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Possible Lumbar Fusion in young adult

Hello -

I am a 32 year old male.  Background on me -

I used to be a pretty serious powerlifter (heavy weightlifter).  For the past 2-3 years i've had lower back pain that has progressively gotten worse.  Last October 2016 I decided to see a pain management doctor.  He ordered an MRI.  MRI showed moderate scoliosis in my lumbar spine (a later MRI showed moderately severe scoliosis in thoracic spine).  MRI showed broad based disc bulges in L4-L5 and L5-S1 with mild to moderate disc degeneration.  disc in L5-S1 is mildly effacing BOTH S1 nerve roots.  Discs in L4-5 and L5-S1 are also pushing on L4 and L5 dorsal root ganglions and I have bilateral neuroforaminal stenosis.

Since October i've had 3 epidural steroid injections and 2 facet joint injections.  The facet joint injections did not help at all.  Epidural steroid injections provided relief for about 2 weeks.  
Here are my symptoms -

1.  Severe lower back pain that feels achy.  Almost like a raw open wound.  The pain seems to be centered on my spine in my lower back.  It gets worse throughout the day (tends to be the worst at night) and tends to encompass the whole lower back area (center of spine and to the left and right of center of spine) .  I have also developed severe radiculopathy.  The lower back pain is usually worse, but I have episodes where the radiculopathy can be just as bad if not worse than the lower back pain.  The radiculopathy is bilateral (in both legs).  It tends to go down my buttock, hamstring and into my calves.  Sometimes I have radiculopathy in my thighs.  I experience foot numbness on most days and sometimes my right upper leg will go completely numb at night (usually when i'm lying in bed).  Lately the pain is going into my groin area and I experience increased low back pain when straining to have a bowel movement.

I saw a neurospine surgeon last week.  He ordered another MRI which I had this week.  The MRI of my lumbar spine was identical (report said "not significantly different") to the MRI report I had last October.  

He is hesitant about proceeding forward with a minimally invasive fusion surgery.  He says my MRI is abnormal but the findings are "mild".  He wants me to have a discogram to see if we should move forward with fusion.

My question is, my pain management doctor acted like my MRI findings were pretty severe for someone my age.  Why would the neurospine surgeon act like the MRI results are mild?  Can someone experience debilitating symptoms with mild MRI findings?  I have done tests for SI joint dysfunction and the tests do not recreate my lower back pain.  I am confident my pain is from disc degeneration of L4-L5 and L5-S1.  What can I expect from the discogram?

Thank you.
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Comments

  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    Greetings Mike and Welcome to Spine-Health,

    A discogram will show if there is disc material leaking from a rupture or annular tear.  If material is leaking out of the disc(s) it can cause nerve irritation and pain-discomfort.  If interested in seeing SEVERE disease at L2-L5 take a look at the imagings and reports in my story link below.

    Hoping for only best outcomes,

    MN 
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    edited 02/25/2017 - 6:17 PM
    Oh one other comment -

    All of the ESI's - Facet injections - Physical therapy - medications - aroma therapy - dry needling - traction - chiropractic manipulation - osteopathic manipulation - prolotherapy - acupuncture - and ancient herbs or voodoo .....  
    Will NOT correct structural problems of the spinal column and associated nerves and ligaments. (IMHO and experience).

    Again,

    MN
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  • Thank you MN for the replies.  One other question, can someone experience severe lower back pain and radiculopathy in legs from findings on MRI showing mild disc bulge at L4-L5, mild to moderate disc degeneration and disc bulge at L5-S1 with mild contact with both exiting S1 nerve roots?
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    Hey Mike - 

    You would appear to be suffering those symptoms so .....
    I believe you have already answered that question - no??

    I think so ...

    Again,

    MN
  • Hi there,

    This is actually very similar to my findings though they were marked as moderate-severe. I saw 3 neurosurgeons, 2 had mentioned that in someone older (I am 27) they would consider a fusion, but at my age they were very hesitant. I experienced both lower back, hip, leg, foot and toe pain. Often excruciating and debilitating. I had a multilevel microdiscectomy on the ruptured discs and a laminectomy. So far, granted I am still recovering, it has been a good decision for me. I am thankful to not have had a fusion. 

    It sounds to me like you need to get a second (or third) opinion from a surgeon. 

    Best,
    Ocines
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