Question
I have had lower back pain for years.  Each time, when it really hurts, is when I have bent over. I suddenly have such lower back pain that I want to fall to my knees.  This last time I was standing with both of my feet pointing in the same direction, bent forward to pick up something that I fell back to the couch and could not stand up.  My buttock was numb and pain ran down my right leg and to stand up was extremely painful.
I went to the ER later that evening and a Xray was done.  The Dr only told me it was the muscles in my back that were causing this pain.
OH well here it is again in my mind.  I went to work on Monday to only be able to sit there for 2 hrs. I then went to my Dr's office for more help.  He set me up for the MRI and the next day I did that.  The results were as follows:          

The lumbar alignment is anatomic.  The Lumbar vertebral bodies maintain normal height.  There are Modic type 1 edematous endplate changes at L 4-5.  The bone marrow signal is other wise normal.  The conus terminates at the L 1-2 level and is normal in appearance.  The abdominal aorta is normal in caliber.
At l4-5 there is desiccation without loss of disc height.  There is a mild disc bulge measuring 2-3 mm in the AP dimension.  This mildly indents the ventral thecal sac but does not cause spinal stenosis.  There is bilateral facet arthropathy and mild right-sided foraminal stenosis. The left neural foramen remains widely patent.

All I can say is standing is hard to do for more than 5 min and that sitting is hard to do at any normal position.
any suggestions are going to be taken only as a second opion and is greatly appreciated.

Please help me to do the right next step.    

Thank you
Mary

Answer
Dear Mary,

The right step is different for every person, but here is the order of things, as I see them:

1) Physical Therapy and Chiropractic Care. If you get relief and help, CONTINUE TO USE THEM even after you feel better.  If you get benefit and the pain then returns, DO IT AGAIN... and again... and again.  This is your BEST option for long term help, combined with a good, prescribed, home exercise program that you do, consistently.  If you forget to do your exercises, repent and start again!

2) Try acupuncture to help reduce the pain.  This will do nothing for your discs, (like medication, surgery, etc...) but if you helps you to have less pain, it is of GREATER value than medications and surgery. There are very few risks, and a potential huge up-side.  If Acupuncture helps to ease your pain... do it again... and again... and again.  Please understand that it is a way of managing your pain, NOT making you grow a new spine with perfect discs.

3) Take oral medications... carefully... and only as needed, and as directed by your medical doctor.  Again, this is best applied as a short-term pain-managing strategy. Pills will NOT heal you, and they come with side effects.  CONTINUE WITH #1 AND #2...

4) Consider epidural injections to the spine of number 1 and 2 above just don't provide enough relief... but then CONTINUE with #1 and #2 above after you get the injections.

5) Neuroablation can be helpful (burning of nerve roots), and typically can give some people relief for up to a month... and you guessed it, CONTINUE WITH #1 AND #2 ABOVE whether or not the procedure gives you relief.

6) Consider spinal surgery if the condition worsens and NOTHING else helps, and only as a last resort.  If you have surgery, then CONTINUE WITH #1  AND #2 ABOVE after the surgery is done. Surgery does not give you a new spine, it simply attempts to cut away some of the damaged tissue (leaving more scar tissue behind) in an effort to take pressure off the nerve root and/or the spinal cord.

Please take this simply as a guideline, and not gospel, since nothing that I can say would trump the recommendations of a trusted chiropractor or physical therapist, or good medical doctor who examines you and recommends care for you.

Good luck Mary. I hope that this helps you.

Keith Biggs, DC
http://www.eastmesachiropractor.com