New member seeking advice regarding DDD in Lumbar spine
 

Hello all,
I'm not sure I'm really "new" at this point (I discovered this site in the August-September timeframe last year, and have been a registered member since October 2015), but this is the first time I'm actively reaching out for input and advice instead of just reading the various discussion threads. I recognize most members are not medical doctors, but during the countless hours I've spent reading the various threads, I've developed an impression that there are some really knowledgeable and experienced members that can be a great resource.

I'm a 54 year old male that has lived a very active lifestyle (little league baseball & soccer, trained karate on-and-off since the age of 12, running, biking, tennis, racquetball, etc.), and now I'm starting to pay for it.

Last Summer I started having debilitating back pain with radiculopathy causing sciatic pain and "foot drop" in my right leg. In August, I had an MRI which revealed the following:

FINDINGS: Alignment is normal. There is mild to moderate L3-L4, severe L4-L5, and mild L5-S1 disc degeneration. Conus medullaris is normal residing at T12. There are no pars defects. Bone marrow signal is notable for mild type 2 endplate reactive changes at L4-L5.

L1-L2: Normal
L2-L3: Tiny midline protrusion.
L3-L4: Disc bulge and small midline protrusion resulting in mild bilateral neural foraminal narrowing, but no canal stenosis or nerve root impingement.
L4-L5: Disc bulge with moderate superimposed right lateral protrusion resulting in severe right and mild to moderate left neural foraminal narrowing but no canal stenosis. Protrusion impinges the right foraminal L4 nerve root.
L5-S1: Tiny midline protrusion.

Question for you all: I'm I screwed? Is the assessment above really bad, not so bad, etc.? Am I looking at 3-level disc replacement? What is the frequency of autofusion? Any input, advice, etc. would be greatly appreciated. I've attached an X-ray from last August that was taken shortly before the MRI was performed.
Thanks,
BIB

I don't think you are screwed, you just need to find your pain generator(s). By your age, we are all going to have some bulges and (likely extensive) degeneration going on with our discs, so some of your findings are totally normal. You just need to isolate what is generating your pain and address that portion of your spine.

I'm going to guess your l4-l5 is the rotten one.

No
 

I don't think so either, looks like most of your levels have plenty of height, and only 4-5 looks troublesome. I think mine looked worse, 5-1 was bone on bone, 4-5 was worse, 2-3 also.

I would not be surprised that if you reach out to someone like Clavel, he might recommend just one 4-5 level ADR.

Also, if your issue is just a protrusion, you might just need a discectomy, which is a relatively successful procedure.

Back in Black,
Two of the best in business are Clavel and Bertagnoli.......they give you free evaluations and reports with their price quotes. You've got nothing to lose. get your X-rays, CTs and MRIs together and fire them out. Light it up and get their opinions too.

Mine was much worse so take heart! 4/5 looks like your problem but get that verified. There are two problems that can potentially occur; 1) That you do too much surgical intervention that wasn't necessary or 2) That you do too little and wind up on your back again.

Give it your full attention on the front end and take your time, IF you have the luxury of time to do so.

Regardless, IMO, if you had other levels of pain generators, say at the L3/4 or L5/S1 then I would definitely throw in the 4/5 too because if you're opened up anteriorly, get her done since it is toast.

FutureRobot, Romakis, Fathub, and drewrad - thanks so much for your thoughts and suggestions, they are much appreciated. The L4-L5 is definitely the pain generator. The orthopedic surgeon I saw in conjunction with the x-rays and MRI being done last August pointed out to me the particular MRI views that showed my nerve root on the right side at L4-L5 being completely crushed, and stated that he disagreed with the MRI report (he thought it was a herniation and not a protrusion). He also said the disc should heal on it's own but suggested I get some epidural cortisone injections to bring down the pain and help the healing process. The 2 injections I got did nothing to relieve the pain, but after 3 or 4 weeks I did notice a steady reduction in pain over a 2 week period. I don't have the sciatic pain or foot drop syndrome anymore, but there is still some mild discomfort in my back and can't help wondering when things are going to get ugly again.

I will reach out to the doctors you recommend. Dr. Clavel seems to be very popular on this board, so he'd be my first choice if I end up going overseas.

Have you checked your pain vs. a nerve ennervation pathway chart? It's easy to say that you have impingement at level x so that's your pain generator but, in a rather public talk given around a decade ago, Zeegers pointed out that it isn't always simple. He had a patient with two disk, one obviously bulging and a second slightly so. The main pain generator was disk nucleus leaking from the slightly damaged, but non-obviously torn disk, not the bulging one. I wouldn't expect that your diagnosis would change if you checked but it's easy enough to find an ennervation pathway chart on the internet and make sure the part of your body that is feeling pain is linked to the nerves that are being pressed at L45.

Thanks Annupurna,
Was not aware of this pathway chart. I will certainly look into it.

Dermatome chart