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Old 08-09-2013, 11:37 AM
 
127 posts, read 242,462 times
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Last year I tried lifting something and injured my lower back good. Had severe nerve pain for a while and went to my PCP + x-ray/MRI. Dr. referred to PT and epidurals, but never sought to explain the MRI beyond "There's a herniated disc and some abnormalities." When I went to the pain management office for the epidurals they said all my lumbar discs were herniated.

A year and 3 total epidurals have passed and I've been going to PT in a new healthcare network for about a month. I get occasional nerve pain butt-shin-big toe when contracting abdominal muscles and still have skeleto-muscular pain just above my tailbone where standing and walking for 15+minutes becomes quite painful. I'll be going to an orthopedic spine Dr. next month to get his take (and a new MRI) so I procured the initial MRI results (getting the imaging itself on Monday). This imaging was done 6 months after the event. Because it was never fully explained to me, could someone translate the following?

COMMENT:

L1-L2: Mild disc desiccation. Shallow broad-based right lateral disc protrusion with annular degeneration.
L2-L3: Unremarkable
L3-L4: Mild facet hypertrophy. Small central/right paracentral disc herniation, extrusion type showing mild distal migration, indenting the anterior thecal sac.
L4-L5: Mild disc narrowing. Moderate sized broad-based extruded central and right paracentral disc herniation showing distal migration, abutting the right L5 nerve root, mildly indenting the anterior thecal sac.
L5-S1: Bilateral spondylolysis. Grade 1 spondylolisthesis. Mild disc degenration. The small central and right paracentral disc herniation showing extrusion and proximal migration in the anterior epidural fat.

Regional soft tissues are intact.

Last edited by krayzbone227; 08-09-2013 at 12:57 PM..
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Old 08-09-2013, 03:10 PM
 
Location: Durham UK
2,031 posts, read 4,501,047 times
Reputation: 1127
Quote:
Originally Posted by krayzbone227 View Post
Last year I tried lifting something and injured my lower back good. Had severe nerve pain for a while and went to my PCP + x-ray/MRI. Dr. referred to PT and epidurals, but never sought to explain the MRI beyond "There's a herniated disc and some abnormalities." When I went to the pain management office for the epidurals they said all my lumbar discs were herniated.

A year and 3 total epidurals have passed and I've been going to PT in a new healthcare network for about a month. I get occasional nerve pain butt-shin-big toe when contracting abdominal muscles and still have skeleto-muscular pain just above my tailbone where standing and walking for 15+minutes becomes quite painful. I'll be going to an orthopedic spine Dr. next month to get his take (and a new MRI) so I procured the initial MRI results (getting the imaging itself on Monday). This imaging was done 6 months after the event. Because it was never fully explained to me, could someone translate the following?

COMMENT:

L1-L2: Mild disc desiccation. Shallow broad-based right lateral disc protrusion with annular degeneration.
L2-L3: Unremarkable
L3-L4: Mild facet hypertrophy. Small central/right paracentral disc herniation, extrusion type showing mild distal migration, indenting the anterior thecal sac.
L4-L5: Mild disc narrowing. Moderate sized broad-based extruded central and right paracentral disc herniation showing distal migration, abutting the right L5 nerve root, mildly indenting the anterior thecal sac.
L5-S1: Bilateral spondylolysis. Grade 1 spondylolisthesis. Mild disc degenration. The small central and right paracentral disc herniation showing extrusion and proximal migration in the anterior epidural fat.

