• 1 month ago

    4 mnth pain. Mri reveals

    Hello,

    I have been dealing with severe lower back pains and left leg pains for nearly four months. Walking on leg is a challenge now. Very bad pains. Pain meds dont work anymore and its strong meds too.

    Most recent mri revealed
    L5 disc dissecation with loss of height disc bulge with focal central herniated component. Along with annular tear measuring 6x4x4 mm. Accuired some enhancement. Bilateral nearul foramina narrowing.
    L4 disc bulging. Endplates changes. Narrowing neural faromina

    What does that mean? Surgery?

    Orginal mri prior to that one was only two weeks apart. So first mri only has disc bulge with protusion. So it appears alot had changed between both mri in just two weeks.
    Symptoms
    Severe lower back and left leg pain. Tingling and numbness in left leg. Trouble walking. Etc

Responses

  • 29 days ago

    RE: 4 mnth pain. Mri reveals

    What type of doctor are you seeing for this? Is he or she a spinal neurosurgeon? That is the type of doctor you need to see for an accurate prognosis and effective treatment plan.

    I pray you find answers and relief soon.
  • 26 days ago

    RE: 4 mnth pain. Mri reveals

    Hello,
    My name is David and I am currently a second year Doctor of Physical Therapy Student. I too have suffered from chronic back pain that was limiting my ability to perform basic activities including walking. I was wondering if you have taken the opportunity to investigate physical therapy as a way to conservatively manage your symptoms?
    A physical therapist is a specialist of the musculoskeletal system who has the ability to identify your limitations and provide individualized interventions that have been proven by research to be safe and effective at resolving symptoms including low back pain. Treatment may include forms of mobilization/manipulation to increase movement of your spine, exercises to increase the strength and motor control of your stabilizing musculature and alternatives to managing your pain.
    In terms of safety, physical therapy interventions have been proven to be much safer than surgical intervention. One study reported the risk of developing serious complications following a lumbar manipulation as less than 1 per 10 million treatments.1 The same study reported that exercise results in a single serious complication per 1.5 million cases.1 Alternatively, disc surgeries, including discectomy and fusion, were found to result in death at a rate of between 2 and 3%.1 This means that there is much greater risk involved when surgery is performed.
    Now that I have demonstrated physical therapy to be a safe alternative to surgical intervention, i’m sure that you are questioning the outcomes. Current literature suggests that physical therapy can prevent surgery while generating similar functional results. A study conducted by Delitto et al.2 found that physical therapy intervention which lasted 2 times per week for six weeks resulted in equal physical function scores when compared to surgery at a 2-year follow-up. Another study reported excellent clinical outcomes in 90% of the patients who met the typical criteria for surgery of a herniated nucleus pulposus and received physical therapy intervention.3 There is also evidence that physical therapy intervention can reduce overall health care costs drastically, lower the number of lumbar spinal injections received and reduce reliance on opioid medications.4
    In your question, you mentioned that your MRI showed disc herniation and bulging at multiple levels, paired with a loss of disc height and narrowing of the foramen. While this sounds intimidating, I want to assure you that it is common for individuals to have abnormal findings on their imaging. In fact, one study reported imaging results which displayed disc degeneration in asymptomatic individuals which increased from 37% of 20-year-olds to 96% of 80-year-olds.5 This means that even those who do not report back pain often show abnormal imaging. I am concerned that these results have made you afraid of movement and exercise and assure you that these are key components to your rehabilitation.
    In summary, I believe that seeking care from a licensed physical therapist will be beneficial to your current condition. This more conservative approach will help restore your functional capability while decreasing the pain that you’re experiencing. I know how frustrating back pain can be and want to assure you that your symptoms will improve. I also want to encourage you to take control of your condition by making decisions that are based on the best evidence available. For now, just remember that movement is a powerful tool that can improve your impairments and resolve your symptoms when it is prescribed appropriately by an expert.
    Best of luck,
    David

    References:
    1. Haldeman S, Rubinstein SM: Cauda equina syndrome in patients undergoing manipulation of the lumbar spine, Spine 17(12):1469-1473, 1992.
    2. Delitto A, Erhard RE, Bowling RW: A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment, Phys Ther 75(6):470-485, 1995.
    3. JA Saal, JS Saal: Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy an outcome study. Spine. 14(4), 1989, 431–436.
    4. Olson, K. Manual Physical Therapy of the Spine. 2nd ed. St. Louis, MI: Elsevier; 2016.
    5. Fritz, Brennan, Hunter. Physical Therapy or Advanced Imaging as First management strategy..Health Serv Res. 2015, Mar 16.