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29 year old, two previous surgeries. need advice!

Hello. I'm a 29 year old female. When I was 24 years old I had an emergent laminectomy done at L5-S1 for a "massive" herniation that caused loss of sensation and a rapid onset foot drop on the right. Not even two years after I had a revision of that laminectomy due to reherniation with similar symptoms.
 For the past year or so I have had unrelenting lower back pain and numbness/weakness on the right leg. I never really had lower back pain before - it was almost always strictly leg pain. Unfortunately this pain has caused difficulty doing normal activities of daily living like laundry, dishes, childcare - I even don't want to get up to pee some days! I have tried pain management and take Gralise for the neuropathy (ext release Neurontin) which has helped. I have tried Vicodin for the LBP but it doesn't work and am afraid to keep upping my dosage as I am only 29 and don't want to become dependent on narcotics for pain relief. I have had 6 epidural injections also.
I have an appointment with a different surgeon coming up (switched jobs and my previous neurosurgeon is not covered under this policy). I have had an MRI with the following results:

Minimal scoliosis. The conus terminates at L1

Endplate changes identified at L5-S1 possibly reactive, nonspecific.

No gross signal abnormality is identified in the visualized portions
of the lumbar cord allowing for patient motion. No definite focal
enhancing lesion seen in the spinal cord. Postsurgical changes noted
in the soft tissues at the level of L4-L5.

Disc heights decreased at L4-L5 and L5-S1. There is disc desiccation
at L4-L5 and L5-S1. Subtle epidural fibrosis may be present at L5 on
the right.

Vertebral body heights are within normal limits

Level by level interrogation was performed.

T12-L1, no focal disc herniation. No evidence of spinal canal
stenosis or neuroforamina narrowing.

L1-2, no focal disc herniation. No evidence of spinal canal stenosis
or neuroforamina narrowing.

L2-3, no focal disc herniation. No evidence of spinal canal stenosis
or neuroforamina narrowing. Mild bilateral facet and ligamentum
flavum hypertrophy.

L3-4, no focal disc herniation. No evidence of spinal canal stenosis
or neuroforamina narrowing. Mild bilateral facet hypertrophy and
ligamentum flavum hypertrophy.

L4-5, diffuse disc bulging with a broad-based central disc
protrusion causing spinal canal stenosis measuring approximately 6
mm. Bilateral facet hypertrophy and ligamentum flavum hypertrophy.
Moderate to severe narrowing of both neuroforamina.

L5-S1, diffuse disc bulging, slightly more prominent to the right
neuroforamina region. No significant spinal canal stenosis. Bilateral
facet hypertrophy. Post surgical changes. Severe narrowing of both
neuroforamina

No evidence of infrarenal abdominal aortic aneurysm.

Impression:

1. Discogenic disease is identified at L4-L5 and L5-S1. Broad-based
central disc protrusion at L4-L5 causing spinal canal stenosis at
this level.

2. Neuroforamina narrowing seen at L4-L5 and L5-S1.

3. Post surgical changes identified at L5. Subtle epidural fibrosis
may be present at L5 on the right.

4. Minimal scoliosis.

My previous MRIs never made mention of any herniation at L4-L5 so now I also have multilevel hernations. Also ever only had neuroforaminal stenosis on just the right, never bilaterally. 

I had had previous discussions with my past neurosurgeon who said if I DID end up needing a third surgery it would be a fusion of some sort depending upon the MRI results. Has anyone ever had two previous laminectomies that have failed and what was your outcome? Anyone have a fusion done in their late twenties and what are your thoughts on that?

My background is in orthopedics (RN) but 99% of my patients are over the age of 70 so I don't ever have anyone MY age to compare to.

Any advice is much appreciated.


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Comments

  • SavageSavage United StatesPosts: 4,299
    edited 07/23/2019 - 1:08 PM
    hello jpenguin! and welcome!
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  • What does your doctor suggest for permanent relief? You are very young to have such issues! Those L4-S1 discs seems to be the main issues in the lumbar region. Just curious, have you suffered any trama to that area?
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  • My pain mgmt doctor recommended a surgical consult so that's what I'm awaiting. He has done the epidural injections which has done nothing. I can't recall any point that I have had trauma to that area or a moment where I felt that I "threw my back out."
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