Thursday, September 10, 2009

Understanding the results of an MRI of the Lower Spine-Herniated disc

A recent question posted regarding Herniated disc

Subject: Understanding the results of an MRI of the Lower Spine


About 2 years ago I was doing a relaxation/Yoga course in NYC and I started to feel tingling in my back. By the end of the program (4 days later) I had severe pain in my lower back and could not sit up for any amount of time. I also found that I was standing bent (to one side) since that was the only relief I could get.

After 3 months of limited mobility I strapped myself up with elastic bandages to hold myself up straight and I found relief.

In July (just over 2 years later) I lifted a heavy suitcase and once more the the pain in the lower back re-started . The problem now is that it is radiating down my left leg, specifically from the side of my buttock down the side of the left leg just above my ankles. Further, I have difficulties walking and if I walk excessively I have numbness in my toes.

I went to a doctor who said I should rest, but now since the problem has gotten a bit more painful he has ordered a MRI.

Could you please explain to me the results:

It says as follows:

There is straightening of the lumbar spine with loss of lumbar lordosis due to paraspinal muscle spasm.

There is loss of T2W signal with complete loss of Height of L4-L5 disc due to desiccastion of the prolapsed disk material. Posterior central and left paracentral extrusion of nucleus pulposus of L4-L5 disc (8-9mm) with compression of the thecal sac and left L5 nerve root in the lateral recess.

The rest of the lumbar vertebrae and discs appear normal. The pedicles, laminac and spinous processes appear normal. The posterior facet joints appear normal. No evidence of any fracture, bone contusion or bone infection seen. No evidence of any bone erosion or destruction seen. The spinal cord appears normal. No definite mass lesion is seen. The conus medullaris and cauda equina appears normal. the pervertebral muscles appear normal.

Thank you for any help provide

The disc material has herniated and is pushing on your nerve root (this is called Sciatica)that would explain the numbness is the toes and difficulty in walking.
Surgery is one option or you may want to consider looking into Non-surgical spinal decompression.
The type of disc herniation you have presents a challenge.
I would recommend that you have a NCV and EMG ordered to see if the nerves are effected and the degree of severity.
In our practice we see patients that have herniated discs and they do great on the spinal decompression table BUT once the disc is extruded 8-9 mm it does make the case more challenging and I would recommend that you have a Neurosurgical consultation to further understand the condition.
Good luck.....

Spinal Decompression works?

Subject: Spinal Decompression For Sports Injury
Question: Hello Dr Shoshany-

My name is Jason. I suffered from a hockey related injury 10 years ago which caused a degenerative disc (i believe the 4L or 3L). At the present time i am in no pain and can handle most exercises without any problem, however, whenever I attempt to play hockey the injury gets severely aggravated and I am essentially paralyzed for a week. Its usually a long, sudden and intense stride that will cause the back to "pop". My question is do you feel i would be a good candidate for decompression? My only fear is that the technique will actually make the injury worse. If it works will I be able to play hockey again or is it just too risky? I would appreciate your feedback - thanks a bunch!

I don't think that if an activity makes your condition worse that you should continue the activity.
Spinal decompression can be very effective in reducing your symptoms.
I would seek out a spinal decompression specialist that can carefully evaluate your recent MRI to determine if you are a candidate for this procedure. This treatment is not for everyone and is not for all types of back injuries. If you have a bulging or herniated disc or a spinal stenos is then consider this treatment.
If you decide to move forward with this treatment you should lay off the activity until you fully recover. What I like about this treatment is that it is very safe and the only real side effect I have seen in 7 years is soreness that goes away once the treatment stops.
Hope this info helps.
Steven Shoshany DC, CCEP
Manhattan Herniated disc treatment

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