Question
Hi I had a MRI done yesterday and I have the report that states that  L5-S1 intervertebral disc has loss of normal water signal consistant with disc desiccation  there is mild disc space narrowing  the canal  is widely patent.  
impression  degenerative disc disease and slight decrease in size of the right paracentral disc protrusion L5=S1   i have sever lower back pain with numbness and burning going down my right leg  could you explain what this means and does it require surgery to fix   thank you

Answer
Dear Lisa,

The L5/S1 disk is the lowest disk in the spine, and is located between the last lumbar vertebra and a bone called the sacrum.  Desiccation means that the hydration of the inner portion of the disk has been reduced, and this leads to degeneration of the disk which results in thinning and a loss of height.  When the disk loses height, the space between the adjacent structures starts to narrow and the nerve roots that exit the spinal cord at those levels are subject to compression.  Fortunately for you the spinal canal has not been compromised at this point... (patent means open).  

Lastly the fact that you have a right sided protrusion of the disk material means that the nerve root that exits on the right side is even more susceptible to compression or irritation.  this can easily result in low back pain, and pain that radiates into the right leg along the nerves distribution pattern.  The nerves most likely to be affected are the L5 and S1 nerve roots.  

For a better reference of the anatomy and how these structures are inter-related, please check out the below links to my website which contain illustrations and explanations about spinal anatomy, disk protrusion, and pain patterns.  There is also a glossary of terms to help you understand specific medical terminology.

http://suncoasthealthcare.net/chiropracticinformation/spinalanatomy-overview.htm...
http://suncoasthealthcare.net/chiropracticinformation/spinalanatomy-detail.html
http://suncoasthealthcare.net/chiropracticinformation/discherniation.html
http://www.apparelyzed.com/dermatome.html

Treatment options: Surgery is not necessarily your only choice.  Chiropractic care and physical rehabilitation has multiple routes to offer in relation to reducing your pain while increasing function.  Most chiropractors can manipulate the spine and reduce pain transmission from disk bulges in a few visits (4-6).  Sometimes a more complete approach is needed though, and special devices and techniques are utilized to pump the disk which helps to rehydrate somewhat and alleviate pressure on the nerve roots.  All of these treatment approaches are conservative and aimed at reducing the disk bulge itself.  Specific names/techniques to research:  Cox Flexion/distraction technique, posture pump expanding ellipsoidal traction, intervertebral disk decompression (DRX 9000, Chatanooga, Accuspina, Spina Systems, Lordex).

In addition to the above devices and techniques, you will need to undergo functional rehab as your pain levels decrease.  You will need to work on the musculature of the low back, abdomen, and pelvic floor to create stability of the spine which will reduce future degeneration.  This can easily be accomplished with the help of the chiropractic physician or a physical therapist.

Always remember though, the above options and their respective success rates will be determined by the amount of degeneration already present, your compliance with getting the care needed ASAP, and following the rehab program as instructed.  Most patients do very well with the above treatment options, but there will be a few that will need pain management or surgery to alleviate the ongoing problems and to improve their quality of life.  Just make sure that you explore all of your options thoroughly, and ask all physicians involved for full explanations of care as well as references to former or current patients who have done well under their care who have similar circumstances/diagnoses.

Good Luck Lisa.  Feel free to write back with any additional comments or questions.

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