To fuse or not to fuse?

[Drahn]

I'm 20 years old and have been told that I have got degenerative discs with instability of my lower spine and a suspected herniated/slipped disc. I have had this back problem since I was 17 and have now been told that I may need a fusion to stabilise my spine and also surgery to free my trapped nerve causing my sciatica down my leg and to my foot and toes.

Would you recommend I go ahead with this fusion and surgery or would you recommend other types of treatments?  

[Drahn]

I think I will actually go and try and see a Rheumatologist as they might have some answers as to what could be truly causing my back pain.

I've had my G.P and two physiotherapists say maybe my pain is muscular but I'm not so sure if they are 'just' saying this because it's easy to say it's only muscular rather than finding out the real cause of pain? I have completely no confidence or trust in any of the so-called healthcare professionals I've seen - one consultant doesn't even want to see me because of reasons unknown.

I still wonder why my MRI and X-ray don't correlate with each other? Are they mine?

I have actually been prescribed physiotherapy to strengthen my core muscles and am doing them at home as well. I'm not happy with my treatments as I don't think I've had enough investigations and they don't know what is wrong with me so that says an awful lot about the fact I require more tests.

Is it really possible to remove pressure from a nerve by strengthening? Never knew that. I've heard that nothing can exactly and truly remove pressure from nerves unless the part of the disc or whatever is putting pressure on the nerves is removed off the nerve.

I still don't understand the fact my MRI doesn't show any trapped nerves, yet I get sciatica-like symptoms though they are intermittent and get better by resting?

Thanks for your help and advice, Marci3. :)

[Marci3]

Rhuematologist will obviously be looking at possible arthritis, however, they are also the specialist for Hyperextension/Hypermobility or for people that don't know the real terminology they would call it "double jointed".  That is actually impossible.  Anyway...a loss of Collagen is the most common reason and sign of this problem.  But, there is not a reliable test.  No blood work.  So, the Beighton Scale which is looking at the most common joints to bend beyond the normal amount.  

What does this all mean?  At your age you can learn how to build the muscles in your body to do the work that the joints aren't doing and learn what not to do ie. allowing the hip and knee to over extend by sitting and standing incorrectly.  

You are young and based on your tests I would not even consider getting near a knife or much medicine.  Excercise-Pilates, Yoga, etc.  they help strengthening your core  which is basically all the muscles in the trunk of your body.  By doing this, your back is supported properly instead of relying on knees when standing and hips, etc. when sitting.  Learn these good habits now and you will be surprised at the speed in which your core strength will allow your back to feel better and let you do more because it will align your body and hopefully remove any pressure that is on the nerves at your disc areas.  I like Pilates better.  Go through a licensed physical therapist that offers the training to make sure you are moving properly.

Good Luck!!  

[Drahn]

Sorry for the double post.

I can email you off forum if you would like me to do that. :)

[Drahn]

Thanks for your time and message.

Here's what the MRI says in full about my lower spine/sacral area:

There is disc degeneration at L2/L3 level with a Schmorl's node and annular bulging. The degeneration would appear to be Grade 3. The remaining discs appear normal. There is no evidence of facet osteoarthritis. The sacroiliac joints are normal. There is no evidence of nerve root compression and all foramina are normal. The conus is normal.

Here is also what the MRI says in full about my pelvis as I had one of my pelvis too:

There is no evidence of an abnormality in the sacroiliac joints or in the pelvis. Both hips appear normal and the sciatic nerves are both normal. There is no abnormality in either ischial tuberosity.

And last of all is what the X-ray says in full for my lower spine:

AP/Lateral; Loss of disc height at the L5/S1 level and probably facet joint degeneration here. Loss of disc height also at L4/L5 but less severe. Mild loss of disc height at the other lumbar levels. Appearances are unusual for a patient of this young age. I note the previous radiograph from June 2007 demonstrating early degenerative change in the first MTPJ. There might be an underlying abnormal collagen variant. No evidence of malignancy. Probably large liver.

Someone has also written on this results report ' ? Seen Rheumatology TCI' as if giving an indication or hint as to what to do with me, asking if I've been to Rheumatolgy or not. I'm not sure if the radiologist wrote this or my G.P.

By the way the June 2007 radiograph that the radiologist is referring to is the one I had for my foot (I don't have a copy of the report for this yet) because I woke up one day and for weeks I couldn't walk or stand on it as it was really painful and my mom took me to the hospital to get it looked at as she thought I'd done something to it like walking into something. Mom thinks it is to connected with my back because they said that it wasn't fractured. The reason the radiologist was referring to this radiograph of my foot is because he was looking to see if there is anything else generally abnormal with my body that could be also contributing to my bad back like rheumatism or something. It seems from what he's found I do have something generalised as it is also affecting my foot with degeneration.    

The other thing that I'm confused about is the MRI doesn't say anything about the lower levels and the MRI actually states a 'new' area where my pain isn't - my pain is lower by my levels in the X-ray. The X-ray actually correlates more with my symptoms and area of pain than the MRI, though another different radiologist looked at the MRI. Strange how it don't correlate with my pain though.

The MRI doesn't say how many MM in size the bulge is or anything strangely enough, only that it is Grade 3.  

As far as the MRI says there is no nerve trapped but I'm not so sure as I get pain like sciatica. I do wonder if they got the right MRI?

My G.P and physiotherapist did a few tests on me to check for hyper extension. I do have a bit of bendyness i.e. my thumb can be bent to touch the hand and I can stand on the floor with my forearms and legs out like in some of those diagrams that can be found on the internet so I'd say I was more bendy than usual. My G.P has actually said that he reckons I've got some sort of extra-bendy syndrome or condition.

I appreciate your time and want to thank you for your helpful reply as I'm still in the stages of getting it investigated as my mom reckons I need to see a Rheumatologist as she thinks there may be an underying condition from what she has read on my X-ray results report. She wants me to go and have some tests like blood tests and stuff to find out.  

    



  

                  

        

[Drahn]

When is Dr Rosen going to be back?

Here is some more information for him to make more of a proper diagnosis/give advice as he was stating that I hadn't given him enough information.

MRI: There is disc degeneration at L2/L3 level with a Schmorl's node and annular bulging. The degeneration would appear to be Grade 3.

X-Ray: Loss of disc height at the L5/S1 level and probably facet joint degeneration here. Loss of disc height also at L4/L5 but less severe. Mild loss of disc height at the other lumbar levels. Appearances are unusual for a patient of this young age. There may be an underlying abnormal collagen variant.  

[tamarabxx]

I was diagnosed with DDD about 10 years ago, with my first fusion in my C-spine C4-C6.  12 weeks ago I had my 2nd fusion, it was multi level L4-S1.  I have had nothing but problems with pain.  I haven't taken any pain medication for a month.  I also had great problems before both surgeries.  With my neck, I had severe foot drag, and numbness, with my lower back, severe leg pain, foot drop, severe lower back pain....so you see, we must decide which is worse, and it varies from person to person.  Do lots of research, look for positive results, as well as negative.  Let this be an  informed decision, you make with your family, your Dr.'s and you.  Good Luck