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  • ian d
    Member
    Post count: 2

    Hi Dr Corenman,
    Just had a few questions!!I am a 41 yr old male with lumbar back pain and I have sciatica and mid pelvic pain for about 3 months! It hurts when I sit down,lay on my back,or side,and in mornings when I get out of bed!It doesnt hurt when I stand or walk!I went to my p.c.p a month ago,and she requested a mri.I got the mri results and this is the findings:(short version)

    L1/L2:Degenerative disc disease with a small likely Schmorls node in the mid anterior L1 verebral body.No evidence of surrounding edema.No evidence of canal,foraminal,or recess stenosis.There are mild anterior osphetic changes.

    L2/l3-is fine

    L3/l4-is fine with mild facet disease and ligament flavum thickening

    L5/S1-there is a small focal area of fluid signal extending into a small central/left paracentral disc that is immediately abbuting the left S1 nerve root in the canal and in the proximal left recess.There are degenerative changes of the facets causing some narrowing of the left greater than the right foramina but no definitive impingement in the foramina.There is at least moderate facet disease and mild ligamentum flavum thickening.

    Impressions:There is a central/left paracentral small disc protrusion with focal fluid that may represent a small annular tear that is immediately adjacent to the left S1 nerve root in the canal and entering into the left recess.Correlate for left S1 radicular symptoms.There is some loss of disc height and degenerative changes of the disc.

    OK,..first question is on the L1 disc it says degenerative disc disease.is that why there is mild anterior osphetic changes(bone spurs?)!So I guess does that mean my disc’s are so worn out its bone on bone now causing osphetic changes?<--(no pain in area) Second question is L5/S1 area..I have read alot of different terms for herniated disc,some protrude,some bulge,some herniate.Is a protruding disc with a annular tear a herniated disc?It says focal fluid,just not sure if thats the nucleus leaking out.!! It hurts,im 230 pounds,and I guess with degenerative changes in disc,the weight puts more pressure on spine!! Any help would greatly be appreciated!
    Oh,since its been 3 months of this pain,which is affecting my way of life,cant get comfortable sitting,sleeping,then should I try conservitave treatments first,then consider surgery?Thanks!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You have buttocks and leg pain along with lower back pain. You have two levels of significance, L1-2 and L5-S1. Your symptoms of back and leg pain occur with sitting and are relieved with standing.

    Most likely, the L1-2 level is not causing you symptoms. First, there is no evidence of any nerve compression here. The second is you don’t indicate any upper low back pain.

    The L5-S1 level is most likely causing most of your symptoms. Herniated discs that compress the local nerve root (in this case S1) will cause buttocks and leg pain with sitting that is relieved by standing and walking. Lower back pain is caused by the annular tear.

    A protruding disc with an annular tear is the definition of a herniated disc.

    If you have no motor weakness (which would be noted as difficulty walking on your toes), then with three months of pain, if you were my patient, epidural steroid injections and therapy would be the next step in the treatment algorithm.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
    ian d
    Member
    Post count: 2

    Okay,
    Thanks for the feedback,really helpful!I mentioned that mild anterior osphetic changes were on the L1/L2,is that considered osteoarthritis?Or bone spurs?Is that gonna get worse without surgery?No pain,just concerned! Thanks again,you have answered all but this question,your awesome!!!<—–happy!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    I see non-symptomatic L1-2 degenerative changes all the time. Don’t worry about this if there are no symptoms.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
     
    Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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