Apophyseal Joint Sclerosis causing back pain and neuropathy

[disabledcoastie]

I have recently discovered that my back is fusing together because of scar tissue build up. I have a L4toS1 fusion utilizing an anterior aproach and instumentaion with cages that was performed in 2002. Now I'm having excurciating pain in my bag and legs. I take morphine 15mg 3 times a day, loratab 10/500 as needed, usually 3 or more, Robaxin 1500mg 3/day, Naproxen 500mg 2/day, as well as antidepressants. I went to the doctor about a week ago for back pain.  He had some x-rays done, part of the report stated Apophyseal joint sclerosis L3-S1 inclusive, the doctor told me that that means there is scar tissue building up on the facet joints and fusing them together. He suggested that the pain is caused by the scar tissue compressing the nerves, he also stated that if I didn't start taking better care of my back that this build up could continue and cause paralysis!  He also stated that I couldn't afford to fall. In addition I was informed that the more I aggrevate my back the faster this scar tissue builds. The interesting thing is that this build up occurred over a 7 month period, I had x-rays, MRI's and a CT Myleogram performed in March 05 and nothing was mentioned about the scar tissue, I was however diagnosed with degenerative facet disease. So far my diagnosis include degenerative facet and disc diseases, osteoarthritis, spondylosis grade1, some bone loss, and now this scar tissue build up. I am also curious as how bad this scar tissue has to be to show up on a regular X-ray.  I thought soft tissue wasn't detected on X-rays.  

I am inquiring as to what my options are?

[CCF-Neuro-M.D.-PW]

Joint sclerosis on a plain xray refers to changes in the bone, not the soft tissue, and just means that the bone appears whiter than it should be implying reactive changes/degenerative changes. These degenerative changes would be expected to get worse slowly over time. Xrays would be the most sensitive way of seeing sclerosis, as it may not be appraent on MRI or CT (although these can suggest other signs of degenerative joint problems). I'm not a radiologist but this is the most likely reason. The bony changes can result in compression of nerves in time, usually by a bony outgrowth pinching a nerve root, or by narowing the spinal canal. Any new symptoms such as weakness, loss of bladder control, or pain that radiaetd down the leg should be evaluated by your doctors.

[disabledcoastie]

Just a point of clarification the osteoarthritis, DDD, degenerative joints and bone loss are all limited to my lumbar spine.  Background information I'm a 36 y/o male, married, 4 children, one of which is 14 months, and the initial injury occured while on active duty in 1991.  Thanks so much for letting me post this question here.

[disabledcoastie]

Just another quick question as to whether or not I should have more diagnostic imaging done?  Thanks

[disabledcoastie]

Thank you for answering my question.  I am a little confused as I have had a couple of opinions that agree that from the film it appears as scar tissue has built up and hardened (calcified?).  Would it be prudent to have futher tests, either CT or MRI to confirm which of these diagnoses are correct?  I have another appointment on the 28th and I'm considering asking for a CT to confirm the doctor's not the radiologist's diagnoses.  I have had x-rays read by this particular radiologist for several years now, in fact he diagnosed the degenerating facets, and bone loss, this is the first time he mentioned the sclerosis, so I am wondering if the radiologist and doctor aren't communicating well on this particular report.

[stillhopeful652]

Hello. I am a 56 year old male, 195 lbs, good health and not on any medications. Never smoked, no drugs and perhaps a glass of red wine a month at most.
About a year ago I bagan having lower backache. I ignored it because I had been doing some lifting and moving etc.
Then, 2 weeks ago (mid Dec 2005) I woke up one morning with really bad pain in my lower back....center and left back.
I could not lift my left leg without using both of my hands.
A few days later, just before going away for the holidays, I was in so much pain that I went to a "walk-in" clinic. I was sent for x-rays and given some anti-inflamatory drugs. Right leg is fine.
This week I returned and got the x-ray results which read....

Left hip - the hip joint is maintained. Regional bones are normal.

Bilateral S.I. Joints.

On these plain views there is an impression of some mild narrowing with sclerosis mainly on the iliac side involving the distral portion of the left S.I. joint.
Right S.I. joint is normal.
Note is made of considerable sclerosis and narrowing to the apophyseal joints of the lower lumbar spine.
End of report from radiologist.

I took the report to my regular doctor who examined me and sent me for blood tests - with a return appointment on Jan 3rd.

This is my first personal experience with any significant medical condition and the word "sclerosis" has some scary conotation....

Any comments would be welcome and very much appreciated.

[disabledcoastie]

I wish you the best of luck.  You need to get to a Neurosurgeon ASAP!!!!!  You most likely have nerve root compression brought on by the sclerosis.  This sclerosis can be either hardening of joints but from what is described sounds like arthritis.  Anyway you need to have a complete set of tests run, ie MRI and CT of the affected areas.  If you have nerve root compression as I'm guessing you are they may be able to repair that with minimal invasive surgery.  I would suggest you look up your symptoms at www.spineuniverse.com as they have a wealth of information available there and best of all it is free.