Updated imaging & I used 3D slicer to make the 3D models from my CT DICOM files. After 7 Years of Chronic Lower Back Pain with debilitating flare-ups, I’ve reached my limit and my whole life has been put on hold. Daily baseline pain of 6/10 that spikes to 9/10 & 10/10 during flare-ups. After going to several specialists who’ve either misdiagnosed me or told me my spine was healthy and there was nothing they could do, and exhausting every single form of conservative treatment, as far as diagnoses go, these past few months have been groundbreaking. After doing my own research, just as I was about to be written off and sent to pain management by a specialist, I heavily advocated for myself and convinced the surgeon to do a diagnostic injection. He performed a CT-guided injection of 5cc of marcaine (numbing agent) & depo medrol (steroid) deep into the super tiny/narrow gap between my right L5 transverse process and my sacrum. The marcaine provided an immediate 85% decrease in pain, and once the steroid kicked in I still had some days at my baseline but a lot of days were 2/10 or 3/10 until everything wore off by week 3. Since this injection confirmed the primary pain generator, the surgeon suggested fusion. Fast forward another month, I go to a second specialist and present my case and injection results. He agreed that other than Hyperlordosis (could add pressure), but spine was in good shape and actually advised against fusion at my age (23) and vouched for resection. Before moving forward with surgery he referred me to a pain management specialist in their facility to do a second injection to be 100% sure. This time it was an X-ray guided injection (last picture shows the spread of injection medicine) and different numbing agents were used in addition to more depo medrol. However they only injected 1 cc this time, specifically focusing on the narrow gap between my L5 transverse process and my iliac crest. While they may have been a very, very slight decrease in pain around the rightmost/outermost edge of the false joint, I really haven’t felt a difference and my baseline this time is still 6-7/10. With this said I consider this a fail, but I’m not sure how this affects my diagnosis or surgical plan. Also I was awake for the second injection and the doctor let his Attending lead while he directed her. Some things they said stood out to me. 1.) The attending said “I’ve either seen it fused or just enlarged but I’ve never seen where there is a clear separation and false joint”, to which the head doctor responded “Yes, that’s bone on bone grinding, which is probably explains why she has been in so much pain”. 2.) Attending: “I’ve never seen it be so gummy like that” Head Doctor:“Yes, that’s surprising, it is quite gummy”. I have no clue what gummy means, really my only guess is fibrous tissue from chronic mechanical grinding and inflammation. Also I am hypermobile, have hip dysplasia & torn labrum’s, but surgery in the past and evaluation by a new hip specialist, it’s been determined that while there could be some interaction, my back is a separate issue from the hips and has its own pain generator that needs to be handled. Anyways… The first question is, what specific factors could’ve caused my injection to results vary and are these factors significant in regard to the denial or confirmation of my primary pain generator and surgical considerations? **But! The BIGGEST Question is: Resection or Fusion? Which could have the higher success rate, and which has the best chance of giving me significant long term relief? *I know no one can diagnose or give me a guaranteed plan, just looking for opinions. Thanks!   submitted by   /u/Curiostyboutthebody   to   r/BertolottiSyndrome [link]   [comments]