Question
QUESTION: Findings T-12toL1 Disk is normal in appearance. The thecal sac and foramina are adequately patent. The facet joints appear normal.
L-1 to L-2 Disk desiccation with mild disk narrowing.A 1-2 mm disk protrusion is noted in the left lateral recess and neural foraminal region.There is minimal left neural foraminal narrowing is seen.
L2-L3 There is disk desiccation with mild disk narrowing.There is mild  to moderate narrowing of the midline thecal sac and moderate bilateral recess narrowing.Moderate bilateral neural foraminal narrowing seen.L3L4  There is disk desiccation. The height is normal. There is a 2 mm disk bulge asymmetric to the left.Bilateral facct hypertrophy and ligamentum flavum thickening is seen.There is fluid signal within the facet joints. Small cystic lesions are seen arising from the left facet joint and protruding into left side of the spinal canal measuring 3 and 2 mm . there is mild to moderate narrowing of the midline thecal sac, severe bilateral neural foraminal narrowing is seen,left right lateral recess narrowing. Moderate to severe bilateral neural foraminal narrowing is seen, left more than right.L4 L5 Disk desiccation with mild disk Bi lateral severe facet hypertrophy is noted There is mild to moderate narrowing of the midline thecal sac and severe bi  latteral lateral recess narrowing.          Moderate to severe bi lateral neural foraminal narrowing is seen, left more than right.
L5-SI The disk is normal in appearance. Bi lateral facet hypertrophy seen. The secal sac appears normal.Mild bi lateralneural foraminal narrowing is seen.

What does all of this mean to me in laymens terms and how or what treatments are available?

ANSWER: Hi Susan

The disc desiccation means it has lost some of its normal fluid, which helps it function, similar to a shock absorber. As the disc looses fluid, it looses height. As it looses height, there is more of a chance that compression of nerves and joints are seen.

Protrusions and bulges are types of herniations of the disc. Like a hamburger, if you push down on it, the juice can come out and parts of the burger can bulge out. This can cause pressure on nerves, but when combined with loss of height, causes compression.

The lateral recess and neural foramina are where the nerve comes off the spinal cord and goes through the bone. As the disc becomes narrow, or with herniations, this can be a cause of a pinched nerve on the left side, the right side or both (bilateral).

The facet joints are in the back of the bones. The joints allow the bones to glide. From loosing height, more pressure can be placed on the joints and this can cause cysts to form along with irritation of the joints and outgrowths of bone (hypertrophy).

As the degeneration occurs and compression places stress on these structures, ligaments that run long the spinal bones can thicken. This can cause compression or narrowing of the spinal canal called stenosis. Sometimes, there is pressure seen on the covering of the spinal cord called the thecal sac.

So, these things can be painful, however, they must be correlated with specific findings of pain complaints and objective testing results in order to be relevant. Sometimes we see these findings in people without many complaints, so these findings are another piece of the puzzle that must be put together in order to formulate a working diagnosis and good treatment plan.

Often, physical therapy is prescribed. Medications such as pain relievers, muscle relaxants and anti-inflammatories are sometimes used. Chiropractic treatment may offer some relief. If no progress is made, spinal and facet joint injections may used. If these methods do not provide relief, surgical consultation may be indicated.

These are general findings of degenerative disc disease. You can see much more about this condition, including pictures that will help you understand and home methods of treatment at http://www.necksolutions.com/degenerative-disc-disease.html

I hope you feel better and that you can find ways to get relief fast.

Regards,

Dr. Steve
www.NeckSolutions.com


---------- FOLLOW-UP ----------

QUESTION: Would you allow spinal block or epidural to be done are they different?

Answer
Hi Susan,

There are different types of injections that can be used. Generally, a block is used to help diagnose the problem. Usually it is anesthetic applied to a specific area to see if this relieves the symptoms. Your findings show many areas of potential pain generators. They could do a block on the facet joints or on the nerve root if you are having specific signs of pain at that level. If they suspect it is a facet joint problem, they could target that area with a block and see if the pain is relieved. If it is, there are other procedures that could target the area for more permanent relief. Same thing with a nerve root or nerve roots. If there are indications of a pinched nerve, a block could target that area.

Because there are many indications of problem areas, if there are no specific findings of a specific nerve root(s) or facet joint(s), then an epidural may be good to target the region with a steroid anti-inflammatory. There is usually large amounts of inflammation and an epidural might calm down the area and give relief. If it does, this can be done a couple more times at certain intervals in hopes to provide lasting relief.

It really depends on the findings. There are a number of different ways to do injections and a number of anesthetic/anti-inflammatory combinations they can use. A consultation with the doctor/anesthesiologist is usually done prior to injections. I would insist on a guided injection with ultrasound or fluoroscopy. If you tend to be nervous, sedation can help relax for better results.

So, if you have tried other methods of therapy and not had relief, yes, I would consult for injections. If you are comfortable with the consult and confident in the doctor, I would definitely consider it. Again, there are many variables with injections, but they can provide valuable diagnostic information and/or pain relief, either short or possibly long term.

I hope this helps and wish you all the best. Keep in touch.

Dr. Steve
www.NeckSolutions.com