Scoliosis, retrolithesis, multi disk deg, and pain

Scoliosis, retrolithesis, multi disk deg, and pain

Q:

Age: 43 Sex: F Concern: Chronic pain

I have always been very active-swam collegiately and then competed in triathlons, last one being the Canadian Ironman ('98). Five months prior to the Ironman, I fell down 4 stairs and basically did a push up to keep my head from hitting the concrete floor. I jammed my lower back, went to ER, then f/u with an ortho. She jerked me upright, ordered an MRI, said it was fine and prescribed 1 month of PT, pain didn't subside, it hurt when I turned/twisted and when I sat down. 1 yr later, I f/u with another MRI that said my anular tear had healed, but my disc was gone at L3-L4 and my pain was bone to bone-I either could have surgery for a cage or nature would heal it in 5 yrs. It is now 11 yrs, I have managed with freq. deep tissue massages and anti-inflammatory med. Until now, my pain is 8/10, meds are not helping, little relief from massage. My left hip is almost 1 in higher than my rt, and rotated inward and I am shifted out to the left, I have pain in my left hip and IT band, my lower back spasms. My recent MRI states "rt convexity of lumbar scoliosis centered L3 assoc with mild retrolithesis on L2 on L3 and L3 on L4, marked DDD at L2-L3, L3-L4, L4-L5 (loss in disc ht and signal) ext. discogenic marrow changes adj to degen. portions of discs at above L2-L5, I have mild-mod facet arthropathy at L4-L5, L5-S1, I have mild-mod rt sided neural for. stenosis and left sided neural foraminal stenosis at L2-L3, L3_l4. I basically can swim and lift wts or I tighten up and spasm. Will I need surgery?

Thank you,
Julie

-- JulieG.

A:

I would say probably not unless you have neurologic deficits. Reconstructive spine surgery for pain is a 50/50 proposition. You can get better or worse. Every case is highly individualized. If you have leg pain and obvious evidence of nerve root irritation or compression, limited surgery to address that level would yield better result. See several spine specialists for opinion. I'd be that you'd get a spectrum of opinions. Go with the most conservative approach first before embarking in invasive procedures.

-- Sherman Nam Tran, M. D.

to ask Dr. Tran.