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]

Hi Marci3 and thanks for your reply and help. :)

I didn't understand because I haven't really got anyone like instructors to tell me about the different treatments like Pilates, only a physio who is only giving me strengthening exercises which, to me seems too obvious but I don't feel happy with doing too much at the moment as they, including my physio doesn't know what is wrong, even though I've had X-rays and MRI. I am going to demand some more tests as they are ignoring my problem and are not helping me very much at all. At times I feel as though it is a waste of my time going to hospital when they don't know what is wrong. How do I even know that the exercises the physio is giving me are right for my problem?

I would certainly be looking into things like Pilates as it does sound good. I must find out what my back problem actually is caused by first though as I don't know what may or may not be suitable because I don't have a diagnosis to work from. I'll ask my physio about Pilates as she may know how to do this with me.

I am actually going to go to a different hospital as the hospital I am currenty at is no help whatsoever to me as their consultant doesn't even want to see me and he hasn't even given me a reason. The physio just told me "he doesn't want to see you" and that's all I know on this. As you probably can imagine I am very fed up of being dismissed by so-called health professionals and have absolutely no confidence in them now at all, unfortunately, after this awful treatment I've been getting from the "invisible consultant".

As for how it effects my life: Yes I am spending a lot of time and energy on my back roblem as I want my back to at least improve rather than ignoring it. I can't work as the pain is too much when I do anything that aggravates it and have now had to tone everything down more and only do the things that aggravate it if they are absolutely necessary. The things that aggravate it are physical things, including bending, standing for a long time, walking for a long time, sitting for a long time. I can't travel as sitting is a problem and not worth the pain.  Currently I am doing nothing as regards working as I'm hoping to get more investigations to find out what is wrong and then see what is suitable as regards work.

I was at college but now I can't do anything full-time. I am still trying to learn new things ready for when I do get into work, like getting my Maths skills better and things like that.    

I cope with the pain by taking some painkillers and anti-inflammatories when it gets really bad and not doing anything that may aggravate it, basically adapting my life.  

The pain is intermittent and can range from just lower back pain when only aggravated a bit or to back pain and sciatica down my left leg and sometimes my right leg with accompanied tingling/hot/cold/numb areas.  

As you might know from my first post in this thread, I am obviously young which is unusual, even the radiologist has stated that so I am determined to get something sorted and find out the cause.

Basically, yes it affects my life bad enough to be an invalid as of currently.

I am certainly determined not to be 'brushed off' by the hospital I am at as I feel I deserve better than to be put up a corner and forgotten which, clearly is what is happening to me currently at the hospital I am at.



      




    

    

[Marci3]

Drahn and others:

I bet Dr. Rosen is gone for a while.  If you notice at the top, it now says that Dr. Paul J. Sloser is supposed to be taking the questions for this forum.  Dr. Rosen is probably on vacation or business travel and Dr. Slosar is not responding.  Hopefully whoever is supposed to manage this site will take notice.

However, I want to help as much as I can.  I cannot sit long so, I have to be brief.

First, your MRI results must say more than what you state above.  ie. the L2 bulge-how many MM (size) but more importantly is it impinging (there are many other words used to describe what a regular person would say as making contact with any nerves).  It's also called radiculopathy.

Next, your x-ray's loss of height in areas that don't match the MRI bulge.  Since it's annular it's more likely to not be noticed on the x-ray however what are they seeing at those areas.

L-2 does not  cause pain down into toes or even much past the buttocks/front.

Then your record casually mentions a collagen variant but again without explanation.

The reason I am even trying to understand this poor report is because of your age and the collagen issue.  My first surgery was at 27 and actually was done by Dr. Rosen's colleague-Dr. Keister.  It was a success until I injured the next disc up from the one he operated on at 43.  That may sound like a million years to you but I guarantee at 43 you do not want to be in the pain I am in.

So, about the collagen...have you ever noticed that you have hyperextension in your joints ie. elbows, knees, hips, etc.?  If so, get back with me.  

Also, either completely write in the exact info from your tests or if you have...run...and find a better imaging company.  

If you want to email off forum, I can be more specific and clarify more for both of us.  

Got to go...back is killing me!

[Debi2008]

I have had an MRI and was told that at L3-4, there is a slight retrolisthesis along with some disc desiccation and a mild annular bulge.  This combines to produce mild bilateral inferior neural foraminal narrowing.  
My T5 vertebra has a mildly wedged shape, with T6 also having slightly decreased height.  Endplate waviness and irregularity at T5-6 and T6-7 suggests a focal variant of Scheuermann's disease.  There is a minimal posterior disc protrusion at C7-T1, with no no effects on neural structures.  However, I have continual pain up my spine, and it's excruciating when I bend over, and can't stand over 15 minutes.  I also have scoliosis, degenerative disc disease, osteoporosis, osteoarthritis, rheumatoid arthritis, fibromyalgia, and have continual hip pain into my lower back, which I was told was bursitis.  Could (or should) these problems be corrected with surgery, and could you explain this in layman's terms on the MRI findings?   Thank you for any assistance you may be able to help with.

