Multi-level spondylosis

In this video, of a 70 year old, male, patient, with multi-level spondylosis you’ll see a variety of problems (lesions), including Modic changes, disc collapse, disc degeneration and herniations, spondylolisthesis of L4, stenosis, joint arthropathy, boney spurring, fatty infiltration of the multifidus muscles, etc.

This is a man I’ve treated sporadically for many years. He is actually a chiropractor, still in practice, with intermittent exacerbations of pain. Recently, he had an exacerbation of his right sciatic pain. He has had 3 lumbar epidural steroid injections, with pretty good relief. The big question now is, how long will he feel better. I’m hoping he gets relief for months to years, but it is important to understand the severity of his anatomical degeneration because it seems clear that he will eventually need surgical treatment.

At the present time, his only symptomatic problem is the right sciatica, so, with a little luck, he might, now, stay reasonably good for a while. But if he relapses soon, as I suspect, he may need surgery to address his pain. And this is where the surgeon can be a blessing. And also raises some critical points about surgery.

Multi-level spondylosis

In a case like this, the surgeon needs to see all the problems, BUT limit his surgery to the least necessary to resolve the pain generator. So in this video, I am pointing out all these degenerative changes, BUT surgery should not be directed at all the problems; only that which is responsible for his present pain and limitation. So in this case, I will point out the right-sided stenosis at the L4-5 level. The surgeon I know might simply recommend a foraminotomy at that level, to remove some of the offending joint arthropathy and disc tissue which is compressing his right L5 nerve root. That would not solve all his asymptomatic lumbar pathology, but it would likely solve this immediate sciatica problem, with minimal risk of an unfortunate surgical outcome.

If I can help you with your neck or back problem, please call me at 404-558-4015.