freaks me out" sometimes...

    I have an appointment with the neurosurgeon on Monday at 1pm, so I'll be sure to post what he said.

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