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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.


  • Most likely because of your age.  Fusion surgery can be life altering.  Most surgeons are concerned with young patients.  Also, even though your report said "mild" that doesn't mean no pain!  If your not doing it already, I'd stay away from lifting or anything of that nature for a while.  Give it time to heal on it's own or to see if it will heal on it's own. 

    Also, everyone is entitled to a second opinion!  See another doctor if you feel your hurting worse than the MRI reflects you should.  MRI's don't always see the problems.


    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • dilaurodilauro ConnecticutPosts: 12,772
    If the MRI findings were severe, then age does not come into play at all.   The image is the image.  Now, based on your age, some surgeons are hesitate about performing surgery.  But if its the only thing that will give you relief, then you may just need it.

    Seeking a second opinion might be a very good option at this point.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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  • Wondering how this has gone for you.

    I found myself in a similar situation - have had back pain for years, first diagnosed at age 18. 2.5 years ago, I had another MRI and went down the conservative route. Tried everything I could think of to deal with the pain including PT, medications, lifestyle changes, pain management, etc. This year, the symptoms worsened again and my MRI showed "moderate progression" but still looked "mild" to the docs. Meanwhile, the sciatic pain was worsening and was developing sensory deficits like numbness and tingling in my legs.

    I had a discogram last week and we found that my major pain generators were L3-4 and L5-S1 (on MRI, L4-5 and L5-S1 look the worst). I will say that it's not a pleasant procedure and it really took about 5-6 days before I was back at my baseline level of pain.

    I'm looking at a multi-level fusion later this month and, while I've done my research, I know I have no real idea what it will be like.
  • SavageSavage United StatesPosts: 7,385
    Hello clemsonmike !
    Please click on link for helpful information!
    Honorary Spine-Health Moderator
    Please read my medical history at: Medical History

  • clemsonmike
    I see you have posted a couple of other posts besides this one which I have not read so forgive me if I ask the same questions that have been asked. You also posted this message on 2/26/17 so have you found out anything yet and did you have the discogram? What was the results if you would share them and how did it go? I had one years ago and he did hit a pain generator but said it was a muscle spasm but I disagree to this day.
    You asked why two doctor's have different opinions through the years of dealing with pain I have ran into that more than once. They can different training, views etc. and we all know how difficult it can be to determine the issues so if you are not happy with your doctor be sure to seek out another opinion. Tests such as MRI's etc. will not 100% find a problem believe me I have been in severe pain for three years now with Si symptoms mostly causing the pain. I am wondering what tests did they do to rule out Si joint issues?
    It has been some time since you posted so please get back with us and let us know number one how you are feeling and number two what did you find out?
    One more thing if you type in the upper right hand corner the "Blend" there are some ideas there on controlling pain. Oops another idea I use some creams you could ask your doctor about if you need the names let me know.
    Best wishes Sherri
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