Posterior disc osteophyte complex causing severe bilateral foraminal narrowing

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  • Ben2480
    Participant
    Post count: 8
    #26999 |

    Hello Dr,
    I have moderate slipped disc in L5-S1 for past 5 years and have been managing it conservatively. My symptoms are intermittent and in left leg. Recently I started having symptoms in my right leg and decided to have a check up. As part of Mri for lumbar spine, my cervical spine was also screened. The L5-S1 disc has protruded slightly more than the previous scan taken 5 years back. However in the new screening, the report says I have posterior osteophyte complex indenting thecal sac and causing severe bilateral foraminal narrowing in C3-4. The symptoms in my neck are just tolerable pain when sitting too long. Occasionally there is some radiating pain to my left hand. But nothing which has bothered me too much. Should I be worried about the report? Should I take further detailed MRI for cervical spine?

    Dr. Corenman
    Moderator
    Post count: 5708

    The C3-4 level is the exit point for the C4 nerve root. This generally is not “too important” a nerve as it does not connect with major arm muscles, The C4 nerve can refer pain into the top of the shoulder and neck as well as occasionally radiate pain to the anterior chest wall. As long as the spinal cord is not compressed and you can tolerate the symptoms, you can “live” with C4 nerve compression.

    The L5-S1 disc has advancing degeneration with bulge (“protruded slightly more than the previous scan”) but you don’t note your symptoms well. See “https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/” to understand how to describe your 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.
    If this forum has helped you, please let Dr. Corenman know!

    Ben2480
    Participant
    Post count: 8

    Hello Dr,
    Thanks for taking time to clarify about my concerns. There is no mention of spinal cord compression in the MRI report. If spinal cord is compressed, would I have more severe symptoms? Right now it is just occasional neck pain and symptoms in hand. I am a software engineer, so lot of times it’s sitting in front of my computer.

    About the back and leg symptoms, it started after a bad fall during snow boarding. Initially the symptoms were just tight back and it was manageable with physio therapy. I did not restrict any of my activities, i.e. playing badminton or snow boarding. However later, I had a very bad back spasm and it kind of locked my spine for almost a week. I was prescribed muscle relaxants to get relief. Since then the leg symptoms would come intermittently. The symptoms are pins and needles, pain through buttocks to leg and feeling of heaviness. The symptoms in back most of the times is just tightness. Discomfort wise it is 20/80 back and leg. The symptoms usually flare up when I sit for a long time or do some cleaning, bending over. During the periods when I am symptom free, I can do most of the activities without much pain. I walk to office 2 miles, I do body weight work outs 4 days per week. However I don’t play sports anymore. I have tried playing but had to stop always after severe back spasm. The spasm happens after a period of playing sports ( like 2-3 weeks of playing). I had 4 such attacks in last 4 years.
    I am 6 foot tall and weigh 78 kg.

    I am thinking if I should go for a discectomy or nucleoplasty or ozone injection. While the symptoms are still manageable for me now, but if the protrusion is progressing and eventually I will have to do a surgery, Is it better to have the surgery earlier? So that I can be pain free and resume all my activities sooner.

    I am sorry for the lengthy question. I am very thankful to you for taking time to give your expert advice.

    Dr. Corenman
    Moderator
    Post count: 5708

    Spinal cord compression is generally painless but if the MRI report stated no cervical stenosis or cord signal change, your cord is probably alright.

    The “locked spine” was probably from an annular tear of the disc. This tear can cause loss of disc height and allow preexisting foraminal stenosis to become symptomatic or allow a greater disc bulge to compress the nerve roots. Since your pain is aggravated by bending and sitting, more likely this is disc protrusion pain. You might try epidural steroid injections as this would reduce nerve inflammation and inflammation is what causes pain. Will these injections cure you? Probably not but can give long term relief.

    Nucleoplasty just reduces the pressure in the disc space allowing further degenerative collapse. Ozone therapy makes no sense to me A nerve decompression or possibly even that with a fusion makes more sense if you fail injection therapy.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Ben2480
    Participant
    Post count: 8

    Hello Dr,

    Yes the MRI says annular tear in L5-S1. I have broad based protrusion, will micro discectomy, work for such herniations? May I ask, if you can please look in the files below for my cervical and lumbar MRI images and provide advice? My goal is to start playing at recreational level, will injection be helpful for that? Is there any further risk like having cauda equina due to further compression, is I resume activities without removing the compression?
    Here are the links for Back and Neck MRIs.

    Thanks a lot for your advice.

    Dr. Corenman
    Moderator
    Post count: 5708

    Sorry but links don’t work here due to fears of virus. You can publish your radiological report here for comments.

    Microdisectomy is very effective for nerve impingement and less effective (but still can work) for tears with local back 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.
    If this forum has helped you, please let Dr. Corenman know!

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