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Undergone eight spine operations on lower back. On high dosage of medicines. MRI showing discs are bad. Advice?

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Spine Surgeon
Practicing since : 2002
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Hi. I am 45 and a disabled vet. I be had 8 spine operations on my lower back including 2 fusions. I am no better pain wise or mobility wise. ,my last surgery was in 2008. I am on high dose of meds and have Bern on the dame dose for 9 years. The meds earen't working. I have made an appt to see an ortho surgeon to see ifthats an option. The VA hospital told me no more surgeries. I do have a referral to see about getting a Med pump implant..I am afraid that no one will want to operate because of my prior ones..give me some advice please. ,y doc won t up my Med dose though offered methadone for pain. I used that for 4 years and gained 40 lbs. And it was really difficult to wean off .. I be said s lot I just XXXXXXX t know what to do.:-) . I know things have changed much since my last spine surgery..I have a recent MRI and all discs except l1 l2 ate pretty bad. The worse pain runs down the front of Mr right thigh diagonally spelling?
Posted Sun, 18 Aug 2013 in Back Pain
Answered by Dr. Rahul D Chaudhari 4 hours later
Thanks for writing to us.
You had 8 spine operations till date. You have been through lots of trauma. Can you tell us what level you were operated? I would suggest to upload your recent mri report to know more about your spine. It will help me to tell you if you really need any further intervention.
Rather depending upon pain medicine I would suggest to find out alternative medicine options such as acupressure and yoga which may help to stretch the stiff body and relieve the pain.
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Follow-up: Undergone eight spine operations on lower back. On high dosage of medicines. MRI showing discs are bad. Advice? 58 minutes later
thank you. I will try to type in my MRI report here it goes..findings: previously reported mild listhesis is again noted at l2-l3 and l3 l4. mild dexttoscoliosis present. Desiccation of the disc l2 -l3. metallic artifact's present at l4_l5 and l5_s1 likely from titanium cages. there are also postlaminectomy changes at l4_l5.
l1_l2 no bulges no stenosis...
l2/l3 level: mild circumferential disc bulge indenting the ventral thecal sac. ligamentous thickening in the facet hypertrophy also indenting the thecal sac bilaterally. the AP diameter of the thecal sac is 9.5 mm compared to 13.8mm at mid l2 suggestive of moderate neural foraminal stenosis due to discogenic change and facet hypertrophy.
L3/L4: mild to moderate circumferential disc bulge with broad based dorsal disc protrusion indenting the ventral thecal sac. facet hypertrophy is noted bilaterally also indenting the thecal sac. the AP diameter of the thecal sac is 9.5mm suggestive of spinal canal stenosis. there is mild bilateral neural foraminal stenosis.
L4/L5: there is no spinal canal stenosis. facet hypertrophy bilaterally , more pronounced on right side. there is moderate bilateral neural foraminal stenosis.
L5/S1: no spinal canal stenosis. facet hypertrophy bilaterally. moderate to marked foraminal stenosis due to facet hypertrophy and possible marginal bony spurs.
the paravertebral soft tissues are unremarkable.
impression: surgical fusion noted at l4,l5 and s1 vertebral bodies with associated laminectomy at l4/l5. Two level mild spinal stenosis at l2/l3 and l3/l4. Variable multilevel foraminal stenosis as described, more severe at l5 - S1.
The normal range of ap diameter is 13 to 21 mm in AP dimension.

OK the above is my MRI word for word. You will understand the terms better than I. By the way I enjoy yoga and it does help. I look forward to your reply now that you have more info. Thank you.
Answered by Dr. Rahul D Chaudhari 10 hours later
You have significant changes in spine. Foraminal stenosis implies to the nerve compression and it cause leg pain. How bad is the leg pain in your case?
You have multilevel disc disease which may lead to back pain.
First we need to know how bad is back pain and leg pain and which one is significant? L5-s1 foraminal stenosis may give rise to leg pain radiating to foot and upper level stenosis may cause pain in thighs. Have you done nerve root blocks? it may give us an idea about painful levels.
You need to wean off from opiates and it will reduce your pain tolerance and it has side effects if we continue indefinitely. I would consider doing nerve root block at L5-S1 level if you have leg pain and discigraphy at L3-4 and L2-3 levels to pin point the back pain. I assume there is no issues with the the back.
You can consider pain pump however it should relieve your pain and you need to be off pain medicine. Otherwise I would consider above protocol. Thanks.
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Follow-up: Undergone eight spine operations on lower back. On high dosage of medicines. MRI showing discs are bad. Advice? 2 hours later
leg pain is severe back pain moderate. I had nerve blocks and s disco gram years ago. the rods and screws removed in case that was worsening my pain. I did a trial stimulator but had to turn the thing so high it was worse than pain. my legs go numb when sitting. I do yoga, that helps. I understand less meds will work better as now my brain doesn't produce endorphins, I get that. I be heard conflicting views on timeframes for my tolerance to go down some say months, others say 5 years or more. and several told me I will always have a high tolerance? anyway provided I have another disco gram, pinpointing, y pain..what surgery would be indicated? I be always felt l3 was the source of my leg pain. the first orthodox I saw did a discogra,m and wanted to do a 3 level fusion but I was 32 and he felt I should wait till I could not stand it before he d do surgery as he said I would lose flexibility. I was disappointed so I ran to another surgeon and had a two level thru the front with 4 titanium cages fusion. the cages shifted within 6 wks as shown by cray. it was a mistake to have that surgery.. 1 yr later at a bigger hospital they went thru the back and put the rods and screws then removed them 18 most later in 2008! I had scar tissue removed several times also. I am going to see the first ortho doctor that suggested the 3 level fusion. I am ashamed to see him again since I be had other surgeries... but trust him as when I idealt with hi, before he ordered the disco gram, had me speak to a psychologist to assess my expectations. so again what. surgery might work? Dr. You are an XXXXXXX medicine doctor, correct? Have you personally answered all my health queries? I ask this because I had thought different doctors names had appeared in my other health questions. I see listed here your name after each one. Did you address my spinal concerns also? I am confused....
Answered by Dr. Rahul D Chaudhari 10 hours later
I think surgery will help you. Definitely L5-S1 need to be addressed and if it is fused in the front then surgeon can do posterior decompression at that level. Now if lL4-S1 completely fused( need to confirm on CAT scan then L3-4 need to be addressed. You may consider doing disc replacement or fusion at that level. (lateral interbody fusion is an option).
If you are close to New York, you can consult DR Girardi at Hospital For Special Surgery. I am trained at HSS. I know he is a good doctor and take good decisions. Thanks.
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Follow-up: Undergone eight spine operations on lower back. On high dosage of medicines. MRI showing discs are bad. Advice? 56 minutes later
Thank you so much for your consult. You have given me hope, really I am now able to feel more positive about my situation . I live in central Pennsylvania so New York would be worth the travel to have the best care possible. At this stage being in skilled hands and good decision making is imperative. I will look online to try to find where the HHS is located and inquire about getting a consult with the doctor you spoke of. also inquiry into what insurance is accepted, etc I imagine there may be a long waiting time for an appointment. I had to wait 4 months for the upcoming appt. At the Orthopedic Institute of Pennsylvania with Dr. XXXXXXX Wolf. Perhaps I can get his opinion also while waiting for HHS, if they will see me. Once again I appreciate the advice and the special attention you have given to my concerns.. Thank you very much Dr. Chaudhari. :-)
Answered by Dr. Rahul D Chaudhari 4 minutes later
Wishing you healthy and happy life ahead. Thanks.
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