Question
I've been dealing with back pain since my early adult hood around 20 yrs old. Pinched nerve in low back here and there that was debilitating. I've had pain in my neck since about 17 yrs ago, I remember because I went from a water bed to a regular bed. So I've had numbness in fingers/hands for years, constant kinks in the neck, pain in elbow, pain in arm coming from shoulder or from carpal tunnel?...anywho
history @ 10 was riding a bike, BIG kid run out in front of me and I hit him flying face first into the cement...broke my two front teeth, 2 accident riding  in 2 seater small truck me in the middle at 17, no seat or belt, they hit a ditch and my head shot up and smacked the top of the cab, blood shot out my nose and I felt something in my neck but didn't' hurt any length of time so life went on.  I was pushed by my ex husband while pregnant and fell flat on my a$$. No injuries resulted, during my 20's I worked in a factors and drove forklift....forklifts have no shock absorbers and I was "it" the shock absorber, I used to get sharp pains in my neck and back. ..in my early 40s I went to the basement in socks and reached below to turn the light on, fell three steps flat on my a$$ again but this time it hurt and it hurt for some time. AFter a few months it hadn't gone and I was having leg pain which I associated with Hrp so we started investigating and did an mri which showed a severely herniated disc and another and some facet joint problems as well as arthritis and degeneration, it's now two years after first mri, dr had a head to tail ie full spine mri and I have I counted 9 buldging discs, facet joint hypertrophy, the one disc is completely blown, mild thoracic scoliosis and spondylosis, mild ventral cord effacement, thoracic discs between T1 & T10 are desiccated, spurs in neck, c3-4 broad central protrusion, cord effacement, mild/moderate canal stenosis and moderate right foramen stenosis. c4-5 broad posterior protrusion/spur complex, larger right side. c5-6 broad posterior protrusion/spur complex, larger right side, moderate to severe canal stenosis. severe right lateral recess and foramen stenosis. moderate left foramen narrowing.
c6-7 broad posterior bulge/spur complex, w/moderate to severe canal stenosis. bilateral foramen stenosis.

L4-5, severely decreased disc height, L4 anterior listhesis, broad annular bulge and broad 3mm posterior portrusion, effacement of thecal sac, and encroachment o foramina, moderate left foraminal stenosis, marked right foramen stenosis. narrowing of left lateral recess. mild facet hypertrophy. marked endplate marrow edematous degenerative changes, greater central and right side.
L5-S1, mild L5 posterior listhesis, and broad 2mm central/left paracentral portrusion, with thecal sac effacement. mild facet hypertrophy. mild thoracolumbar scoliosis. and last but not least

Thoracic Spine without contrast......
mild thoracic scoliosis. mild spondylosis between T2 and T10. Mild ventral cord effacement. no focal herniation, no market bulge or posterior spur. no canal or foramen stenosis noted.

So what is the worst area that you can see and does it look like surgery? I'm being sent to the top neurosurgeon in the area. I wonder if I could get on disability...?

Answer
Dear Elizabeth,

Sorry it has taken me a few days to return your question.  I have been swamped at work and with two small boys at home, and I wanted to be able to devote some uninterrupted time for your answer.

The worst problem area I can ascertain from your MRI descriptions is in the lower lumbar spine (low back).  The L4/L5 and L5/S1 vertebral levels have significant dysfunction and degeneration.  The term listhesis means movement of a vertebral segment from its proper position in the spinal column. You have this movement backwards at L5 and forwards at L4.  The movement places increased stress on the associated disks, and increases tension and pressure on the spinal cord.  This is coupled by the fact that your disk material at that level is already pushing on the outer covering of the spinal cord (the thecal sac), and is affecting the nerve roots exiting the spine in that area.  The term stenosis is used, which basically means that the diameter of the holes containing the spinal cord and the nerve roots has been narrowed.  This does not allow free movement of the structures and can easily result in inflammation, friction or pressure on the nerve roots and spinal cord.  Now, couple all of these findings with degenerative facet joints (the joints between the vertebra that allow movement), and you are probably in significant pain locally in the low back which probably radiates into the buttocks, hips and legs.

What would I recommend?  I think that you should explore a non-surgical option called intervertebral disk decompression therapy.  It utilizes spinal traction at specific angles to target the disks in the spine.  It is typically used in the low back (lumbar spine) and the neck (cervical spine), but not in the mid back (thoracic spine).
Names to research are Accuspina, DRX 9000, Chatanooga DTS, Lordex, Spinal Aid, Spine Med, and Vax-D.  I favor the Vax-D because it is the original decompression machine and the only one classified as performing decompression by the FDA. Orthopedic surgeons, neuro- surgeons, chiropractic physicians, and pain management physicians have also endorsed the Vax-D  Check them all out though, so you can get an appreciation of what is out there.

Buyer Beware:  The technology is good, however, the price may not be.  When looking for a decompression clinic make sure that you get all the information up front concerning the program and costs associated with it.  The program should be somewhere in the range of 24 to 30 visits, and physical rehabilitation should be included.  Some clinics charge $5000.00 to $6000.00 for these programs which is a rip off.  Do not pay more than $3500.00.

Now having said that, it is definitely possible that you may not be a candidate for decompression.  Some authors have stated that if you have spinal stenosis, you should not do this.  On the other hand, all disk bulges produce some form of stenosis, and this technology was developed specifically to help disk pathology.  Make sure you get all the facts about the machine you choose.

Surgical correction:  I have seen hundreds of patients in my clinic because of the fact that they have had back surgery that did not work.  The medical community has actually coined new diagnoses for this called failed back surgery and post laminectomy syndrome.  Basically meaning that the surgery did not help reduce pain or increase function, and may have made the situation worse.  I am always in favor of trying to eliminate the need for surgery if possible, however, I have also sent patients to surgery when needed, and I have to say that the patients I have referred out for surgical correction have all done pretty well.  Sometimes surgery is the best option, and you must consider that possibility.  I would also recommend that you make your surgical consult so that you can get all the options...just do not expect the surgeon to be well versed in decompression therapy, its not how he makes his money.

Lastly, I hope you would not need disability.  Why would you want it?  Staying positive and weighing your options for the best treatment is a better way to look at things.  Not to mention you will need to have tried conservative options first, and surgery second before disability is even an option.  No agency will give you disability if there are available treatment options.  Furthermore, your doctors will have to evaluate your condition and give a recommendation for a disability rating to be considered.  I hope you will not need this evaluation, and that your pain can be reduced and function improved...that's the best resolution for everyone.

Good Luck Elizabeth.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net