First post, advice needed!

[rbrown]

MRI of the Lumbar Spine 4/23/2013:Clinical Indication: Remote microdiscectomy in 2006. Recent redevelopment of bilateral lower extremity pain associated with numbness and paresthesia.
Siemens Espree 1.5 Tesla
Sequences: Coronal PD; sagittal T1, T2 and STIR; axial T2.
Comparison: March 30, 2011
Findings:
Redemonstrated is the grade 1 anterior displacement of L5 on S1. The lumbar vertebral body heights are maintained. Degenerative marrow changes at redemonstrated opposite the L3-L4 and L5-S1 disc spaces.
The L1-L2 and L2-L3 disc spaces remain normal.
L3-L4: Redemonstrated is the right hemilaminectomy and partial right facetectomy. The central canal remains widely decompressed. Normal neural foramina bilaterally.
L4-L5: There is mild posterior annular bulging without canal or foraminal stenosis.
L5-S-1: The bilateral pars interarticularis detects are redemonstrated. There is stable mild posterior annualar bulging. There reminas mild to moderate narrowing of both neural foramina.
Normal conus medullaris. Normal paravertebral soft tissues.
Conclusion:
1. Overall, no significant change from the March 2011 exam.
2. Stable post-operative changes at the L3-L4 level without residual or recurrent canal or neural foraminal stenosis.
3. Stable degenerative disc bulging at L4-L5.
4. Stable grade 1 isthmic spondylolisthesis of L5 on S1 with stable mild to moderate bilateral neural foraminal narrowing.

[jsewell]

Hi Randy,
I actually live in Duarte, almost in Monrovia now. Still neighbors. I am no good at interpreting MRi's that is for sure . but in reading yours what i want to say first is i have had some MRI's that have stated mild changes which hurt like you know what. So i don't believe everything that is stated is correct regarding pain. I had a right hip MRi that stated no arthritis. My hip surgeon did arthroscopic surgery looking for a simple tear and found my whole hip was arthritic on both weight bearing surfaces. Next step total hip replacement.
So in reading yours it sounds to me like the L5-S1 is impinging on nerves for sure and could certainly be the cause of your problems.
I know you have been to a few different health professionals. But have you had a second opinion with a spine surgeon? That would be my first step. "And quickly.
I have had 9 spine surgeries in the last 5 years and most with the same surgeon. I trust him, but i just cancelled the surgery which was planned this summer after getting a second opinion. The second opinion doc made so much sense regarding my problem with walking and even standing. My whole spine is very out of sagittal alignment. I can't stand up anywhere near straight and it is getting worse . So a total reconstructive surgery is now planned with this surgeon that i just saw on Monday.
I am ok when i am sitting up in bed and that is where i have spent the whole day. Standing and walking i am all hunched over and it gets more painful the more i do it. My spine no longer has the normal curves it needs.
Good luck in getting to another doc soon.
Judy

[rbrown]

Any recommendations for a 2nd opinion? I'm in Monrovia, Los Angeles County. I have United Health Care HMO and am in the Healthcare Partners network. We are thinking about switching to PPO if needed!

[Maria]

Hi and Welcome
I agree w/Judy re MRIs sometimes stating things in a manner that would appear nothing much should be bothering one or not so much and the reality is quite different in terms of pain. I also suggest seeing a good spine surgeon.

If your spine situation isn't Workers Comp and you have an HMO you are pretty limited in who you can see w/o paying cash. I'd definitely switch to a PPO if able to. The only thing is you will still be limited to surgeons within a network and if you go out of network you'll pay probably at least a 40% of the costs.

Can you find out what spine surgeons would be in a PPO plan that you might be able to obtain and then see if you can switch to that plan? Or would you want to pay cash for consultations while you're in an HMO?

Do you want to see a Neurosurgeon or an Orthopedic Surgeon or both for opinions?

My last spine surgery consults were in 2006 and I saw Rick De La Marter (sp) in Santa Monica, John Regan (think he was at Cedars) and Frank Coufal in San Diego.

The first two surgeons mentioned are orthopedic spine surgeons and the last one is a Neurosurgeon. I decided not to have more spine surgery (had 2 discectomies back in '89 and 92).

Good luck and keep us posted! Maria

[rbrown]

Originally Posted by Maria

Hi and Welcome
I agree w/Judy re MRIs sometimes stating things in a manner that would appear nothing much should be bothering one or not so much and the reality is quite different in terms of pain. I also suggest seeing a good spine surgeon.

If your spine situation isn't Workers Comp and you have an HMO you are pretty limited in who you can see w/o paying cash. I'd definitely switch to a PPO if able to. The only thing is you will still be limited to surgeons within a network and if you go out of network you'll pay probably at least a 40% of the costs.

Can you find out what spine surgeons would be in a PPO plan that you might be able to obtain and then see if you can switch to that plan? Or would you want to pay cash for consultations while you're in an HMO?

Do you want to see a Neurosurgeon or an Orthopedic Surgeon or both for opinions?

My last spine surgery consults were in 2006 and I saw Rick De La Marter (sp) in Santa Monica, John Regan (think he was at Cedars) and Frank Coufal in San Diego.

The first two surgeons mentioned are orthopedic spine surgeons and the last one is a Neurosurgeon. I decided not to have more spine surgery (had 2 discectomies back in '89 and 92).

Good luck and keep us posted! Maria

These are some of the questions I dont know the answers for. Should I see a Neurosurgeon or an Ortho Surgeon. Ive already seen Neurosurgeon Dr. Ross in Pasadena he performed the procedures I had done in 2006. He basically said only I know how much pain im in and he could do a fusion if I choose to have surgery. I wasnt in much pain when I saw him 2 months ago. He didnt offer or suggest any other test, or even give a diagnosis besides "your a young guy with a bad back". I have almost no leg pain besides a slight feeling in my left calf. When I'm off the Prednisone my low right back goes into full lock up spasms which is very painful if I move. If I'm lying down not moving, no pain. I had an appointment with Dr Seltzer at Pasadena Rehabilitation. He is the medical director there. He is an anesthesiologist. I am approved for lumbar facet medial block injections. Does it make sense to have these if I'm not having leg pain? Just really felt like it was take a number and heard me out as fast as possible with no feeling or wanting to get to the bottom of the pain and why.

[jsewell]

Randy we had car issues here today and i was out and on the phone and missed calling you. it is 10 now and i feel it is too late. i will try harder tomorrow.
I see DrSeltzer as my pain management doctor. My spine surgeon, in Pasadena, DrWilliam Costigan has done all my injections. Is DrSeltzer not giving you anything for pain or were you ok when you saw him. I am currently on morphine. I would get myself to a spine surgeon and ask for a diagnosis . hopefully we will talk tomorrow
judy

[rbrown]

Originally Posted by jsewell

Randy we had car issues here today and i was out and on the phone and missed calling you. it is 10 now and i feel it is too late. i will try harder tomorrow.
I see DrSeltzer as my pain management doctor. My spine surgeon, in Pasadena, DrWilliam Costigan has done all my injections. Is DrSeltzer not giving you anything for pain or were you ok when you saw him. I am currently on morphine. I would get myself to a spine surgeon and ask for a diagnosis . hopefully we will talk tomorrow
judy

I wasnt in pain when I saw Dr Seltzer. He did prescribe Norco 10/325 in case. After the first cycle of Prednisone was gone and the spasms started I used the Norco I think three times and didnt feel it did anything. Hopefully we will talk tomorrow. I'll be free after the Chiropractor after 1:00pm.