Question
Would you please assist me with this?  I hurt my back playing football in college and had surgery in 1999 (a discetomy on L3-4 & L4-5).  I began having pain again in 2003 and had another MRI and discogram in 2004, which concluded my L2-3 & L5-S-1 needed to be removed and they wanted to fuse all 4 together.  
Here are the results on my MRI....any help you could give would be appreciated.  Thank you:

Discogenic degenerative changes are most significant at L3-4 through L5-S1 with desiccation and height loss.  Schmorl抯 node endplate deformities of the inferior endplates of L3 and L4 demonstrate mild edema likely acute to subacute in nature.  There are facet degenerative changes throughout the lumbar spine.  Bone marrow signal and alignment are otherwise normal.  The cord has normal signal character and morphology.  The conus ends normally.  No evidence for intradural extramedullary lesions.  Findings by level are as follows:

T11-12:    Mild broad-based disc bulge and facet degenerative change result in mild bilateral foraminal stenoses.

T12-L1 through L1-2:   No significant disc pathology.  There are mild facet degenerative changes.  No significant stenosis.

L2-3:   Broad based disc bulge with focal central protrusion, facet degenerative change, and ligamentum flavum laxity result in a mild to moderate canal stenosis.  There is a focal left foraminal protrusion.  There are mild bilateral foraminal stenoses.

L3-4:   Broad-based disc bulge asymmetric to the right and facet degenerative change with ligamentum flavum result in a mild canal stenosis.  There is a moderate right lateral recess stenosis affecting the traversing right L4 nerve root.  There are mild to moderate bilateral foraminal stenoses.

L4-5:   Broad based disc bulge with focal central protrusion and facet degenerative change are noted.  There appear to be postoperative changes status post left hemilaminotomy.  There is a mild canal stenosis.  There are mild to moderate bilateral foraminal stensoes.

L5-S1:   Broad-based disc bulge asymmetric to the right and facet degenerative change result in a mild to moderate right lateral recess stenosis affecting the traversing S1 nerve root.  There are moderate right and mild to moderate left formainal stenoses.

IMPRESSION:
1.   Multilevel degenerative changes with possible involvement of the exiting right L5 nerve root and possibly the right traversing S1 nerve root.
2.   Acute to subacute appearing Schmorl抯 node endplate deformities of the inferior endplates of L3 and L4.


Answer
As a general rule, you want to exhaust all conservative treatments before you opt to go under the knife. Your MRI report shows you've got a lot going on in your back. Since you have the disc protrusions at multiple levels and off to the right side, I'm assuming you have pain radiating down the right side of your leg. If you have persistent aching, numbness, tingling, or a burning sensation in your legs along with weakness and atrophy in the muscles, then you would probably be a surgical candidate. If you're having any bowel/bladder control issues then you need to seek immediate medical attention. A qualified orthopedic surgeon will be able to explain the pros and cons of doing a multi-level fusion.

Keep in mind that nothing is guaranteed post-surgery. You may still have the symptoms so then what are you left with? Do intense physical therapy and seek chiropractic care for several weeks to see if your back pain responds. If conservative options fail, then you may want to explore getting injections before considering having the fusion done.

Hope this helps,

Dr. Park