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[minolfa]

HI, I am new,living in Italy and I apologize for bad English...
My MR showed that at L5 S1 my disc space is almost completely
collapsed and I have Modic 1 change on L5 and S1..inflammation
and oedema of spugnosa and inflammation of the remaining disc
(but it is almost gone)...

I have me pain, but my greatest problem is lumbar stiffness....
One doctor said that the vertebrae will autofuse soon....
another doctor suspected infectious discitis....in my blood work
neutrophils are slightly elevated....but I had three steroid iniections...
can steroid increase white cells count??
Anyone with Modic 1 and disc almost gone at L5 s1?

From a biological point of view, what fusion is?
is it like healing of fractured bone?
thanks for any clue....
carla

[Maria]

Carla,
Your written english is fine. I have a first cousin whose name is Carla, another cousin (male) Carlo and an uncle Carlo. We are Italian American. 3rd generation. I cannot speak Italian however can speak Spanish.

RE your discitis I imagine that is painful. I hope you have good medical treatment re this situation and/or a Pain Management doctor that is helpful.

I have autofused at my L5S1 disc space after many years of problems and pain at this level and the two levels above it. Had 2 surgeries (L4 and L5S1 discectomies). L5S1 was probably my worst disc space considering all the pain I endured over many years and also as you mentioned stiffness.

Now that L5S1 has autofused I feel much better. My spine even if autofused seems to have more flexibility and stability.

I hope this will happen to you as well. I cannot take Nsaids due to gut problems so even tho they were greatly helpful during the years this disc area was painful/problematic/stiff~ I was unable to use Nsaids or cox inhibitors.

I do hope you'll find relief perhaps when this level does autofuse. I'm glad it did on me and I didn't go for more surgery at that level. However that's not to say that more surgery like fusion or ADR might have made a difference earlier on.

good luck and please keep us posted. Your english is definately fine so don't worry about that or even apologize!!!

[mmglobal]

It is my understanding that with discitus, you'd not be able to walk around without SEVERE pain. Your description of lumbar stiffness sounds much less severe. Having said that, I'm glad that your doctors are being thorough and ruling out the possibilities. Your blood work should tell the story.

Fusion is where they take multiple vertebrae and 'weld' them together into one. I hope you'll have the opportunity to evaluate your options for motion preservation techniques, including artificial disc replacement (ADR), before you have surgery.

Do your homework, make informed decisions. Good luck, all the best,

Mark

[Keano16]

Hello and welcome.

How come your disc space is collapsed? Have you had any previous spine surgery or this are very sever degenerative changes?

In such a cases when disc space collapses and when your pains are so hard that you can do your normal daily activities, logical way would be to find an educated and well experienced surgeon and discuss possible ways to treat your problems. Most probably increasing disc height, and only ways for that are ADR (artificial disc replacement) or fusion.

Regards

Originally Posted by minolfa

HI, I am new,living in Italy and I apologize for bad English...
My MR showed that at L5 S1 my disc space is almost completely
collapsed and I have Modic 1 change on L5 and S1..inflammation
and oedema of spugnosa and inflammation of the remaining disc
(but it is almost gone)...

I have me pain, but my greatest problem is lumbar stiffness....
One doctor said that the vertebrae will autofuse soon....
another doctor suspected infectious discitis....in my blood work
neutrophils are slightly elevated....but I had three steroid iniections...
can steroid increase white cells count??
Anyone with Modic 1 and disc almost gone at L5 s1?

From a biological point of view, what fusion is?
is it like healing of fractured bone?
thanks for any clue....
carla

[dshobbies]

Hi Carla and welcome,

We understand you just fine.

If I may give you a little more detail than Mark - fusion is - the complete removal of your disc material between two vertabrae - then a substance that will eventually turn into bone, sometimes cadaver (dead person) bone chips are used and kept in place with a wire cage (which is held where it should be with screws) until these chips solidify into solid bone. This last part is like the healing of a broken bone. Once the bone is solid, this cage and screws are no longer needed but rarely are taken out unless there is a problem.

Once this is solid, there is absolutely no movement from between these two vertabrae as it is now one piece of solid bone. And artificial disc replacement allows for the movement to act like almost normal. However, if you have very little disc space left, you may not be able to have an ADR and/or you may autofuse at that level.

