mri results

Hello,

I have a few questions for you.. I had ACDF surgery in Aug 07.. I am having complications from that but I also have chronic low back pain from a bad disc at L5S1.. My questions to you are:  I have had many MRI's in the past year because they arent sure what is going on post surgery..Can you tell me what this means?  L5S1-The disc is of normal height. It is moderately to markedly dessicated. There is a posterior central annular fissure and tiny subligamentous disc protrusion. The spinal canal and neural foraminar are widely patent.  The facet joints are unremarkable. There is no evidence of nerve root compromise at this level.  conclusions:  Small posterior central annular fissure, L5-S1 with small subligamentous disc protrusion. The lumbar spinal canal and neural foramina remain widely patent at all levels..  My question is would this cause significant back pain.. I have pain in my neck post surgery but also have pain in thoracic and lumbar areas as well. I believe this low back pain I am having is from that disc at L5S1.  I cant even sit down for 20 minutes without my lumbar area hurting.  Is it safe to get epidural injections at this level when it is dessicated?

Thank you

[Paul J Slosar]

If the other lumbar discs are normal then the L5 S1 disc may be causing your pain.  An epidural is a reasonable treatment option but is usually more helpful for leg symptoms rather than back pain.  Some surgeons use a test called a discogram (an injection of the disc itself to confirm pain) before offering a patient surgery.  If symptoms do not improve with treatment over 6-12 months then fusion surgery may be a consideration.  

Contrary to the post above, the discs are rarely able to "fuse themselves" so the role of surgery is still helpful to many patients.  Mininally invasive fusions are often better tolerated and I use many different options to help patients like you every week but always try non-surgical treatments first.

[worried878]

I think a doctor may answer these questions...i am just kinda looking around...i do know that an annular tear can cause pain tho..the contents inside the disc leak into the subarachnoid space and it causes pain...a disc that is dessicated is when the fluid has leaked out of the disc causing it to be thin, leather like and of little use as a cushion anymore....this often is a signal that the body will fuse itself at this point soon....but when the body fuses on its own it is much less detrimental than having a surgical fusion done like i unknowingly did...i am a nurse but have learned alot of this thru self experience/unfortunately

[ms38]

Thanks for the respone docor. Anyways the pain I have is lumbar with left hip and left outer leg and left buttocks pain. I am not sure how long I have had this bad disc but I believe I have had it for quite a long time. Just cant take the pain anymore.. What nonsurgical options are there besides physical therapy and medication? As far as the mri of my lumbar area that is the only disc that was abnormal. And I really dont want to have fusion surgery since I did have ACDF C5-C7 last year August 2007 and have had problems post surgery..  They still havent diagnosed what is going on in my neck.  I had 3 level fusion in my neck that apparently was my only option and I really dont want to have to resort to a fusion in my back.. I have had 2 stellate ganglion blocks, one cervical ESI and one occipital nerve block post surgery with no relief. My sed rate has been elevated for about 10 months or longer. I have seen neurologists, rheumatologist and a pain doctor and I am scared to get any more injections in my neck.. I believe that I have some type of inflammation in my cervical region because I am on Naprelan CR and it does relieve some of the pain in my neck that is persistent after surgery.. Do you recommend lumbar ESI's in the L5S1 area? Sometime I would like to talk to you about my neck but right now my back is hurting more at the moment..

[ms38]

bumping up

[Sandy2003W]

I had a Laminectomy and Discectomy 1980 on L4, L5 & S1.  At the time I could not walk so the surgery was very necessary.  However it did not solve all my problems and scar tissue is a big problem for me now.

The one thing I did a few years after the surgery that did the most good was to get cortisone injections into the lumbar area.  They froze the area and then injected the cortisone.  I have never regreted do it and that was about 18 years ago.  I am now thinking I may try the same thing again rather than have more surgery.   I am  presently waiting for an appointment with a neurosurgeon to see what my options are before I choose what route to take.  

Good luck with your back problems.
Cheers Sandy W