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Back Problems Message Board

Back Problems Board Index

Welcome to the board...and sorry for the reason you found us. Do you have pain in your leg?

As you know we are not doctors and of course you will need to see your physician for an accurate report. MRIs are one piece of the diagnostic puzzle that your doctor should correlate with his findings upon physical exam, a basic neurologic exam and after listening to your symptoms.

Most people beyond their late twenties will show some signs of disc degeneration and dessication. Discs are the cushions between the bony vertebrae. They are made up mostly of "water" so they tend to dry out as we age. It is common to have some signs of "wear and tear" and many times is asymptomatic...but when MRI is given for another purpose, the person discovers there are bulging discs.

In your case, you have some of this showing in your lumbar discs. You will note it says "disc space narrowing." As the disc begins to lose moisture, it can cause a loss of disc height, which causes the bones (vertebrae) to move closer together. There are disc bulges at each of the segments and also there are signs of facet joint arthritic changes, which often goes hand in hand with degenerating or bulging discs.

The facet joints are synovial joints (with fluid, like the knee, hip, ankle, etc) at the end of the vertebra that connect the vertebrae together. They are subject to enlargement, bone spurs, and other arthritic changes just like other synovial joints.

Sometimes when these joints enlarge and or a disc bulges outside its disc space it can cause stenosis. This means narrowing and in this case is nothing more than the disc or facet taking up room that is needed for the nerve to function properly. There are two areas were stenosis most commonly occurs: one is the central canal and the other is the foramen. The foramen are openings through which the spinal nerves exit the spine and go out to the limbs or body. When something causes one of these openings to narrow, the nerves can end up getting "pinched" or compressed.

[B]l4-l5 there is a diffuse disk bulge ..facet arthropathy and ligamentum flavum hypertrophy causing mild central canal narrowing.. There is severe left neural foraminal stenosis. There is Moderate right neural foraminal stenosis[/B]

You have the disc bulge, facet arthropathy and ligamentum flavum hypertrophy at L3-L4 as well, but it is causing more stenosis at L4-L5. The ligamentum flavum is a thick elastic tissue that connects each joint capsule to the lamina and serves as a protective covering to the spinal canal. As we age, it can thicken...with the result being stenosis. You will note at L4-L5 these issues are causing MILD narrowing in the central canal, but on the left side the amount of stenosis in the foramina is rated SEVERE. This means that there is little space for the nerves...and the compression is probably causing you to feel pain somewhere along the nerve as it goes down the leg and into the foot. It can cause pain anywhere along this path.

At the next level down, Lumbar 5-Sacral 1 the conditions for stenosis are similar. It is causing stenosis in both neural foramen, mild to moderate, but there is none in the central canal.

(There are specific words that are used in radiology as a type of "ranking system" and they range from minimal, mild, moderate to severe. Minimal and mild usually mean the doctor will tell you everything looks OK. Once you get to moderate, the doctor will first recommend conservative treatments such as a course of physical therapy, oral medications, perhaps a series of epidural steroid will always be considered as a last resort.

I would suggest that you see a spine specialist for an accurate diagnosis. This could be either a fellowship-trained orthopedic spine surgeon or a neurosurgeon whose practice is limited to the neck and back.

A course of physical therapy will be helpful to teach you the appropriate exercises to increase your muscle strength in the core and back. You should avoid activities that involve twisting or bending at the waist and you should not be trying to lift anything that weighs more than about 10 pounds until you know more about the condition of your discs.

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