I'm glad your doctors are staying on top of a possible infection - but as for the ultimate decision on what to do - please ask a lot of questions until you're satisfied with your understanding of what is wrong and the possible fixes. Please don't make a final decision until you know what you're talking about. Your decision will be final!

Good luck to you, Dale

[Maria]

I was 28 when I injured my spine and the L5S1 was operated on 7 years later (open discectomy). I was told that eventually my pain might stop if I autofused (no surgery involved, natural fusing of adjacent vertebral bodies) and that process from date of injury to date of reported autofusion was something like 28 years. So it wasn't a rapid process even tho I believe it was hastened by my discectomy at L5S1 and removal of disc material at that level.

In between those years of initial injury to autofusion there lots of painful episodes and even going from episodic pain to chronic pain.

I sought surgical opinions and would have had surgery if I had not started feeling better than I had in long long time. Surgeries recommended in the interim were 3 level global fusion in 2001, 2 level ADR in 2003 and hybrid surgery with fusion at L5S1 and ADR at L4 in 2006.

As recommended by others here I did seek multiple surgical opinions/consultations. Something like 6 throughout the course of years with my regular Primary treating doctor offering several differing types of surgical solutions over the years. I obtained several opinions from same surgeon with changes in MRIs/CT scans/Xrays over the years.

I agree with getting several opinions at least where surgery is recommended.

Again I wish you the best and if you're able take the time to do thorough research and seek at least several opinions hopefully you can arrive at a conclusion that will best fit your own individual needs.

Mark is a wonderful resource person here with regard to spine surgery/spine surgeons and others are excellent resource people as well such as Keano and those who've had ADR and fusion surgeries. I'm one who hasn't had ADR or fusion and I am doing better however I still take a low dose pain medication daily and I stopped working at the height of my disabling pain.

Good luck!

[minolfa]

I have no pain sitting, but I have VERY
shortened walk and shuffling gait...because of lumbar stiffness.
I did ozone, steroids, etoricoxib.

Maria: was your autofusion confirmed by magnetic resonance imaging?
I am looking for pictures of "autofused L5 S1" in the internet ...

Keano: I did not undergo previous spine surgery, I found a surgeon,
but he got fixated about infectious discitis....he noticed raised neutrophils
in my blood work, but my ESR and RCP are in the normal range.
MRI with contrast and needle biopsy can confirm disc infection,
however I think infection is not probable with normal ESR and RCP....

Dshobbies: yes, I have very little disc space left..
maybe it is a silly question, but how do I realize that my L5 S1 level
autofused (without surgery)? After autofusion, people have stiffness
all the same??

many thanks for your comments

carla

[Maria]

Carla,
My history of low back probs is long starting in early 80's so original films date back to then and up until mid (2006) 2000's. Last diagnostic was an xray that my OSS had ordered because an MRI wouldn't have been warrented as I was feeling better not worse. At this point he said L5S1 has autofused.

*** I'm editing to add that since the L5S1 disc has thought to been autofused I have FAR LESS stiffness and MUCH MORE mobility. What do I conclude? That the stiffness I experienced in the past was more related to an effort of the body to stabilize the spine against the spasming that was going on and some degree of arthritic type of condition if not mobile enough. I RARELY experience stiffness now and if I do it's likely do to the L4 level that's still bulging.

I would think so as there's been a marked improvement at this level since about 2005. I had great difficulty sitting but more so what I considered instability because my back used to "go out" so frequently and I'd spend weeks in bed trying to recuperate.

Now the only time I have problems of this degree is when I either sit too much or I end up hobbling due to other concerns like foot or knee problems as then my back seems to torque and spasms set in.

I have however found that an injection of 60mg Toradol IM will usually ease the spasms to the point of a quick resolution/recovery.

The autofusion as a natural process takes a long time I think and in my case it seems it has taken something like 24 years. I have to admit that I'm still glad I waited because the difference between how I feel and how I felt is enormous however I don't think I'd recommend waiting this long to someone younger. It's just the path I took and greatly because of a failed spine surgery in '92 and never wanting to feel that badly again for as long as I did (5 years post surgery).