Regional soft tissues are intact.
I'm not a Doctor but I am a RN.
1.Not all your lumbar discs were herniated as L2-L3: Unremarkable is another way of saying "normal"(as far as they can see!).
2.You had disc herniations of varying degrees in all the other lumbar vertebral spaces. Some of the terminology used eg annular degeneration (the annulus fibrosis is the tough fibrous ring around the outside of the disc which protects the soft , gel like center, the nucleus) suggests the disc and you aren't spring chickens anymore(unless they've told you have any other condition that could cause the degeneration)
3.Your pain corresponds with what's going on around L4-S1 just above your tailbone where it seems the worst herniation is (moderate- rather than small, disc is herniated in 2 places around the vertebra) and it's affecting where the L5 nerve leaves the spinal cord. This is causing the typical sciatica pain from butt to big toe.
Causes of Sciatica Pain and Sciatica Symptoms with Info On Sciatic Nerve Involvement
4.Spondylolysis is a abnormality of the vertebra that occurs only in lumbar vertebra and usually in L5. I believe it's a weakened area-maybe a hairline crack which can be caused by certain types of repetitive movements- particularly some sports, however it can also be to do with the shape of the vertebra and can be hereditary. It can also happen when a baby is trying to walk and falls on his butt!
5. Spondylolithesis (due to the spondylolysis apparently) means your L5 vertebra is not quite sitting on top of S1 correctly- but grade 1 means it's only just out of alignment.

Hope this helps.
Wonder if you'd had any back injury/problems before this.

PT is really important to try and strengthen abdo and other muscles and improve pelvic stability so that there's less strain on the area.
If the Ortho spine Doc suggests surgery I would get at least 3 other opinions!
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Old 08-09-2013, 06:52 PM
 
Location: Up above the world so high!
45,270 posts, read 86,039,386 times
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Quote:
Originally Posted by Whatsthenews View Post
I'm not a Doctor but I am a RN.
1.Not all your lumbar discs were herniated as L2-L3: Unremarkable is another way of saying "normal"(as far as they can see!).
2.You had disc herniations of varying degrees in all the other lumbar vertebral spaces. Some of the terminology used eg annular degeneration (the annulus fibrosis is the tough fibrous ring around the outside of the disc which protects the soft , gel like center, the nucleus) suggests the disc and you aren't spring chickens anymore(unless they've told you have any other condition that could cause the degeneration)
3.Your pain corresponds with what's going on around L4-S1 just above your tailbone where it seems the worst herniation is (moderate- rather than small, disc is herniated in 2 places around the vertebra) and it's affecting where the L5 nerve leaves the spinal cord. This is causing the typical sciatica pain from butt to big toe.
Causes of Sciatica Pain and Sciatica Symptoms with Info On Sciatic Nerve Involvement
4.Spondylolysis is a abnormality of the vertebra that occurs only in lumbar vertebra and usually in L5. I believe it's a weakened area-maybe a hairline crack which can be caused by certain types of repetitive movements- particularly some sports, however it can also be to do with the shape of the vertebra and can be hereditary. It can also happen when a baby is trying to walk and falls on his butt!
5. Spondylolithesis (due to the spondylolysis apparently) means your L5 vertebra is not quite sitting on top of S1 correctly- but grade 1 means it's only just out of alignment.

Hope this helps.
Wonder if you'd had any back injury/problems before this.

PT is really important to try and strengthen abdo and other muscles and improve pelvic stability so that there's less strain on the area.
If the Ortho spine Doc suggests surgery I would get at least 3 other opinions!
Great job interpreting things for this OP

I was just going to say that the good news is that most of what was discovered is "mild" and hopefully good PT and exercise can help the OP to avoid any kind of surgery.
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Old 08-09-2013, 08:07 PM
 
Location: In a house
13,258 posts, read 34,613,675 times
Reputation: 20198
The mild disc degeneration of L5-S1 - from what I was told, is a very common occurrence as people age, it usually hits adults in their 50's and progresses very slowly. That'd be the "general lower back ache" that seniors complain of.

Trauma can cause it to start earlier - I've had degenerative disc disease since I was around 30, because of a car accident when I was around 20. It started at L5-S1 and it's moved to the disc above it as well. Keeping your stomach and back muscles strong will take a -lot- of the pressure off your lower spine. Wear comfortable shoes with sturdy arch supports if you walk around a lot, and if you normally partake in high-impact movement - you might want to switch that up for low-impact movement. Check with your doctor though - I don't know anything about any of your other back issues and they might have different recommendations.

