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Failed Fusion & large annular tear

I had an L5-S1 fusion last yr when I was 18 yrs old after suffering from back pain for 4 yrs for spondylolisthesis w/ pinched nerves. I have been told now that it did not fuse.

Now I am in just as severe, if not more pain that is radiating down my right side. I had a discogram last week at L4-L5 & am trying to understand the results. If you can help me, or enlighten me about treatment options, it would be greatly appreciated.

...L5-S1: the interbody cage is partially incorporated with a small amount of intact interbody fusion bone at the posterior aspect of the disc space. On the current examination, there is no definite solid fusion noted posterolaterally.  

L4-L5: There is a large annular tear at the six o'clock position with contrast extending into a central to right disc protrusion which contacts the anterior aspect of the thecal sac as well as the proximal right L5 nerve root and may minimally contact the proximal left S1 nerve root. The facet joints remain patent & no lucency is noted along the pedicle screws.

Thank you!! Just trying to feel better so I can continue college without pain:)
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517190 tn?1211642908
Dear Summer,

One needs a CT scan to really come close to diagnosing if you have a non-union or not.  From what you say – and I’m not sure it’s an MRI or CT – there’s no definite conclusion that I can hear.

But say it is not fused, then it most likely is the source of the pain largely.   As far as L45, discograms are notoriously inaccurate for predicting anything.  Although it could be an additional source of pain, as to whether that needs to be included in the re-fusion, or more likely needs either just a discectomy or nothing, would have to be determined by correlating your precise symptoms and clinical exam of strength loss or sensory loss, etc to know.

Dr. Rosen

Charles Rosen, MD
Clinical Professor of Orthopaedic Surgery
Spine Surgery
University of California, Irvine, College of Medicine
Founding Director, UCI Spine Center  
Orange, California
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