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    Suggest treatment for degenerative disc disease post multiple discectomy

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Posted on Sat, 4 Jun 2016 in Brain and Spine
Question: hi, I am 39 yr old man, I have had two discectomy on L4 L5 in the past ten years. I am now living in severe constant pain, my latest mri from 2 months ago show that I have degenerative disc disease in 6 discs, my doctors and consultants have told me I have a spine of an 80 year old and they can do nothing else for me, someone must be able to help me, I am in severe pain and have no quality of life
doctor
Answered by Dr. Erion Spaho 41 minutes later
Brief Answer:
Extended laminectomy and fusion should be considered.

Detailed Answer:
Hello and thanks for using HCM.

I have read your query and understand your concerns.

Sorry to hear about all these problems especially at your age.

In my opinion, multilevel discs disease of the lumbar spine needs to be treated surgically with extended posterior laminectomy (multiple levels laminectomy) and posterior multilevel hardware fusion, if other measures (physical therapy and antineuralgic drugs failed to improve your symptoms).

However, it is necessary for me to examine the MRI report or images, in order to be more correct in recommendations.

It is necessary to also for further examinations such dynamic x-rays of the lumbosacral spine (flexion and extension position) to evaluate any instability.

Awaiting for the MRI report......

Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Erion Spaho 1 hour later
Hi thanks for your reply. I have tried to upload the disc with the mri from February but it will not upload, how else can I get this to you? We have been told by consultant/spinologist that an operation will not help, he was talking about a fusion and that this could possibly Make it worse.
doctor
Answered by Dr. Erion Spaho 19 minutes later
Brief Answer:
You can use google drive.

Detailed Answer:
Welcome back.

You can use google drive to upload the MRI DICOM file and post the link here, or you can write or take a picture of the MRI report here.

Greetings.
Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Erion Spaho 30 minutes later
I have took a photo of the report and put it up, can you let me know if you can read it. If not I will try Google drive. thank you
doctor
Answered by Dr. Erion Spaho 26 minutes later
Brief Answer:
The report was not uploaded.

Detailed Answer:
Hello again.

The report is not uploaded, it should be uploadable as a picture using the reports section/button on your HealthcareMagic page.

Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Erion Spaho 10 hours later
Hi, thanks.

The report says the following: degenerative changes at all lower dorsal and lumbar levels but most severe from L 2 downwards loss of disc height.
Minor chronic endplate changes of 23 03/04.
Minor encroachment into the exit vitamins bilaterally at 3/4.
From L4-S1 there are more marked there are protrusions extending into the left lateral recesses abutting against the adjacent nerve roots. This is most severe at s1 where there is root displacement also.
Minor ligamentous thickening of adjacent facet joint also.
Summary: multilevel degenerative changes as described with tight narrowing of the recesses of local levels on the L5/S1.

Look forward to hearing from you
doctor
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
Surgery should be considered.

Detailed Answer:
Hello again and thanks for the clarifications.

As I suspected, there are multilevel degerative changes of your vertebral column with compression on neural components.

The root of your symptoms seems to be arising from changes from L4 to S1 levels, and if there is clinical correlation too ( pain and numbness distribution ), in my opinion, laminectomy, foraminotomy and fusion in these levels (L4 to S1) should improve your condition and stop further progression.

Hope I helped you.

Greetings.
Above answer was peer-reviewed by : Dr. Deepak
doctor
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Follow up: Dr. Erion Spaho 1 hour later
Hi, thanks for the reply,

I have seen two consultants in XXXXXXX and both have said that I should not have surgery/fusion as this will probably make me worse. Is the procedure you are suggesting different than what they suggested? They also said a fusion could be done maximum 3 levels.
My pain is deep in my lower back , going down into both legs but mostly my right leg, not below ankle.
I have been told no surgery in XXXXXXX will help me.

Thank you
doctor
Answered by Dr. Erion Spaho 6 hours later
Brief Answer:
Surgery is possible.

Detailed Answer:
Welcome back and thanks for being on follow up.

Surgery that I suggest consists on laminectomy, or decompression of spinal cord and nerve roots by removing a bony part that confines the spinal canal posteriorly, and fusion/stabilization with screws and rods to prevent lumbar column movement.

Basically this surgical procedure prevents further deterioration by stabilizing lumbar column and improves symptoms by decompression of neural structures.

Actually I proposed a L4-L5-S1 laminectomy and fusion that includes three levels regarding to MRI report, however, when needed, laminectomy and fusion can be extended by four or even five levels.

It is true that there may be recurrence of the condition in the future at upper levels (L3-L4, L2-L3) because of the transfer of vertebral column loading at these levels, since levels below are fused, but, with proper precautions (avoiding weights, loosing body weight, avoiding excessive bending or stretching, exercise to enforce lumbar musculature) this can be prevented.

It is a surgery performed by spine Surgeons or Neurosurgeons.

Hope I helped you.

Take care.
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3852 Questions

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