MRI results show bulging discs: what are my options?

@saleha59 Welcome to Connect. I am a Mayo spine surgery patient and I have a biology science background and studied a lot about spine issues when I was going through the need for surgery. I understand your hesitation about surgery, but to help yourself have the best possible outcome, you need to take a different approach. Instead of asking how you can avoid surgical treatment, why not ask about what benefit you could have with surgical treatment and compare that to what your future will be without it?

You have multiple levels of involvement with spondylolisthesis which is the vertebrae slipping because the discs are not healthy, and retrolisthesis is the backward slipping. This instability is going to continue happening and it puts more pressure on nerves that get pinched in the foramen at the nerve roots and compression of the spinal cord itself. This misalignment also creates uneven pressures on the endplates of the vertebral bodies, and this pressure causes the bone to remodel which can generate bone spurs and further compress the nerves. You have a lot of symptoms now that can be spine problems, and a surgeon needs to make the diagnosis. For me, it took 20 years after a whiplash for my spine issues to compress my spinal cord and cause significant neurological issues.

The best thing you can do for yourself right now is to see a good spine surgeon who specializes in deformity cases. Both neuro-surgeons and orthopedic surgeons operate on the spine, but choose a surgeon who only does these types of surgeries. They are not all alike or have the same skills. Sometimes there are different procedures that can address the same problem. You have a lot of nerve root compression, but also at L1 L2, a central disc protrusion that is narrowing the central canal through which the spinal cord passes. If a chiropractor starts pushing on that with instability from the vertebrae slipping, that can directly impact the spinal cord, and this can also further narrow the foramen which is the space between the vertebrae where the nerves exit. You have significant disc bulges into the foramen which causes inflammation and arthritis bone remodeling there. I believe a chiropractor would cause you significant harm with your current condition. I know that isn't what you wanted to hear, but you can learn a lot from honest patients who have spine surgery experience. Surgery at the lower end of the spine is a longer recovery than my cervical surgery.

You choice of a spine surgeon is critical because spine surgery can make you worse. Often screws and rods are placed, and if the screws are not set at the correct angles into good quality bone, they can pull out with the pressure at the lower spine and twisting movements. I'm not trying to scare you, but this is why you need the absolute best surgeon who has good statistics of success with these procedures, and you should ask for their success ratings. You should consult a spine surgeon to see how they can help, and get several opinions because this is a critical choice that you can't undo after the fact. I was refused by 5 spine surgeons, and then came to Mayo in Rochester and had an excellent surgeon and care that was exceptional with great results. Do your research on ratings of medical centers and surgeons and find the best that you can. If I had understood this difference in quality of care, and that my case was unusual, I would have come to Mayo first and saved myself a lot of wasted time. If you are not able to come to Mayo, find a place with a good track record. Call your insurance company for recommendations as they may have ratings and you need to find one in your network. I can help if you have further questions. I would highly recommend my Mayo surgeon, Dr. Jeremy Fogelson who is a spine deformity expert. Here are some links about him and my patient story. Let me know if I can be of further assistance.

My patient story
https://sharing.mayoclinic.org/2019/01/09/using-the-art-of-medicine-to-overcome-fear-of-surgery/

https://www.mayoclinic.org/biographies/fogelson-jeremy-l-m-d/bio-20055624
https://www.mayoclinic.org/medical-professionals/neurology-neurosurgery/news/specialized-expertise-for-spinal-deformity-surgery/mac-20469055
https://sharing.mayoclinic.org/2017/07/26/spinal-surgery-saves-teen-swimmers-mobility/
https://sharing.mayoclinic.org/2012/12/23/repaying-a-gift-scholarship-recipient-says-thanks-in-a-special-way/
http://www.startribune.com/in-second-term-minnesota-gov-markdayton-dealing-with-more-health-problems/361662931/
http://www.startribune.com/gov-mark-dayton-to-undergo-third-back-surgery/497015811/
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-scoliosis-screening/
https://www.beckersspine.com/spine-leaders/item/37080-spine-surgeon-leader-to-know-dr-jeremy-l-fogelson-of-mayo-clinic.html

Thank you. I will check into all your info. I have one main issue....I cannot ever get a GOOD surgeon unless my state funded medicaid(I am on disability) will ALLOW it. I do not get the best care, I get the cheapest care.

