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Back Problems Message Board

Back Problems Board Index

Welcome to the board. For the purposes of this post, I am going to assume that you are new to the world of spinal anatomy, and issues that cause pain. I will define some of the terms in your radiology report so that you can better understand what is going on.

I will start out by telling you that even though it looks like there are many things that are "wrong," your lumbar spine is in pretty good shape.

You will notice the word "spondylosis" is used several times. The basic definition of spondylosis is age-related wear and tear on the spinal intervertebral discs...sometimes also referred to as spinal arthritis.

Spondylosis can affect the spine’s intervertebral discs and facet joints. As people age, there are normal age-related cellular changes that combined with the effects of daily wear and tear can cause or contribute to discs losing normal shape, size, and height. The discs are what provide the cushion (shock absorption) between the vertebrae (bones of the spine), and, along with the facet joints, allow the back to bend and twist. They are composed of 90+% moisture but do not have a direct blood supply, so as we age, the discs tend to dry out and flatten. This brings the vertebrae closer together and is sometimes referred to as "disc space narrowing."

These structural changes can affect normal movement of the facet joints. Osteophytes (bone spurs) develop, which can pinch a spinal nerve root and cause inflammation and pain. This whole process is sometimes described as degenerative disc disease.

One other useful thing to know is that the aging process in the spine of human beings begins in are twenties! This is when the discs can begin to lose moisture and to begin to suffer from the force of gravity pushing down as we walk upright.

Now to the will see that all the lumbar discs are showing a small amount of wear and tear. They are described as having bulges of approximately 2mm. In addition, the facet joints at each of these levels are showing signs of hypertrophy...joint enlargement and degeneration. This is a minimal amount and nothing to be worried about.

At L4-5, the degeneration is a bit more pronounced. The disc bulge is a bit larger and is pushing out to the posterior side. This, combined with the enlargement of the facet joint and hardening of the adjoining ligament, is pushing over toward the central spinal canal, resulting in some stenosis.

Stenosis means narrowing. In the spine it occurs in two places: the central canal and in the neuro foramina, which are openings located at each vertebral level that allow the spinal nerves to exit the spine to go out to the area of the body they innervate. This narrowing is caused by the enlargement of body parts that take up room that is needed by the nerves to function normally...things like bulging disc, enlarged facet joint, bone spurs, etc.

When something pushes into the central canal, it causes symptoms like pain, tingling and numbness that can be felt in the back or anywhere along the path the nerve travels...i.e., radiating pain. L4-5 usually causes pain when walking or standing, pain that runs along the back of the leg and sometimes buttocks. This pain at L4-5 often feels better when the person leans forward as when pushing a shopping cart.

In your case, the central stenosis is described as moderate (this is on the following scale: minimal, mild, moderate and severe.). This would be treated through conservative treatments such as a course of physical therapy, oral medications for inflammation and pain, perhaps a series of epidural steroid injections for the same purpose. I would be amazed if surgery were recommended at this point!

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