[Judy1961]

I am still having problems with pain and pressure in my lumbar spine.  My legs still bother me tremendously.   I had major surgery in October 2007 T-11 to L-3 with rods, screws and cages.   When I try to walk even a block, it feels like someone is trying to hold me back in my legs when walking.   I have increased pressure in the area of the surgery.  I have just recently been able to sleep in my bed again.    This has been nine months post op now.    It hurts to turn over in bed.  Hurts when I lay on my side in bed and try to get up.   I have an upcoming appt at the end of this month, versus ending of November to see the neurosurgeon again.  Also, I have a ripping feeling in my surgery scar area when wiping after going (I have to lean to the left) to restroom and that is the side that the graft was taken from my hip.

I don't see how my neurosurgeon thinks I am able to work with all of this pain.

Judy

[Marci3]

You did not understand when I said "Pilates", I did not mean "just excercise".  Pilates is the best physical therapy/excersice for the back because of 2 major reasons:

1. Breathing in Pilates is the proper breathing to strengthen your lower abs along with numerous other benefits of learning the breathing with the body movement.

2. The body movements are very simple and yet they work your body back to being aligned.

MOST IMPORTANT-MAKE SURE YOU ARE ON A ONE ON ONE BASIS FOR YOUR INSTRUCTION.  If you aren't instructed properly, you won't understand the huge benefits of this type of excercise.  

Other excercise, such as riding a bike has nothing to do with your back...it's just cardio that is ofcourse healthy in general but Pilates is more like a system that focuses on proper body movement in time with proper breathing.

You are spending a lot of time and energy on your back problem...however...I don't recall if you stated how it impacts your lifestyle (what you were oing and cannot do now) and pain levels and how you are dealing with that.

Please update on the overall back problem vs. living life.

M


  

[Drahn]

Sorry for double post. I don't think I can edit to add this. :)

I'll try and get some more tests other than just 'imaging' ones as these, I've heard are not always reliable and sometimes don't always show the real cause for the pain.

Once I know exactly the cause of my pain then I will look into doing some Yoga, pilates, riding my bike, swimming, etc as these, like you said will all help to build the muscles up.

I don't think surgery is the answer in any case of real back problems as it isn't guaranteed to 'fix' the problem completely. There are alternatives like Prolotherapy that I may consider.



  

[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

[chuck064]

doc, im a 43 yr old fuel tanker driver,I slipped and fell while delievering fuel,i landed on my butt bone.This was 1/27/08.I went to the workmans comp doctor,he sent me for x-rays and mri.The doctor said i had degenerative disc diease.He then sent me to a nuero surgeon.To make a long story short,I had a lower lumbar fusion done 4/18/08.He had me on 20mg oxy's one every eight hours and one hydrocone every four hours 7.5/500.I have been in terrible pain every sense,which i have had x-rays taken every month before my Dr's visit,he kept saying everything looked fine,cept my left leg had bad reflexes.So on july 28 of 08 i'd had enough and went to the emergecy room.The E.R. Dr. had a mri done the first i had sense the surgery.She found some sort of small pockett on the mri.so she called in my surgeon.he looked at it and thought it might be an infection,so that following monday he did surgery to take some cultures.Well the next day he came to my room and said he took the cultures but it didnt look like there was any infection.So i asked him why was I in so much pain and what was that pockett on the mri?Dr rosen he never gave me a straight answer.The nurse told me later not to say anything but she thinks it was an air pockett.Sir could you please give me your opion on this? Im still on the same medice and dosage thank you for your time sir.

                                                                                          chuck064

[Drahn]

Thanks for sharing your experiences, jenka and Judy1961, I really appreciate it as no one else seems to be answering my questions here at the moment. :)

I'm probably not going the fusion route now as I have heard a lot of unsuccessful outcomes in a lot of places. I feel sorry for both of you, jenka and Judy1961 and thank you kindly for posing your experiences.    

[Judy1961]

I am still having back pain and trouble walking and my whole lumbar spine has been surgically fused.

[jenka]

DO NOT GET SPINAL FUSION SURGERY! It is awful man. I went through it, my leg felt better instantly yet after a few months the pain and the instability became 1000000 times worse than before surgery.. it is an awful, awful awful thing.. don't do it!

[Drahn]

Could you please tell me what information you need?

Thanks.

[Charles Rosen, MD]

Dear Drahn,
There is not enough details for me to answer.  Sorry.

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