Significant DDD Throughout Lumbar and Cervical spine. Lumbar curve off by 70 degrees

Background: I have severe and significant DDD throughout my lumbar spine and in the cervical spine. My lumbar spine curve is off by 70 degrees from where it should be – kyphosis where it should be lordosis.

I had been in the care of the physical medicine department for 3 years for severe pain in my left foot and then developed a foot-drop in my left foot.

During this time, my course of treatment included physical therapy, medications-meloxicam, tramadol, gabapentin-and steroid shots. These helped for several years, but then as the pain and drop foot worsened, it was recommended I consult with an orthopedic surgeon. I consulted with 3 different orthopedic surgeons. The first recommended fusing L3-L4-L5-S1. The second recommended hydrocortisone shots at L3-L4, and the third recommended ALIF L5-S1 fusion. I went with the ALIF l5-s1 procedure in June-2020. My lumbar spine curve was 70 degrees from where it should be, and the surgeon was able to correct this by 19 degrees with the cage.

He noted I had very ‘good’ bones.

The results were good for approximately the first 8 months, but then the old pains and sensations began to return.

I especially am having pain in my left hip when waking in the morning and during walks. Also, I notice while walking, I am looking down at my feet rather than straight ahead, and there is pain between my shoulder blades. Perhaps my discs are continuing to degenerate. I do find some relief with tramadol and gabapentin.

Has anyone had a similar experience and then had a second surgery to fuse more segments or perhaps some other procedure? If so, would you share your experiences and thoughts? From my readings, I am concerned with adjacent segment disease associated with multiple segment fusions.

Is being pain-free after the procedure realistic? I hope to walk for an hour or more before I need to stop due to pain. At 3 months post-op, I could do 50 minutes, and now it is down to 30 minutes, and then I need to lie down for 30 minutes. Anything comments from experience, background, or general knowledge on this subject to help me decide whether to have the multi-segment fusion is greatly appreciated.

**Notations from imaging, probably TMI—

Weightbearing AP, lateral and lateral flexion extension views the lumbar

spine x-rays

Diffuse advanced lumbar spondylosis. Severe disc space narrowing involving the entire lumbar spine. Kyphotic deformity of lumbar spine due to advanced DDD. Degenerative scoliosis with apex to the right. Large anterior and lateral osteophytes in lumbar spine. With lateral flexion extension, there does not appears to be any significant physiologic motion in lumbar spine.

Weightbearing AP and lateral of the entire spine x-rays.

Mild degenerative scoliosis. Lumbar scoliosis and associated hypokyphosis

of thoracic spine.

SVA=5 cm., LL= 15°, SS= 20°, PI= 60°, PT= 38°

Severe cervical spondylosis with cervical kyphosis with apex at C4-5.

Evidence of severe disc degeneration at C3-4, C4-5 and C5-C6, and to

lesser degree at C6-7

symptoms - Left lumbar radicular pain with new left foot drop after 15 minutes of walking.

Procedure: Sagittal T2, axial T2, sagittal T1, axial T1, sagittal STIR sequences.

FINDINGS:

Alignment: There is mild reversal the normal lumbar lordosis and 3 mm retrolisthesis of L3 on L4.

Vertebrae and vertebral marrow signal: No fractures. There is mild 3-4 and moderate L5-S1 reactive endplate edema.

Conus and imaged portions of the caudal cord: Normal.

Lumbar disc levels: T11-12 and T12-L1 disc levels are normal.

At L1-2 there is moderate disc degeneration with small annular disc bulge, mild central canal stenosis, and mild neural foraminal stenosis

(unchanged).

At L2-3 there is severe disc degeneration without central canal or neural foraminal stenosis.

At L3-4 there is severe disc degeneration with small endplate osteophyte, mild central canal and neural foraminal stenosis, and mild facet arthropathy (unchanged).

At L4-5 there is severe disc degeneration with small annular disc bulge, mild central canal stenosis, moderate neural foraminal stenosis, and mild facet arthropathy (unchanged).

At L5-S1 there is severe disc degeneration with broad-based central disc protrusion, mild central canal stenosis, mild effacement of the lateral recesses, severe bilateral neural foraminal stenosis, effacement of both L5 nerve roots, and mild facet arthropathy (progressive).

Paraspinal musculature and paravertebral soft tissues: No evidence of acute paraspinal soft tissue abnormality

IMPRESSION:

1. L5-S1 severe disc degeneration with moderate reactive endplate edema, broad-based central disc protrusion, mild central canal stenosis, mild effacement of the lateral recesses, severe bilateral neural foraminal stenosis, effacement of both L5 nerve roots, and mild facet arthropathy (progressive).2. 3 mm retrolisthesis of L3 on L4 with severe disc degeneration, mild central canal and neural foraminal stenosis, and mild facet arthropathy (unchanged).
2. L4-5 severe disc degeneration with small annular disc bulge, mild central canal stenosis, moderate neural foraminal stenosis, and mild facet arthropathy (unchanged)

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