Question
I am 47 male, who suffered a preforated diverticulitus 0n 12/03/02 complications led to ingunial herina 8"wide by 12" long I attempeted to work in april 2003 and started having leg swelling, numbness and low back pain,  diogn. is L-4-5 disc buldging degenrtive changes, biladlateral neural foriminal stenosis,L-5 S-1 disc buldging 4mm paracentraldisc protru.moderate stenosis also secondary to end plate  degentritive changes as well as gd.1 sublaxtion bilaterial spondylolthis, I am recovering from abdominal reconstrution and clostomy reversal since aug 13/04 Where(the disorder) and when do I begin to treat the back disorders? the Pain is taking a toll on me,I'm in pain mgt on fentenyl,50 mg,hydrocodone5/500mr, naproxen 500mg and flexeril 10 mg, State HMO dicscontinued Phsycial therapy as untreatable cronic condittion and  my ortho DR. realeased me saying he could not do anything else because of the high risk due to the abdominal issues. Any suggestions as to my next step,Primary care is to sch. MRI to re-evaluate the back and the surgon has  requested CT for abdomon  WHAT a mess this all is!! HMO wants an ENDOSCOPIC DISCOMTOY and LAMINECTOMY thanks for your help in advance!!!

Answer
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Dear Mr. Normandin,

Your condition is indeed a complex one. From what you describe, surgery for your lower back might be indicated, but the abdominal problems might make it a bit more complicated.
Without having a good look at your CT and MRI, it would be irresponsible of me to suggest surgery, but from what you have written it appears that the main back problem would be the L5-S1 Spondylolisthesis (= forward slippage of the L5 vertebra over S1), causing both back and leg pain. This problem is usually treated on a sliding scale according to pain severity and response to treatment. We start with mild pain killers, Physiotherapy, Lumbar brace support etc. and graduate to epidural steroid injections and eventually surgery if all else fails.
You seem to have received all treatment options, so surgery might well be indicated. As I said, it is imperative to see your imaging before suggesting the exact surgical procedure necessary, but Spondylolisthesis is NEVER treated with a decompressive procedure only (as you have stated your HMO thinks you need).
If you are able to upload your imaging somewhere, and send me a link, I will gladly have a look at them and tell you what I think.

Sincerely,

Dr. N. Rahamimov