[elesh]

#30462

Dear Dr. Corenman,

I would like your expert opinion, suggestion and support. Please advise any treatment and if surgery is neccesary or can be avoided. Thank you for your time and attention on this matter.

New MRI
RN 503143 DATE 03.05.19
MRI Lumbar Spine
Sag T1/T2/ STIR, Ax T2
Clinical: To rule out disc prolapse at the lumbo-sacral region
FINDINGS:
T11/L1- Right posterolateral disc bulge seen, laterally compressing the central anal to a diameter 10mm, however the AP central canal diameter is 15mm. Bilateral lateral neural foramen appear normal.
L2/3- Posterocentral disc bulge seen, causing thecal sac indentation and narrowing of central canal to a diameter of 12mm, and encroaching bilateral exiting nerve root foramen.
L3/4- Posterocentral disc bulge seen, causing absolute canal stenosis, AP central canal diameter reduced to 9mm, with severe B/L neural foraminal stenosis.
At L4/5- Posterocentral disc bulge seen with absolute narrowing of central canal and severe narrowing/almost obliteration of bilateral exiting nerve root foramen. AP central canal diameter measures 9mm. the intervertebral disc shows mild high T2 signal intensity, however without narrowing, no lytic lesion in bone nor end plate changes.
At L5/S1- posterocentral disc bulge seen casuing relative canal stenosis, AP central canal diameter: 12mm, and severe narrowing of bilateral lateral neural foramen.
Alignment of vertebral bodies is normal.
Modic type II changes at L4/5 end plates.
Rest of lumbar vertebral bone marrow demonstrates no significant abnormality
Normal appearance of conus medullaris.
IMPRESSION:
1. Right paracentral disc bulge at T11L1 with lateral canal compression, but normal diameter.
2. Relative canal stenosis at L2/3, with encroachment on B/L neuroforaminal stenosis.
3. L3/4 and L4/5- absolute canal stenoses with severe B/L neroforaminal stenoses.
4. L5/S1- relative canal stenosis, with severe B/L neuoforaminal stenoses.

Previous MRI 2014
Protocol: Sagittal T1 T2 and Axial T1T2 sequences.

Loss of lumbar lordosis is noted. Schmmorl node is seen at L4 vertebra
L2/L3- diffuse disc bulge with mild thickening of yellow ligament is seen. No canal stenosis or facet arthropathy noted. The exit foraminae are clear
L3/L4- diffuse disc bulge which obliterates bilateral exit foraminae are seen. There is a 8mm canal stenosis with hypertrophy of the yellow ligament and mild facet joints arthtopathy
L4/L5- diffuse disc bulge noted with obliteration of both neroforaminal exists. No canal stenosis seen. The facet joints and yellow ligament are normal
L5/S1- diffuse disc bulge which partially obliterates bilateral exit foramina is noted. No canal stenosis noted. Mild thickening of yellow ligament is seen alongside with mild facet joint arthropathy
The spinal cord at the level of L3 shows altered signal s/o edema
Conus is at L1 and returns normal signal.

Impression:
L2/L3, L4/L5, L5/S1 diffuse disc bulge
L3/L4 diffuse disc bulge with 8mm canal stenosis

Thank you Doctor, Awaiting your earliest response. Your support is highly appreciated.

[elesh]

#30463

Please find below links for MRI images. Thanks

https://streamable.com/6y2lt
https://streamable.com/qkjou
https://streamable.com/xoii3
https://streamable.com/dwpdc

https://ibb.co/Tcsg1qX
https://ibb.co/DCc0pGP
https://ibb.co/WKzTsc0
https://ibb.co/w63xFcj
https://ibb.co/v482w2S

[Donald Corenman, MD, DC]

#30469

Part of the problem with your presentation is that you don’t note symptoms. Please read this section and respond with your history and symptoms. https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-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.

[elesh]

#30472

Dear Dr. Corenman,

My aplogies for not submitting syptoms. Please see below. I would appreciate if you can advise any alternative treatment that can possibly be available in order to avoid surgery and do it as a last resort. Many thanks.

Pain is most on the left side yet numbness is more on the right. Yet on both side after walking more than about 60 to 80 m.
Location and quality of pain

The pain radiate. It starts at the midline lower back and move to the right buttocks becoming more painful and then to the right thigh. At the same time lesser pain in the left buttocks and thing (sometime negligible) most of the time. It s move to the right calf.(rarely)
The pain most of the time aching and burning.
Yes depend on activity (if vigorous)
No skin hypersensitivity
No skin change etc.

Percentage of pain by location
30% back 70% buttocks and leg

Intensity of pain

Current Worst
Lower back 4 7
Buttock 5 7
leg 4 6

Weakness
Very little weakness with the pain (depending of intensity)
Weakness due more to neuropathic
A limp due to pain more
Sure certain activities are more problematic example climbing stairs, running, picking and lifting objects. (No walking due to foot drop or feet won’t push forward-here no problem)

Onset and length of time symptoms has been present
I had mild bulging of disc in 2009(L2, L3, L4, S1) with exercise and injections in vertebra, I was able to come to normal (walking and running etc only could not sprint regularly)
I use belt to do heavy duty like lifting heavy objects, mowing of grass..
But since Nov 2013 I have been playing football and pain started a little. I have to stop vigorous activity yet was able to jog etc and carry some heavy works (have to use belt)
On one occasion I forget to use belt and was mixing concrete and felt a pain
I continue with less vigorous activity like mowing of grass washing floor with karcher etc with belt. Pain accumulating little by little
Jan 4th have great difficulty to work with great back pain. Admitted in hospital putting weight for 4 days and on the 5th day had injection in vertebra
Since then heavy pain decrease, but could not walk for long distance (less than 100m)- back, then buttock pain grew harder and right leg burning more while left leg seemed heavy with little numbness
Activities
Now little pain but could not walk too much though a little more than 100m. Sometimes cannot stand for long. Even cannot sit for too long
Everyday I did exercise (stretching) well, feeling relief but after walking felt the pain though less sometimes at the lower back then to the right buttock more
When driving has to use belt, also when doing vigorous activity like cleaning yards
I am avoiding bike riding and all those vigorous activity as pain will increase
Neck pain no so affected with bending
Yes there is instability pain
No, daily function doesn’t go smoothly. The pain is mild but sometimes it grows
Pain interval
No, pain is always here (may be mild most of the day, but grows harder for a few moments)
Pain is always here as said mild most of the time. But with time and activity walking, standing, sitting too much pain increases sometimes burning a lot.

Activity and Occupation restriction
Yes
Yes
Yes (most of them, like jogging, cycling, power lifting)
I do some stretching exercise, use anti-inflammatory and sometimes using electric wave
I m a physical instructor (PHYSICAL ACTIVITIES)
Have to instruct and demonstrate the sport activities. Yes but is avoiding them
No
I was on vacation leave, but restart with restrictions demonstration, only instruction
For 1 month

[elesh]

#30478

Dear Doctor,

I would really appreciate when you get chance please have a look and advise me. Thank you.

[Donald Corenman, MD, DC]

#30479

You have some significant findings on your MRI which could be causing some or all of your symptoms. Your findings include: “L3/4 and L4/5- absolute canal stenoses with severe B/L neroforaminal stenoses..Modic type II changes at L4/5 end plates”. The central stenosis could cause standing lower back pain and buttocks symptoms. See https://neckandback.com/conditions/lumbar-spinal-stenosis-central-stenosis/ to see if this disorder fits with some of your problems.

You also have isolated disc resorption at L4-5. This can cause loading type lower back pain. See https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/ to see if this fits with 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.
 
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.

[Author]

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