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What does "schmorl nodes,minimal degenerative retrolisthesis at L5/S1" mean?

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Posted on Mon, 28 Jul 2014
Question: Can you tell me what all this means? I have been through conservative treatments for around 9 months now including LESI and other injections and ablations with no relief could I need surgery? Back problem for over 2 years now. MRI results- schmorl nodes,minimal degenerative retrolisthesis at L5/S1,degenerative changes greatest at L5/S1 with moderate to severe disc space narrowing, spondylosis,and type 1 discongenic end plate changes. Marrow signal intensity overall mildly uniformly diminished,may correlate if there is concern for anemia. Lumbar disc displacement L5/S1 w/ generalized disc bulging superimposed mild to moderate central and left paracentral disc herniation with extrusion also likely extending into the proximal left foraminal region,may also extend into right paracentral region with disc herniation abutting the bilateral S1 nerve roots. Broad based left foraminal to extraforaminal disc protrusion,abutting and displacing the left L5 nerve root, and disc bulging and spondylosis in the right foraminal region abut the right L5 nerve root. no significant central spinal stenosis. Neural foraminal stenosis greatest and at least moderate on the left at L5/S1. I have severe nighttime pain barely able to role over or move my legs at night. pain is better in an upright position. I also have systemic lupus, hashimotos thyroid, and RA.
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Answered by Dr. Karl Logan (51 minutes later)
Brief Answer:
Spinal surgey indicated

Detailed Answer:
Hi, Thanks for your question. The symptoms you are experiencing sound very significant. It sounds to me as if you are nearing exhausting non-operative methods of managing them.

Based on your symptoms, MRI report and your age I would have thought that you would be a good candidate for surgery to your back to decompress your nerve roots and possibly fuse your L5/S1 level. An orthopaedic surgeon or neurosurgeon with an interest in spinal surgery should be able to give you further advice and hopefully offer you a more definitive solution to your problems.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Karl Logan (9 minutes later)
would you have any idea what may be happening at night? Some times it feels as if the bones pop around some how could this be happening from what is indicated in the report info.? Pain management just wants to do more LESI would you suggest this, is there an amount that is to many or unhealthy? Or in your opinion should I get to the orthopedic surgeon for review and consult??I see you are an orthopeadic surgeon. May I ask if I were your patient is there a particular surgery you would advise?? Just want some type of comparison for future advice. Considering my age and problems of course? I know it may be a little difficult to say without an actual examination. But a rough guess maybe. Thank you for your time and help.
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Answered by Dr. Karl Logan (5 hours later)
Brief Answer:
Treatment options suggested

Detailed Answer:
Hi,

Thanks for your follow up question.

I would recommend that you see an orthopaedic or spinal surgeon.

I would not have thought that further local anaesthetic and steroid injection would be of benefit.

Essentially the surgery that could be done would be to decompress the nerves at the L5-S1 level that are being compressed by the disc prolapse. Consideration should also be given to fusing this level of your spine. This would be done by removing the disc between the L5 and S1 vertebrae so the bones join together. Some metal rods and screws would be put into your spine to hold the vertebrae together until they fuse.

I hope this answers your question.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Karl Logan

Orthopaedic Surgeon

Practicing since :1999

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What does "schmorl nodes,minimal degenerative retrolisthesis at L5/S1" mean?

Brief Answer: Spinal surgey indicated Detailed Answer: Hi, Thanks for your question. The symptoms you are experiencing sound very significant. It sounds to me as if you are nearing exhausting non-operative methods of managing them. Based on your symptoms, MRI report and your age I would have thought that you would be a good candidate for surgery to your back to decompress your nerve roots and possibly fuse your L5/S1 level. An orthopaedic surgeon or neurosurgeon with an interest in spinal surgery should be able to give you further advice and hopefully offer you a more definitive solution to your problems. Best wishes