lower back pain-fusion in 2000

[barbjr]

When I was 36, I was told that I had DDD, Lumbar stenosis, & disc space narrowing, protrusion on S1 nerve root. I had my back fused in 2000 when I was 38 on the L5-S1. It relieved a lot of pain & only had issues a few times a year. In 2008, I started having more pain, longer durations & issues that I had never had in past before fusion. Family doc put me on prednisone off & on & it did help at least 70%. In 2012 The pain greater and more often & was taking the prednisone to the limit in a 12 month time. The last MRI was in 2011. For the last 6yrs I have spasms in lower back almost every morning, last 20 min or so & it feels like its deep in lower back & not the muscle at all. I have had while walking like a knife being turned in lower back and I went to the floor(2 times this happened). I have had upon waking what I call a lock pain, the pain is so great that I cannot get up, move ect last 15 or so minutes, I take this to be the spasm at its greatest, do not know thou. A good day for me is it feels like I fell on my tailbone or been hit in the back. It radiates into hip & right leg to the back of the knee. standing sitting & sleeping is a issue. I went to a ortho doc last month-he put me back on prednisone and for the first time it did not help at all. He did talk of surgery of the disc above fusion by replacing it. I am adding the impression of MRI back in 2011 and hope to get some advise or thoughts on where I stand. My fear of where I will be in another 10yrs.
L1-L2 there is minimal diffuse disc bulge w/out significant central canal or neural foraminal narrowing.
L2-L3 no disc space abnormality is identified
L3-L4 there is no disc bulge or herniation. Minimal facet joint degeneration changes are noted. There is minimal bilateral neural foraminal narrowing w/out evidence for neural impingement.
L4-L5 there is minimal diffuse disc bulge. Enhancing epidural scar tissue is seen within the lateral recesses. There is moderate to severe bilateral facet joint hypertrophy with mass effect on the lateral aspect of the thecal sac. There is mild to moderate right neural foraminal narrowing at this level.
L5-S1 laminectomy defects are identified. enhancing epidural scar tissue is seen within the lateral recess. there is no evidence for a disc bulge or herniation. There is mild bilateral neural foraminal narrowing; evaluation is limited due to artifact from fusion hardware.
Conus medullaris terminates at L1 level and is normal in morphology. Following intravenous contrast administration, there is no abnormal enhancement. The cauda equina nerve roots have a normal appearance.

thank you so much

[barbjr]

Thank you. I do not want the surgery, at this point I feel I will get temporary relief like I did with my fusion but what am I adding down the road. I have had the steroid injections before the back surgery and it did not work but have not done any lately. I did go to a pain management doctor in 2011, was kinda turned off, it looked like a drug house with people giving urine before before they got the prescriptions.(lol) I have trouble with pain medication because I have a seizure disorder and taking meds for that, infact it started right after surgery for the fusion, hours after surgery I had a grand mal and 4 more since. I will give the steroid injections another try thou. Thank you so much for reading my post and replying.  

[philnoir]

When the spine is fused at a specific level, nearby discs, joints, and ligaments are under increased stress because they now have to perform the tasks of those structures at the fused level. Thus, they wear out. A fused back, therefore becomes like a row of dominoes, with each neighboring level falling in succession. You are lucky that you had 8 years on that L5 disc -- that's longer than normal.

The MRI reports "moderate to severe bilateral facet joint hypertrophy" which is known as facet syndrome or spondylosis. This requires treatment.

If I were you, I'd see an interventional pain and spine doctor, who may be able to treat your back pain with procedures short of surgery, such as steroid injections or RF ablation of the sensory nerves involving that facet joint.