Question: Surgery or not? What would be your opinion. I am going to give you my MRI findings in writing, one surgeon said wait to have anything done as their will only be a 30% chance of recovery, another said I would need approximately 4 surgeries over time. Do you recommend Physical Therapy again. I have had it several times. Swimming and the electro heat/cold therapy along with massage helps. I just want my life back so where I can spend time outdoors with my family and have quality of life back. At this rate now, I have none. I do not leave the home unless I have to. I live very rural area up at 8000 feet in Colorado and have to drive 3 hours to doctor appts in Denver and do you know of a surgeon you would recommend in Denver or Pueblo area? MRI Findings: L1-L2Minimal disc bulge no central or neural foraminal narrowing L2-L3 Min. disc bulge Intridiscal contrast is confined to the nucleus pulposus and extends slightly to the inner third of the annulus posteriorly and to the left. Small amt of gas within intradiscal space. Consistent with a Grade 1 tear of the annulus. No neural or central narrowing L3-L4 Moderate diffuse disc bulge with extension of the intradiscal contrast nearly circumferentially around the outer annulus of the disc margin, particularly anteriorly and to the right where it extends slightly caudal to the disc space. The is felt due to a disc extrusion rather than extension of the contrast outside the disc. It is most consistent with an extensive grade 4 tear. There is mild bilateral facet arthropathy and thickening of the ligmentum flavum. The is mild central canal stenosis and mild bilateral neuroforaminal narrowing. L4-L5 There is mild disc bulge. There is intradiscal contrast in the nucleus pulposus with slight extension into a small schmorls node in the anterior endplate of L4. There is no extension to the annulus of the disc. There is mild bilateral Facet arthropathy and mild thickening of Ligamentum flavum thickening. There is minimal bilateral central canal stenosis due to the disc bulge and ligamentum flavum thickening. There is mild bilateral neural foraminal narrowing. L5-S1 There is a mild disc bulge. There is intradiscal contrast within the nucleus pulposus and extending to the inner third of the annulus posteriorly and to the left. This is consistent with Grade 1 tear. There is also a small schmorls node in the inferior endplate of L5 which does not have contrast extending into it. There is mild bilateral facet arthropathy. There is no central or neural foraminal narrowing. Impression: 1. Nearly circumferential extensive grade 4 tear of the annulus at the L3-L4 with contrast extending inferiorly to the disc space anteriorly, likely do to disc extrusion rather than a grade 5 tear. There is also mild central canal stenosis and mild neural foraminal narrowing at this level. 2. Minimal central canal stenosis and minimal bilateral neural foraminal narrowing at L4-L5 with contrast extending into a schmorls node in the inferior endplate of L4. 3. Grade 1 tears of the annulus at the L2-L3 and L5-S1. The surgeons have told me that if I have a fusion done, that ultimately the other levels are going to eventually break down and to try and put this off as long as possible. Its been a year since being told I need surgery. I am a mother of a 10year old boy, have no quality of life because walking is hard (also due to hot spots in feet, ankles, knees, hips from Osteoarthritis) I use a cane or walker and spent a year in bed due to pain being so bad and not being able to walk more than approx. 30 yards at a given time. I have many other issues if you see my profile. What I need to know is if I start with any kind of surgery to reduce this pain as my doctors are wanting me to do something rather than just take pain meds all the time (been on them about 10 years now) (also hit by drunk driver in 2009 at 65mph...we tboned) It aggravated the already ongoing degenerative disc disease and facet arthritis and injured levels as I was only dealing with L4-L5 and L5- S1 for many years. I am very confused and do not know what to do. I have heard some good things about Laser but also some bad things and my doctors are trying to steer me away from it it seems. They offered a PRP injection of stem cells but 50/50 chance and having to pay out of pocket with it being very expensive I don't know if I have the funds to risk a possible failed procedure. No injections have ever worked for me. Currently my meds are 60mgs Morphine 3x day. Dilaudid 8mg. 2 pills 3x day and Robaxin 500mgs 1-2 x day. I also have High blood pressure, overweight but have since lost 30lbs from changing opiates and stomach bug. Used to take 50mgs methadone for approx. 9.5 years with a short acting and they dropped me from that in 4 days leaving me ill and on Exalgo 32mg per day sick for 1 month, then stomach bug for the month of Feb. Changed to Morphine in March and feel much better. I think the Exalgo didn't agree with me and the half life is way less than methadone so I suffered severe withdrawals changing medications. But my question to you is do you recommend surgery and what level do we start at? I feel most pain in lower back ,upper buttocks down the left leg and behind the calf and some right groin pain along with r thigh being numb across the outer edge approx. 