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Back Problems Message Board

Back Problems Board Index

If I were in your position, I would make an appointment with a spine specialist from another practice. Obviously we are not doctors....just fellow sufferers who share information based on personal there is always the chance I am completely wrong here, but you know what you are experiencing and this doctor is not being very helpful. Some spine surgeons aren't as helpful as they could be when it is obvious that no surgery is in the immediate plans...but most are willing to answer questions and direct you to an appropriate source for treatment.

First let me explain what I see in your radiology report. Remember that the MRI is just one piece of the diagnostic puzzle...the doctor correlates what he sees with what he finds when he/she examines the patient, performs a basic neurologic exam and listens carefully to the patient's description of symptoms and how it impacts his/her life.

So a MRI is a starting point -- sometimes things sound worse than they are; other times things that look insignificant can actually be causing a great deal of pain.

First of all it is helpful to know that radiologists use specific adjectives that are used to describe specific issues that function as a type of ranking system. The system begins with minimal, mild, moderate and the worst level is severe.

You will note the most of your issues are listed as mild...which usually means that something is going on that can be handled with conservative treatments which would include things like oral medications, a course of physical therapy, perhaps massage therapy, acupuncture and a series of epidural steroid injections.

The discs both at L3-L4 and at L4-L5 are protruding, and are bulging out enough that they are pushing a tiny bit into the thecal sac...but probably not enough that it is having an impact on the nerves located within the thecal sac. These discs also have annular tears. The annulus is the tough outside radial membrane of the disc that contains the soft, gel-like inner nucleus. It depends on the type of tear, but they can be very painful as the outer periphery of the disc is filled with pain-carrying nerve fibers that are called the sinuvertebral nerves. When a tear occurs in this area, even if very small, it can cause a great deal of pain.

Also at L4-L5 the facet joints are showing degenerative changes, "arthrosis and overgrowth" which means the joints are enlarging and spreading into the adjacent foraminal opening. It is correct that you do not have stenosis in the central canal, but there is a second area that become narrowed and that is the foraminal opening (foramina/foramen). The foramen are openings that the spinal nerves travel through as they move from the spine on out to the limbs. When they become blocked or narrowed, the result is nerve irritation or compression. At this level it is causing a bit of an issue with the descending L5 nerve root.

Similar degenerative changes are occurring at the last lumbar segment, L5-S1, which is resulting again in a pinching of both the L5 and S1 spinal nerves.

These last two lumbar segments (L4-L5 and L5-S1) contain the spinal nerves that innervate the buttocks, groin, back of leg and down into the foot. When one has a sciatic-type pain, it is usually coming from one of these nerves...same with numb toes, pain in the buttocks and in the groin.

Also, I personally know several people including my mother-in-law who was being treated for hip bursitis/arthritis for several years...turned out it was a herniated disc at L4-L5. Due to the large muscles that attach into the spine and run across over to the hip, it is not uncommon for a lower lumbar problem to cause what we perceive to be "hip pain."

I'm not suggesting you do not have a hip issue...but wanted you to be aware that it could also be the back that is causing your pain in the hip area.

So basically you have 3 protruding discs, several annular tears, some effacement of the thecal sac, facet arthrosis and stenosis in the lateral recess and foraminal areas...with some compression of the L5 and S1 nerves. Sounds like a lot...but all of it is rated to be "mild" so your issues are being dismissed by this doctor. No doctor would look at this and tell you that surgery was on the immediate horizon...but that is not to say that your pain is minimal, or that you are not exhibiting signs of nerve compression, such as weakness and numbness.

Look online for a "dermatome map" if you are interested in seeing the specific areas that are innervated by each spinal nerve. I imagine you will notice that your pain follows a pattern that is fairly typical for a L5-S1 nerve compression. Remember, when a nerve is compressed, you can have pain in the back or anywhere along the pathway of the nerve....

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