If it helps at all, to compare: I have degenerative disc disease and osteopenia in my right hip and lower spine. This is -all- from a car accident in 1983. At age 52, I work out at least twice a week at the gym, I ride my bicycle at least 10 miles on nice days, I can still do a cartwheel, and I can still climb willow trees. I'm in pain all the time, but it's never unmanageable and I rarely take any meds for it at all. I take a children's chewable vitamin and a TUMs extra strength for calcium every day. Humidity is tough on my bones, but I "weather" through it (pun intended).
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Old 08-10-2013, 06:37 AM
 
127 posts, read 242,462 times
Reputation: 53
Quote:
Originally Posted by Whatsthenews View Post
I'm not a Doctor but I am a RN.
1.Not all your lumbar discs were herniated as L2-L3: Unremarkable is another way of saying "normal"(as far as they can see!).
2.You had disc herniations of varying degrees in all the other lumbar vertebral spaces. Some of the terminology used eg annular degeneration (the annulus fibrosis is the tough fibrous ring around the outside of the disc which protects the soft , gel like center, the nucleus) suggests the disc and you aren't spring chickens anymore(unless they've told you have any other condition that could cause the degeneration)
3.Your pain corresponds with what's going on around L4-S1 just above your tailbone where it seems the worst herniation is (moderate- rather than small, disc is herniated in 2 places around the vertebra) and it's affecting where the L5 nerve leaves the spinal cord. This is causing the typical sciatica pain from butt to big toe.
Causes of Sciatica Pain and Sciatica Symptoms with Info On Sciatic Nerve Involvement
4.Spondylolysis is a abnormality of the vertebra that occurs only in lumbar vertebra and usually in L5. I believe it's a weakened area-maybe a hairline crack which can be caused by certain types of repetitive movements- particularly some sports, however it can also be to do with the shape of the vertebra and can be hereditary. It can also happen when a baby is trying to walk and falls on his butt!
5. Spondylolithesis (due to the spondylolysis apparently) means your L5 vertebra is not quite sitting on top of S1 correctly- but grade 1 means it's only just out of alignment.

Hope this helps.
Wonder if you'd had any back injury/problems before this.

PT is really important to try and strengthen abdo and other muscles and improve pelvic stability so that there's less strain on the area.
If the Ortho spine Doc suggests surgery I would get at least 3 other opinions!
Thanks, that was very helpful. For reference--and I should've mentioned--I'm only 28. I've "pulled" my back once before while playing soccer and was immobile for a couple days. I've generally had weak lower back muscles where I could never do many ab exercses, if that gives a point of reference, but that would still seem more muscular, I'd imagine.

The last couple epidurals haven't helped the pain much, which luckily isn't AS nerve-related this year. PT for the past month hasn't been helping, but as strengthening my core is important to me no matter what, I'm not giving up.

As it is, I can't run, jump, play any of the sports I used to, wait in any significant lines or walk on uneven surfaces (which puts a damper on pain-less vacationing), and can't lift things with strain on my back (even just adding a load to a standing position). All these things are really making me feel poor about the prospects of starting a family sometime in the next few years and it's depressing.
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Old 08-10-2013, 08:59 PM
 
Location: Durham UK
2,031 posts, read 4,501,047 times
Reputation: 1127
Quote:
Originally Posted by krayzbone227 View Post
Thanks, that was very helpful. For reference--and I should've mentioned--I'm only 28. I've "pulled" my back once before while playing soccer and was immobile for a couple days. I've generally had weak lower back muscles where I could never do many ab exercses, if that gives a point of reference, but that would still seem more muscular, I'd imagine.

The last couple epidurals haven't helped the pain much, which luckily isn't AS nerve-related this year. PT for the past month hasn't been helping, but as strengthening my core is important to me no matter what, I'm not giving up.

As it is, I can't run, jump, play any of the sports I used to, wait in any significant lines or walk on uneven surfaces (which puts a damper on pain-less vacationing), and can't lift things with strain on my back (even just adding a load to a standing position). All these things are really making me feel poor about the prospects of starting a family sometime in the next few years and it's depressing.

