Lumbarised S1. and Severe facet arthropathic change particularly at L5/S1

[sueleahy]

I’m a 59 year old woman who have been in two motor car accidents in 1997.  I suffer from constant lower back pain, and lately I also feel a clicking in the L5 area.  I had 6 cortisone injections in the lumber pinal area 10 months ago.  It took three weeks before it made a difference and then only lasted for 2 weeks.  Since then I’ve been on anti- inflammatories and pain kills. I just had an MRI and CT can done and the results are below.  I’m wondering what the best treatment could be.

MRI LUMBAR SPINE MR51.9
Scanning protocol:  Sagittal T1, sagittal T2, with axial T1 and T2 imaging as well as M.R. myelography.

The distal cord appears intact.
Impressions on the thecal sac at multiple levels.
Multilevel disc dehydration and degeneration.
Parasagittal images demonstrate patent exit foramina.
There is lower lumbar facet arthropathy but no lysis.
The soft tissues anterior to the vertebral bodies appear preserved.

Axial images:
L4 Vertebral body – L4/5 Disc
Disc bulge at this level. No spinal stenosis. No effacement of lateral recess fat. No involvement of downgoing nerve roots. No entrapment or displacement of exiting nerve roots.

L5 Vertebral body – L5/S1 Disc
There is a disc herniation at this level with some inferior extrusion. This is contained by the posterior longitudinal ligament. There is no convincing spinal stenosis. No definite effacement of lateral recess fat. No involvement of downgoing nerve roots. No convincing entrapment or displacement of exiting nerve roots.

CONCLUSION
Multivelvel facit arthropathis change is documented.
There is multilevel disc degenerative disease.
There is a disc herniation with extrusion at L5/S1 but no convincing downgowing or exiting nerve root involvement at present.

CT LUMBAR SPINE   M51.9
Axial CT slices with coronal and sgittal reconstructions as well as 3D reconstructions.

A transitional vertebrum at L1 present with lumbarisation of S1.
There is prominent facet arthropathy noted at the L4/5 and L5/S1 levels.
There is also some facet arthropathic change at S1/2 consistent with a transitional nature of the vertebrum.
The disc spaces demonstrate narrowing particularly at L4/5 and L5/S1 as described on the MR study.
The visualized SI joints appear Normal.

CONLUSION
Lumbarised S1.
Severe facet arthropathic change particularly at L5/S1

[sueleahy]

Thank you so much for your very informative reply.  I had a session with my Nero Surgeon this week.  It seems not as bad as I originally thought when I received the MRI and CT scan report.  I will have to have one fusion at the L5/4 level as the L5/S1 already had a "natural" fusion with the two sacral wings lumbarisation.  My doctor did however state that he is only giving me feedback on the scans and that it is up to me to decide whether I want to stay on the pain and inflammation medication and for how long.  He also said in most cases if you have a fusion that in 10 yrs time I might have to have a 2nd fusion due to the over extension of the other vertebras.   I’m glad he is not one of those who just want to operate.  He referred me to a Biokineticist, who I trust will assist in guiding me in the best way forward regarding my training as it is not always very comfortable walking with the click-clacking of the vertebras.

[ggreg]

I am not expert at reading radiology reports, but the doctor who ordered those scans SHOULD sit down with you and explain what it all means for you, and he should also have an improved treatment plan.  Now, I can tell you this from my similar experience, I too was in a car wreck that fractured my vertebrae in three places, and it also twisted and deformed it to where I have a curvature in the thoracic spine, and also have facet joint syndrome in the lumbar spine.  You'll see that "facet" is mentioned a lot in your reports.

The facet joints are those butterfly bones that stick out from the back of the spine, it allows easy movement of the spine.  But when that gets goofed up, it can hurt like mad whenever you do most anything.  I also DID notice on your scan reports some things about your discs having some problems, which is the cushion thing between each vertebrae.  Those are the two things both scans found, especially at the L5-S1 location.  But since you have those conditions throughout your lower spine, if they were to perhaps fuse or replace the disc at that one location, the others may continue to be a source of pain.  At least the scans said no nerves were being crushed or stuff like that.  But you're like me, it still hurts like the devil.

Me, I've been dealing with it by taking medicines for many years.  In fact, this fall, I have to ask my neurologist to increase my doses on codeine and pregabalin (Lyrica).  That Lyrica medicine is expensive, but it does a pretty good job of handling the lower back pain for me.  Still, I am in pain all the time, it is frustrating, I am tired, I can't hardly do anything I used to do.  So, I also asked my doc to prescribe me a back brace to help me when I'm up and about the few times a month I go anywhere.

One other thing I have found helps is to strengthen the tummy muscles, for they are what help the most in holding the lower spine together.  Also, I often lay flat on the floor with my legs up in a chair or in the couch, takes all the weight off the spine.  Heat helps, too, from a pad or hot water bottle, or a soak in the tub.  But anyway, your physician is supposed to go over your scans with you, you may need to set up a followup appointment with him, so he can decide how best to approach the various problems that showed up in your report.  I feel for you, I have very similar problems, I'm a 61 yr old female, so it's really SO annoying when we still feel so much life in us, and yet we can't hardly do much of anything anymore.  But hopefully your doctor will now try to do SOMEthing rather more dramatic for you than he has been.