4 inches in length from knee up, then it stops. I also have Fibromyalgia so any trauma to my body I found (after having my C-section with son) is really hard on me and cause me to not even want to be touched. The slightest brush against my arm sends me into a pain frenzy. I want my life back but do not know how to go about it at this point and I am too young to let this go and end up in a chair not being able to walk. Please help with an opinion on where to go from here because I cannot make a decision. I need to be well this summer as my 10 year old is having Open Heart Surgery so I cant make any moves till Fall anyhow. Also my doctors are thinking about Rapid detoxing me to clean up my receptors and start over, at this point I don't see what that is going to do for me either. The morphine and dilaudid are working and I am no longer having any trouble with medications. I had 2 months of problems due to severe withdrawals of coming off of 50mgs of methadone and put on a drug with half the half life and didn't agree with me. So they are coming up with this detox thing....just out of the blue. I have always been a compliant patient, clean blood draws and UA's with this clinic , I feel its like a punishment since I had trouble for 2 mos...with a med change....that didn't agree with me. Now that I am on the moriphine and dilaudid I am fine med wise.Your opinion would be greatly appreciated on where to go from here, do I wait? do I get the first fusion done, wait for the rest to break down and have more surgeries. I am afraid if I start I will be in surgery more than I want to be to fix all this and then to fix what breaks after whats fixed, over and over again. I also have 4 disc issues in my neck I have not even begun to address due to my back issues.. Thanks for listening. I am at a point now of asking What would you do if you were here and had these issues?

Also doctor, what is a schmorls node? and what type of fixes would be done other than the fusion? A facet ablation? will there be hardware? Would disc replacement be a better option? And what is your opinion on PRP injections? Where they take my plasma and get the stem cells and re-inject them back into the areas needed. Its not covered by insurance and its a 50/50 chance. Waste of money??? Also what is duloxetine? I have been on Lyrica and cannot take it as I swell very bad from it and I took Neurontin as well and was up to 1300mg with no relief either. They Lyrica did help me but the swelling was making it hard to walk as well along with breathing issues. I also have Sleep apnea and need 3 liters of 02 when I sleep and use a Bipap.

Thank you kindly for all your help. I will take this to my doctors. If I may, since being on high doses of narcotics what is the best way for my doctors to take me down to a lower dose so I can have surgery. The PA in the office was mentioning a RAPID DETOX then start all over with new medications. This terrifies me being strapped to a table for six hours while they flush my system. I have heard horrible things about this and am not a fan. Can they force this on me? Or can they just to a slow taper to get me down before doing surgery. I cant do anything anyway for a few months because my son has to have Open Heart Surgery for a Sub Aortic Membrane. He comes first. Do I have the choice of how I want my detox plan to go? They mentioned a rehab for tolerance reduction and not for addiction but I cannot leave my home for something such as that, I have a family. So do you think a slow taper would be better? When they took me off the methadone I had been on for 9 years because it worked so well for my pain they dropped me from 50mgs to 0 in 4 days putting me on Exalgo 32mgs which didn't agree with me GI wise first of all and secondly was not enough to hold me since the half life of that drug was half of what methadone was so I was sick for an entire month with withdrawal symptoms. I am off the exalgo and on the morphine and dilaudid now and am fine with this dose, not sick any longer. I am just very scared of all this. I have however since being so ill the last few months (caught a stomach virus after the w/d) and lost over 30lbs which has helped my walking and pain and am determined to get the rest off. I still have some Gastroenteritis I think happening which frankly has made me not have an appetite for much other than soup and water, which is easy on my stomach and fills me up fine. Being on the methadone I gained 50lbs but maintained that weight after the gain but was in much more pain and in bed more because of the pain. Now I am doing much better. Take your time in answering I know your busy and I am grateful for your advice so far. Thanking you in advance.