Sorry that you have these back problems at such a young age. I am thinking that maybe you must have done damage at the time when you hurt it playing soccer and that has lead to some degenerative changes which would normally be seen in older age.
The back doesn't seem to be very forgiving if you don't look after it well.
I had a whiplash injury when I was about 25. Fell from a horse who then proceeded to kick me under the chin (by accident) when I was on the ground. Had severe pain for 4 days.
Now -25 years later I have cervical vertigo (I get off balance if I change the position of my head and neck too quickly, or try and walk in one direction whilst looking another.
I don't know enough about spinal/ortho medicicne or surgery to add anything else, except that surgery can sometimes make the situation worse and I would be very reluctant to let a surgeon mess with my back.
I wonder if you could try acupuncture? I had an RN friend who hurt her back at worl when she was 32 and had to leave nursing 2 years later. She swore by acupuncture.
The other thing I wonder about would be a TENS machine. She used to use one every morning for 20 minutes before she got out of bed.

I don't know enough about Chiropractic to suggest it, but some people seem to swear by it.

Try and stick with the physio and see if it helps over a longer time period.

I'm not going to say "chin up" or "be strong" because it must be hard for you!
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Old 08-11-2013, 02:59 PM
 
Location: in a house
3,574 posts, read 12,839,778 times
Reputation: 2332
Quote:
Originally Posted by krayzbone227 View Post
Thanks, that was very helpful. For reference--and I should've mentioned--I'm only 28. I've "pulled" my back once before while playing soccer and was immobile for a couple days. I've generally had weak lower back muscles where I could never do many ab exercses, if that gives a point of reference, but that would still seem more muscular, I'd imagine.

The last couple epidurals haven't helped the pain much, which luckily isn't AS nerve-related this year. PT for the past month hasn't been helping, but as strengthening my core is important to me no matter what, I'm not giving up.

As it is, I can't run, jump, play any of the sports I used to, wait in any significant lines or walk on uneven surfaces (which puts a damper on pain-less vacationing), and can't lift things with strain on my back (even just adding a load to a standing position). All these things are really making me feel poor about the prospects of starting a family sometime in the next few years and it's depressing.
I would also suggest a physiologist (MD) in addition to the spine guy; there is probably one on staff. Are you prohibited from back strengthening exercises in addition to the abdominals? Have you tried yoga?
My youngest son is a soccer player and plagued with issues similar to yours - he is a sweeper - and has tried the back strengthening approach with some relief. Also, agree with Whats - get another opinion if surgical intervention is suggested.
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Old 08-11-2013, 07:07 PM
 
127 posts, read 242,462 times
Reputation: 53
Quote:
Originally Posted by mm_mary73 View Post
I would also suggest a physiologist (MD) in addition to the spine guy; there is probably one on staff. Are you prohibited from back strengthening exercises in addition to the abdominals? Have you tried yoga?
My youngest son is a soccer player and plagued with issues similar to yours - he is a sweeper - and has tried the back strengthening approach with some relief. Also, agree with Whats - get another opinion if surgical intervention is suggested.
Yeah in physical therapy I'm doing core strengthening exercises like contacting my abs while doing limb lifts on all fours as well as during wall pushups and squats. Is a physiologist much different from a PT?
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Old 08-12-2013, 12:24 AM
 
Location: in a house
3,574 posts, read 12,839,778 times
Reputation: 2332
Quote:
Originally Posted by krayzbone227 View Post
Yeah in physical therapy I'm doing core strengthening exercises like contacting my abs while doing limb lifts on all fours as well as during wall pushups and squats. Is a physiologist much different from a PT?
Yes. (I meant to spell physiatrist. It's late.) Physiatrists are physicians (MD/DO) who have completed training in the medical specialty of physical medicine and rehabilitation. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system and rely strongly on a "team "approach with other professionals (PT/OT for example). I first became aware of this specialty during a continuing ed presentation on low back pain. A physiologist is someone who studies the acute and chronic metabolic responses of the body to biochemical and physiologic changes; this is usually a PhD.


http://www.aapmr.org/patients/aboutp...ysiatrist.aspx
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