Your mri reads like the spine of every 50 year old out there whether or not they have pain. There’s nothing there that implies surgery is required as you didn’t report any progressive weakness or other red flags. You were on track seeing physical therapy. If you didn’t get results find a different one credentialed in the McKenzie MDT method of examination and treatment.

I happen to read this thread and while not a doc, agree.

I would get a combination of PT and Training done to correct the underlying issues. Restoring balance and increasing blood flow to the affected areas works wonders.

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Training Tweets: https://twitter.com/Jagersport_com
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If an ortho is suggesting anything other than possibly an epidural, punch him in the mouth and run. PT and back stregthening exercises are key.

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Be Uncommon

Well, 3 months of chiro, massage, and plenty of strengthening stuff did very little, and that has always been my approach with injuries and has worked in the past. Not this time around. 2014 mri compared to 2019 shows one bulging disc, and additional bulge/shrapnel in the 2019. And, symptoms are dif than what I have had historically. Other discs, fluids, ligaments all look very different, healthy. One clear trouble maker pressuring the nerve canal.

I'm not dead set on surgery, but it's more than on the table, so if anyone can rec a surgeon and/or ways to find/compare, that's what I'm looking for, thanks!

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The Ride of Truth - OWN your ride.

Repeat studies of MRI in the spine show that there is poor correlation between seeing atypical things with imaging and have them being the pain generating structure. Move away from imaging and toward movement patterns that are limited. Imaging is not reliable to give you an answer.

Massage, strengthening won’t help this. You’ve described a very mechanical problem with your spine that needs addressing. In the absence of red flags, surgery at this point is not your answer, find a good PT.

And sometimes you can do all the PT, McKenzies, and stretching and follow every ounce of advice to stay out of surgery but the pain never goes away, and you finally cave into the micro / laminectomy and you wake up from surgery with no pain for the first time in years and you wonder why the freak you waited so long.

And you go on to have the best couple of years in the sport you've ever had because you can train properly and have no pain (and you can sit at a desk, at a movie, at a restaurant without squirming in agony).

I don't know any surgeons in DC, but I wish you well, and can tell you that back surgery is no longer the end of the world. It gave me back my life. Just be super cautious in recovery (I was 8 weeks before doing light ellipitcal - 12 weeks before PT, bike, "yogging" and light weights).

I have a classmate who is in North Carolina but likely further than you want.

The patient who does well with spinal surgery is one who has a discrete abnormality on MRI that explains specific symptoms. The more dramatic the symptoms aside from pain the better the outcomes it seems IMHO. If you have demonstrable weakness, lack of reflexes explained by a an L5-S1 lesion for instance that has not responded to a good go at physio and time (months) then you might be someone who does well with a surgery. If one physio doesn't do it likely good to try another.

If it is just pain (I know WTF just pain!) waiting six months or longer and doing a lot of physio to avoid surgery is a good idea.

I am in Canada and the wait time for spinal surgery for these types of things is measured in years. Bad for those who genuinely need surgery good for those who get better even 12-24 months later without surgery. We once had a pain specialist move to our area from Minnesota. We were all bitching about wait times for spinal surgery and he said we are better off than where he was in Minnesota where many folks were operated on fairly quickly and then had lifelong problems from the surgery. I have been doing general family practice for 25 years and see long term outcomes for these types of things. Some patients have surgery and are worse or never get better.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

I was in the same boat as you not long ago.

I went from not being able to stand for more than 15 minutes at a time, to pain free in just a few weeks. This was in December. In June I did a half Iron and I've done a few Olys as well.

I was about to have the first of what the Dr told me would be several surgeries just to get my standing again.

What I "discovered" was Foundations Training. I know I sound like an infomercial, but it seriously changed my life.

I had a herniated L4/L5, and Sacralilitis.

I don't want to link to anything because (Again) I know I'm sounding like an infomerical. But try googling it or looking for the book on Amazon. I personally got the most out of the first Foundation book as well as the free videos

I'll check out FT, thanks.

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The Ride of Truth - OWN your ride.

Do it. It can't hurt

I seriously had my bike for sale. Thought I'd never run or ride again. Couldn't even turn in the pool.

I'm not surgeon, but I treat this all the time. Obviously I haven't seen the MRI, but by description there's not much to operate on. Surgery works well when there is a significant anatomic abnormality that correlates with your symptoms. But asymptomatic MRI abnormalties are very common and more like age related than anything else. An article came out just last month showing 49% of healthy air force cadets with disc bulges. Keep in mind these are 22 year olds with no back problems. So your MRI is only a small part of the overall picture. That said, A. Jay Khanna is a good ortho spine doc in Bethesda and a good resource. Really exhaust non-operative care before considering surgery, PT, injections, etc.

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Brian
“Eat and Drink, spin the legs and you’re going to effin push (today).” A Howe

John Romero is a PT in Kensington/Bethesda. I had major back problems for years and was considering a synthetic disk at one point. My Doc pushed me to go see John and he worked his magic. I never looked back. His treatment was not the typical stretch, core strengthening crap that I got everywhere else.

https://www.sports-pt.com/meetourteam

Thanks TriBri and others who have responded.


Let's see if I can add some of my MRI images...


edit in process.

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The Ride of Truth - OWN your ride.

Pic added.
I'm no better, still thinking surgery, bilateral lam, maybe discectomy if there are disc shards to remove.

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The Ride of Truth - OWN your ride.

With that MRI you have shown this advice is spot on. I would trial conservative treatment options first (which include things like nerve sleeve injections or epidural steroid injections) to settle any inflammation down and potentially delay/take away the need for surgery. Spinal surgery can suck big time and will not always take away your pain or symptoms.

Interesting. Goes to show I'm no expert. And not expecting mri reading expertise here either. Thought that MRI might get a lot of the opposite reaction, like - yes, can't PT your way out of that, surgery is worth considering.

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The Ride of Truth - OWN your ride.