Question
I have had back pain for 22 years following a bad fall when I landed on my lower back. For the past 14weeks I have had severe pain in both my legs, lower back and feet. My MRI results are: Multi-level disc dehydration, disc space narrowing and disc bulging noted throughout the lower thoracic and lumbar spine.  L3/4 There is a shallow disc bulge with moderate facet arthrosis but no significant stenosis or nerve root impingement. L4/5 There is degenerative grade 1 anterolisthesis with uncovering of the disc and severe bilateral facet arthrosis causing severe stenosis of the lateral recesses bilaterally with bilateral L5 root impingement and moderate stenosis of the canal and left foramen with crowding of the cauda equina and mild left L4 root impingement. L5/S1 There is moderate bilateral facet arthrosis but no significant stenosis. COMMENT: Multilevel lower thoracic and lumbar spondylosis. At L4/5 there is a grade 1 degenerative anterolisthesis with severe bilateral facet arthrosis and significant stenosis of the canal, both lateral recesses and the left neural foramen with crowding of the caudia equina and impingement on the L5 roots bilaterally and the left L4 root.

Answer
Dear Christine,

WOW...sorry to say this, but your back is a mess.  Multiple areas of disk degeneration with arthritic changes at the endplates of the vertebral bodies and in the joint spaces (facets), this is not good.  Moreover, anterolisthesis is a slippage of one vertebra on the next which means that the supportive ligaments are in bad shape as well.  Luckily you have a grade 1 at this point which means that the vertebra has slipped less than 25%.

Stenosis means that the spinal canal has lost some of its shape in size, and that the cord and the nerve roots are being squeezed.  Stenosis usually implies a surgical fix to the problem if it has progressed enough.  Crowding of the cauda equina is squeezing of the bottom nerve root plexus which supplies the information needed for bladder, bowel and sexual performance.  This is not an area you want to loose function of.

Bottom line is that with changes like this a surgical consult should occur, but that doesn't necessarily mean that you will need surgery.  Conservative measures such as chiropractic care or decompression therapy may offer you some benefit, but again, surgery is a viable and realistic option at this point.  Both avenues should be explored soon.

For more information on terminology and anatomy, feel free to visit my website.  I have detailed explanations on spinal anatomy, disk herniations, and a glossary of terms complete with some illustrations.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net