[jftaylor89]

#28667

Hi, I first want to thank you because after reading your forum for a bit you seem extremely kind and helpful to many people suffering. I am a 28 year old white male, 6′-0″ 155 lbs living in the southern US, I have had a desk job for the past five years, I am usually moderately active and try to stay in decent shape, used to run at least 6-10 miles a week. Have never had any health issues other than being born prematurely by two months.

Starting in February of this year I was picking up a miter saw to do some wood working and I felt some back pain that evening, it was not debilitating, I was able to get relief with ibuprofen every once and a while and heating pads. This pain lasted two months, some days it was there, others it was not. Then one day it all changed to just feeling like a pressure in my lower back, no pain at all but it felt like someone was lightly pushing their fist into my back. Shortly thereafter I woke up with both of my legs tingling and feeling funny. over the next month, that would come and go, I then also started getting tingling/sensation changes in my genitals and groin area. I set up an orthopedic appointment and had a lumbar MRI completed. The report was as follows:

T12 Thru L2: Unremarkable
L2-L3: Minimal Annular Bulge
L3-L4: Minimal annular bulge with minor ligamentum flavum hyptertophy
L4-L5: Minimal Annular Bulge with mild ligamentum flavum hypertrophy. Mild relative central canal stenosis.
L5-S1: Mild disc dessication with annular bulge. Small broad-based central disc protrusion contributes to minor ventral sac impression. Mild to moderate right and mild left foraminal stenosis. Developmental asymmetry of the facet joints.

ImpressionL L3-L4 disc bulge, L4-L5 disc bulge with mild central canal stenosis, L5-S1 degenerative disc disease with small broad-based central disc protrusion. L5-S1 foraminal stenosis.

After this MRI, my ortho said these findings did not seem to attribute to all of my symptoms so he referred me to a neurologist. The neurologist check my reflexes and said I seemed hyperreflexive and my other symptoms seem to make him think there might be something going on higher up so I was then MRI’d for my thoracic, cervical, and brain. They found no major abnormalities except in my cervical section. The MRI read as follows:

C2-C3: Unremarkable
C3-C4: Normal disc height with moderate right-sided uncovertebral join hypertrophy. Moderate right foraminal stenosis. The left neural foramen is not significantly stenotic. No spinal stenosis. The thecal sac measures 10 mm AP.
C4-C5: Normal disc height with mild uncovertebral joint hypertrophy bilaterally. Mild bilateraly foraminal stenosis.
C5-T1: Unremarkable

Impression: 1) There is degenerative spondylosis at C3-C4 and C4-C5. Moderate right foraminal stenosis at C3-C4 could affect the right C4 spinal nerve. Mild bilateral formainal stenosis at C4-C5.
2) No abnormal cord signal. No abnormal enhancement.

Up until that point I had had no neck pain or radicular symptoms in my arms or upper body. My neurologist asked if I had any problems with my neck so at the time I said no and he did not tell me anything about my cervical findings. He recommended PT which I have been doing for the past three weeks 2x/week and he started me on Cymbalta to see if it could help with some of the sensation changes in my legs/groin.

Since starting PT and the Cymbalta I have seen noticeable improvement in my leg sensations and low back pain. But my neck has started to hurt and have had some very acute episodes of pain down the side of my neck into my upper shoulder when I move to a certain position when sleeping. THis pain is very short lived and relieves once I get back to a certain position. I am hoping you could help clear up some things that my doctors didn’t really touch on.

1) Ligamentum flavum hypertrophy seems to be something seen in older individuals, should I be concerned about this finding in my lumbar region.

2) Uncovertebral joint hypertrophy is an overgrowth of bone which restricts the neural foramen. My PT was very surprised to see this in someone my age. Is this also something I should worry about? Also what sort of treatments are there for this?

3) From the listed MRI findings, what would your plan of action been? (if this is not an appropriate question, please disregard. I’m just trying to compare my doctors recommendations.)

THanks again for everything!

[Donald Corenman, MD, DC]

#28681

You are the proud owner of CBS (crappy back syndrome). The discs have no blood supply so cannot heal any injuries to their annular walls. Some people have brittle annular fibers that make up the back wall of the disc and these fibers can and do tear under load. Since the back wall of the disc is full of nociceptors (pain fibers), back pain is the defining symptom in some people.

You are one of the individuals who has a “well educated back” meaning these tears send substantial messages to your thalamus telling you that you have a back injury. There are many individuals who have these tears and don’t even know it. They have what I call a “stupid back”-annular tears without any knowledge of the tears. In this case, stupidity is an asset.

You can have genetic ligamentum flavum hypertrophy. If the central canal is wide enough (you have no central narrowing or stenosis), then this can be ignored.

Uncovertebral joint bone spurs are somewhat common and in an individual like you with genetic degenerative disc disease, it can be expected. As long as you have no nerve compression causing symptoms, again-ignore it.

You need to be especially careful how you lift and load your back. See https://neckandback.com/treatments/conservative-treatment-mechanical-lower-back-disorders/

Pilates should be your best friend.

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.

[jftaylor89]

#28703

Dr. Corenman,

Thank you very much for replying so quickly, I truly appreciate it! I have reached out to a Pilates instructor and I am looking into learning more about that. I forgot to ask a question previously that I am also curious about. What exactly is meant by developmental facet asymmetry? Thanks again!

-John

[Donald Corenman, MD, DC]

#28707

Developmental facet asymmetry is also called “tropism”, the turning of a joint surface due to development disorders. Generally, tropism is nothing to worry about. I see many individuals with this “disorder” who have absolutely no symptoms.Theoretically, you could wear your facet out prematurely due to the abnormal loading but this tends not to be the case. In your case, the annular tears are your pain generator.

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.

[jftaylor89]

#28718

Thank you for explaining that! Well I guess my question now is, will my “educated” back ever re-educate itself to where its not so susceptible to the pain? Meaning will this pain be persistent, also can the bulges, including the one in my degenerative disc move back in to place with continued therapy and core strengthening? Thanks again for your insight.

-John

[Donald Corenman, MD, DC]

#28730

Degenerative changes can lead to a “stiffened spine” which can be less painful over time. Degenerative bulges will never “move back into place” but can shrink down occasionally. Core strength will stabilize the spine to prevent aberrant motion that can further damage the disc.

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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