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Back Problems Message Board


Back Problems Board Index


Welcome to the board.

The discs are comprised of something like 85% "moisture" and as such, are subject to drying out as we age. This degenerative process is called "dessication." It results in a weakening of the disc, or in some cases, the disc becomes pancaked so that the adjoining vertebrae actually touch.

At the disc located between the lumbar 4 and lumbar 5 vertebrae the disc is reported to be protruding. A disc protrusion is a type of disc herniation --it means the disc contents is protruding out beyond the normal confines of the intervertebral disc.

Think of a water balloon. When you push on one side of it, the displaced water causes there to be a bulge out the other side. This is similar to what happens with the disc. In your case the protrusion is described as small, but it is still pushing into the thecal sac, which is a thick membrane that contains the spinal nerves in the central canal. This puts pressure into the side of the thecal sac, which can result in nerve pain.

At the next level, L5-Sacral 1, the disc is also dessicating. It too is pushing into the thecal sac, "indenting" it. There are some signs of degenerative change located in the facet joints at this level.

The facets are synovial joints that are located at each level and connect one vertebra to the next. They, along with the discs and connecting ligaments are what allow the spine to bend, twist and flex. They are subject to arthritis just like other synovial joints like the ankle, knee, hip, etc. This facet arthropathy is a very common source of lower back pain.

Sometimes the joint enlarges which causes stenosis of the foramen. The foramen are openings through which the spinal nerves pass from the spine out into the body. When the enlarged facet takes up more than its own space, it causes the foramen to narrow...which puts pressure on the spinal nerve. This can result in nerve compression or irritation. All of this is described as "mild" in your report...meaning that it is noticed but it has a long ways to go before it would require a surgical procedure of some type.

The disc at this level is drying out and it has an annular tear as well. This is a tear in the outer circumferance of the disc...which may or may not be causing pain.

Since the described issues are "mild," I would imagine that the spine specialist would recommend treatment with conservative modalities such as a course of physical therapy to strengthen the core and back muscles, oral medication for pain and inflammation and perhaps a series of epidural steroid injections to relieve inflammation and help the tissue to heal.

You will want to be very careful to avoid any activity that involves bending or twisting at the waist, pushing, pulling, reaching up overhead or to the side, and you should not lift more than a small amount of weight...with a herniated disc people are restricted to about 10 pounds until they are healed.

Just to ease your mind...many doctors will look at your MRI and probably say things look pretty good. Radiologists use a series of adjectives that serve as a ranking system: minimal, mild, moderate and severe.

The human spine begins the aging process in our 20s...so most people beyond that age show a bit of "wear and tear" in their spine, especially with the discs and facet joints.

Where do you feel your pain? Do you have pain or numbness in legs or feet?
That's a lot of questions! I'm not sure where to begin...but I will start with "am I falling apart?" When spinal issues begin, it often seems that way. It is actually not unusual to develop cervical and lumbar issues at the same time -- and this makes sense since all the discs are structured alike...and the processes that affect one area affects all the discs.

Another significant thing is the bio-mechanical aspects of the spine. All the bones are connected (do you remember the old song about "the leg bone's connected to the thigh bone...the thigh bone's connected to the hip bone...etc?")...so when one develops lower back pain, the body compensates for that pain by changing position, trying to take pressure off the painful side. This throws off the structural alignment in other areas, causing uneven wear and tear, etc. Pronation of the feet sometimes gets things going -- other injuries can cause one to change gait, for example, which over time, can cause other issues.

Just as some people naturally make more scar tissue, some of us are more prone to the effects of arthritis...but everyone has some degeneration going on to some extent.

[B]the report said small to moderate central herniated disc protrusion which compresses the thecal sac in the midline? What does that mean?[/B] You know what a herniated disc is, right? The disc can bulge out to the left or right side or the bulge can be in the middle -- it can also push forward or it can push out to the back. When it pushes far enough to the back, it can press into the thecal sac, which is the membrane that encompasses the spinal cord above the lumbar area, and athe bundle of nerves that run through the central canal called the "cauda equina" that runs through the lumbar and sacral area before it branches into two as it enters the legs as the big sciatic nerve.

Twenty years ago surgery to repair a herniated disc was almost never performed. This is the case in many countries around the world today. We in the US have tons more surgeries for spine problems than any other country. The discs were left to heal on their own. Only if it ruptured or was putting extreme pressure on the cauda equina was surgery performed.

Today the thinking is that a nerve should not be left in a compressed state too long...so surgery is ordered much more quickly than in the past. I suspect this will change again once Obamacare goes into effect in a year or two....(just my guess ;) )

Dessication is the process where the discs of the spine are losing moisture -- it is the first sign that there is some degenerative disc disease going on. Multi level dessication means that this is happening at several or many different discs --

This is not an unusual finding. If one disc is dessicating, chances are that there are some others that are doing the same thing.

Lots of times, people have Cervical problems without being aware of it. That was the case with me. When I had my first cervical MRI, I discovered that two vertebrae had fused together just as if I had had surgery for this...and, I was not aware of even having any pain at all.

Hope this helps you understand your reports. As you know we are just fellow spineys, not doctors...so you will need to speak with your doctor to get an official report. I just want to help you understand the language so when the doctor talks to you about possible treatment options, you will understand better what he/she is saying.





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