Spine MRI_ anyone who should I see next Rehab doc. or Neurosurgeon?

you dont' appear to have radicular pain, so i don't think your bulging disc nor spinal stenosis is causing your pain. it's probably your facets that are causing your symptoms. unfortunately, there's no good surgical fix for facet disease. unfortunately, facet arthritis isn't very amenable to physical therapy either, and you may be better off taking motrin and getting bedrest.

From the way you are describing your back pain, I doubt that there is a surgical procedure that could be performed to alleviate the pain. The fact that you have a transitional vertebra probably contributes to your back pain, but there is no surgical intervention that would address that. (Just to clarify - it's not certain that you have an extra vertebra. It may be that the vertebra that is normally S1, or the uppermost part of the sacrum, is not fused to the sacrum. So, instead of having five sacral vertebra, you would have four, with the transitional vertebra sharing characteristics of both lumbar and sacral vertebrae. It is not possible to say for sure from that description.)

The desiccation of the disc is something that happens normally with age - most people 35 or older have this to some degree, and it's not uncommon in younger people. The theory I hear most often is that this may lead to "microinstability", which in turn may cause pain. But, this isn't proven, and there's no surgical fix at present. The changes around the left L5 nerve root (bulge, hypertrophy, etc.) could be cause for surgical intervention, but you haven't described the symptoms that would be present if that was truly an issue, so I doubt many surgeons would rush you to the OR.

In conclusion, every neurosurgeon I've worked with would send you to physical therapy first. You need to strengthen the muscles in your back and lose weight (if you're overweight) and work at all of that for at least a couple of months before even considering going to surgery.

After reading the extra information - First, I don't think that a history of a broken tailbone would be likely to contribute to this problem - assuming that when you say "tailbone" you mean coccyx. I still doubt that your symptoms are related to the trouble with your disc, and, therefore doubt that surgery would help solve your problem. It is very likely that issues surrounding your transitional vertebra are contributing to the pain, but like I said before, there isn't a surgical intervention that has much promise for showing improvement. I'd recommend going to see the PM&R doc, as your doctor suggested. A PM&R doc will be very familiar with issues like this and know when it's time to see a surgeon.

An extra vertebral bone... cool.

You do have stenosis (narrowing) of the space in the bones where the L5 nerve root exits on the left (plus a little bit on the right).

Sometimes this narrowing can cause the nerve root to become irritated and inflamed, and this can be treated with a series of epidural steroid injections. If this is ineffective and your pain is not relieved with medication, surgery can be done to open up that space and set the nerve free.

You might want to call the rehab guy and see if he has anything to offer you in the way of conservative treatment. If he doesn't do steroid injections, the neurosurgeon should. You may also want to look into a chronic pain clinic - call the anesthesia department of your local hospital.

If you don't have insurance, ask the doctors' office manager about reducing your bill to something affordable.

Good luck!

Wow. That's pretty interesting. Sounds like you have 1 more lumbar vertebra than most people.

I am definately not a back expert...but, I think your decision on who to see depends on what the doctor who ordered the test (yes, I know he is a GI doc) thinks and how much pain you are in.

You might want to see both, hear what they have to say, then decide what you want to do.

Sorry I can't help ya more.

Later: Arachnoid cyst = I would go to the neurosurgeon

As for how often a 6th lumbar vertebra occurs in humans...I am finding numbers from 4% to 18%. (I only remember seeing it once myself)

Normally, I would not answer a question like this as my expertise is generally in medication but I had severe sciatica while I was pregnant with my 3rd child (after having had twins) and I had sciatica so bad that I was finding it difficult to walk. I tried massage therapy and physical therapy and could not take medication

When it comes to your spine, don't mess around, go see the neurosurgeon and make sure you bring your medical files too, so he can see the doctors reports and test results(scans and e-rays and such) for him/herself. It could also be helpful to have a list of any questions to have along, so you don't forget. Best of luck & God bless.

You know all this and you don't know what kind of doctor to see? I'd ask my primary care physician for a recommendation, since he's able to read your MRI and will know which kind of doctor would be best for your situation.

You may want to take these findings to a neurologist first, and get his/her opinion before going through rehab or surgery.