Diffuse bulge...

[Hawg]

I have issues with my C Spine and L Spine.  After visiting my surgeon my next option for my C Spine is surgery.  We reviewed my MRI results for my lumbar and the doc told me surgery in not an option.  I know every case is different and you cannot see film here.  However, here is a portion of the MRI report.  Perhaps you could intrepret these and shed some light.
"At L4-5 there is mild to moderate disc hydration and there is a diffuse bulge of the annulus and disc.  There is a posterior  disc protrusion  by 1-2mm at left lateral recess and 2-3mm at right lateral recess.  No root effect is suggested to right or left"
Pain is subjective and there are days I about cry trying to get out of bed, sitting with comfort is about impossible.  Driving for any length of time is horrible. From what you've read, what are your thoughts? I've used an RS Medical unit for my C&L spine since Oct with not any relief that I can tell.  I've had an ESI on my CSpine, no luck.  I have an ESI on 3.7 for the lumbar - SI Joint injection, transforaminal injection is what is recommended.  God forbid these provide no relief, what are my options?  The last thing the Pain Mgmt doc told me when he did the ESI on my C Spine was "sometimes these work, sometime they don't"  Well it did not on my CSpine and I'll be going for sugery.  After reviewing the info provided from my report, what are your thoughts for treatment options should the ESI not work?  I know that the dehydration is degenerative and can't be fixed, but I'd like to think there are various treatment options for the bulging issues.   Thank you!!!

[Hawg]

Thank you for your time.  I am not overweight.  I am a 45 YO male, 5'11" and weigh 205... large framed but no pot belly etc.  The doctor did point out on the MRI a narrowing of the foramina and hence his reasoning I'd imagine for having me go for a Transforaminal ESI and SI Joint injection.  I'd never consider issues with the soft tissues being involved and that is a nightmare all on it's own I'd imagine.  I'd kind of hoped for a "cut and dry" solution, no pun intended.  My Cspine issues are easily fixed with a laminectomy according to the doctor.

I'll review the posts you've mentioned.

Thank you for your time

Hawg

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

Disc dehydration is common with normal aging, and is likely not to be causing your symptoms

I cannot give you accurate information on your scan without seeing it, but if the report is correct, the disc bulge does not seem to be compressing the spinal cord or roots (lumbar stenosis). Certain positions, like extending the spine can reduce the disc space and cause the space to become tighter, this can cause some positional symptoms. In this case sitting forward/riding a bicycle position can increase disc space and relieve symptoms. If significant lumbar stenosis is confirmed by MRI or myelogram then surgery may be beneficial.

Alternatively, other structures ie soft tissue/ligaments can be responsibel to chronic back pain too - not just the nerves/spinal cord. Unfortunately it is hard to differentiate (although less likely to be neurological) sometimes especially if there is no evidence of spinal cord/root involvement by MRI or EMG.

Other procedures for chronic 'discogenic' back pain are available like IDET or prolotherapy (see question answer from last week re IDET) but the scientific effectiveness of these procedures is not confirmed.

Physical therapy and weight loss (if overweight), posture training etc is very important. Surgery is not a cure all and can result in a worse situation than before.
Good luck