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I was told by my pain management doctor, who performed two Epidural injections at left L-5,S-1 a month ago to stop bending and lifting due to a recent back Spasm from DDD. My primary doctor ordered a new Lumbar MRI at my request after those injections as my last one was 2 years old. I was considering your advise in an earlier post to see a spine surgeon for a workup and he needed a new MRI report. My primary says it is ok to perform McKensie Extension exercises and a PT that I have been in contact with say to only perform flexion exercises. What is your opinion Dr. Corenman? I would like to do the McKensie extensions as I have a 3mm bulging disk at L-3/L-4 and a 4mm at L-4/L-5. Minimal foraminal narrowing. Minimal central canal narrowing. Small posterior disk tears at 3 and 4 noted. It is noted that at L-5,S-1 there is moderate to severe disk height loss, a small posterior disc osteophyte complex. Mild facet joint hypertrophy causing mild to moderate bilateral foraminal narrowing. No bulge at l-5,S-1. In the MRI two years ago I had a 3mm bulge noted at L-5,S-1. I bought the book by McKensie, “Treat Your Own Back”, which has world wide acclaim from PT’s for individuals with chronic lumbar back pain due to DDD. I am concerned about this PT I am in contact with that says the small posterior osteophyte complex will damage and compress the L-5,S-1 disk and therefore only perform flexion exercises. From what I understand flexion is not helpful for patients with DDD as it could make my posterior bulges bigger. My primary doctor says my MRI results and the fact that I don’t have sciatica pain does not warrant a meeting with a surgeon. I am not in pain at this point in time in my lumbar spine. By the way, my MRI two years ago stated that my L-5,S-1 had a 3mm disk bulge resulting in moderate to severe bilateral neural foraminal narrowing. Nothing about disk height or osteophyte complex?
You report: “I have a 3mm bulging disk at L-3/L-4 and a 4mm at L-4/L-5. Minimal foraminal narrowing. Minimal central canal narrowing. Small posterior disk tears at 3 and 4 noted. It is noted that at L-5,S-1 there is moderate to severe disk height loss, a small posterior disc osteophyte complex. Mild facet joint hypertrophy causing mild to moderate bilateral foraminal narrowing. No bulge at l-5,S-1”.
The restriction in extension (McKensie Exercises in general) is for patients who have stenosis or narrowing of the spinal canal (or foramen and lateral recess. There generally are no restrictions for extension other than those exceptions.
According to your MRI, you most likely have lumbar isolated disc resorption (IDR-see website). When you load the disc by bending forward (flexion), that might increase your pain. In my opinion, you would be better served to work on extension to load the (hopefully) normal facets, unload the disc and reduce pain.
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.The disk height centerline on the T2 scan at L4-5 is about 1/2″ tall. The L5,S1 disk is about 1/4″ tall. The lower half of L5 is about 70% white on its lower half. The 30% grey is in the middle lower half. There are 2 small end plate fractures on top of S1. The T3-4 and T4-5 are rather grey vs the L2-3 which is clearly a white disk. I see your point on the resorption. Is there any hope for the artificial disk at L5,S1 in the near term future? It reads like my future will be your fusion technique. I will be on Medicare in a year and a half. Moving to Cedar City, UT next July to start my early Social Security retirement at 64. No more hardwood floor installation going forward from today. My employees will be performing those tasks as I supervise. I plan on renting my tools and mentoring do it yourselfers in the Southern Utah region when I move there for extra SS income. lol
Curiously my 2013 T2 scan at L5,S1 looks very similarly to the current scan visual results at center line. I assume things don’t change that quickly. Although in 2013 the radiologist only commented on a 3mm bulge and nothing about disk height and osteophyte complex conditions as the current Radiologist. The 2013 scan was performed in a closed MRI and the current one was performed in a 1.5 open end on each end.
The L5-S1 level is probably IDR (isolated disc resorption lumbar). Unfortunately, the years of placing hardwood floors along with your preexisting genetics has worn out your L5-S1 disc.
Many radiologists do not understand the significance of degeneration of the vertebral body and will not report these changes. I think however that many are “catching up” and are better at reporting these changes.
I am not at this time a fan of artificial discs for the lumbar spine. There are problems with implantation and failure that makes these devices still less than desirable to me.
The good news is that if you do have IDR, you have almost no motion of L5-S1 and would not be a candidate for an ADR in the first place. This is why fusion of this level works so well. You stop the painful micro-motion but do not sacrifice motion loss of the lumbar spine with surgery.
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.My goal is to stick it out until I reach Medicare age; 1 1/2 years from now. I will be in Cedar City so not too far from Vail; 7 hour drive. Do you think I could come to Vail and be capable of returning to Cedar City the day after the procedure then do my PT in Cedar with local follow up? Base on a new MRI could I come to Vail and you would be prepared to perform the procedure?
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