I am a bit puzzled by your statements about Medicaid, cheapest care, etc. I don’t know where you live and yes, you may not have the option of going anywhere you want, especially if your care is limited by the confines of an HMO or similar. But just because you have Medicaid does not automatically equate to a poor quality of surgical care. I worked as a hospital RN and just by general percentages, know that some of our patients were receiving disability, on Medicaid, Medicare, private insurance, HMO, PPO, etc. It still was the same surgeons doing the same surgeries, the same OR team, nurses postop, etc. Patients weren’t treated differently that any of us were made aware of. Nor did us staff have time to worry about who was paying for or covered by what! One of my nursing coworkers had 2 children with congenital disease who had extensive spinal surgeries; I know they were covered by SS Disability, etc. Perhaps I am not understanding your question/comments? I myself had a very unusual condition that needed to be fixed surgically (extensive surgery). Because my HMO could not provide what I needed, they were mandated to provide me with appropriate care by law. They weren’t happy about it. I had to keep pushing! But they did it!

Also, another question. You mention hip pain. Do you think it is spine related or have you had regular hip XRays looking for signs of arthritis? The hip and spine pain may (or may not) be two totally different issues.

I have arthritis in ALL my joints. My last CaT scan of hip showed a cyst. Not one single Dr. cared about it or my complaints of not being able to hardly walk any distances.(the hip issue started in 2017) Also, the hip issue could be related to spine and sacroiliac joints. The vertebrae that is misplaced is lower so that could affect my hip too. Lots of pinched/compressed nerves. As for being treated different because of my insurance, I have always been limited on what Dr./surgeons I can see. Many times they could could not do the things they wanted to do because they were limited because of my insurance. Many things were not done.

The health insurance racket has to be stopped! Corporations and their profits should not have any say in our health care.

@saleha59 You need to advocate for yourself. Call your insurance company and ask for approval to see a surgeon. The squeaky wheel gets the grease. There is enough on your MRI report to warrant medical care. That diagnostic test was ordered by a physician and have they given you a response to the results or a recommendation? I know it can be frustrating and scary at the same time, but you have to imagine yourself having a good recovery and the journey begins with a single step. Speak up for yourself until they listen to you. This insurance problem isn't the doctor's fault, so be careful about voicing frustration to the doctor. I'm sure they hear a lot of it and it just makes their job stressful.

Correct. Even try a different primary provider if you feel like you are not getting proper attention. Doctors are rushed these days and it is not their fault - it is who they work for (clinic, hospital, insurance). You need to have all your ducks in a row before you are seen. WRITE down specific questions to take with you. You may wish to specify you need a longer appointment time. But you must be your own advocate or have someone help you figure this out ahead of time.

I was referred to the Neuro Spine clinic. I ended up seeing a physiatrist. He was only one who accepted to see me. (the clinic has all necessary Drs., orthopedic surgeons, neuro surgeons, etc. ) He ordered the MRI. He recommended physical therapy, injections and possibly a chiropractor. I am going to call a chiro. today. I cannot see how a physical therapist can move my vertebrae that is out of place, let alone help with all bulging discs. I do know my entire spine is BAD, especially my neck but I am only allowed to address ONE area at a time. I have so many pinched nerves and bulging discs. I personally do not want to rush into surgery though. Hoping I can get help before it gets worse. Decades a go, a chiro. did help me when I only had 2 bulging discs. But once I got fibromyalgia, a chiro makes EVERYTHING much worse. But willing to try it again.

My rheumatologist is who referred me to the Neuro Spine clinic. They only specialize in the spine.