Question
QUESTION: Hello.
I am a 22 year old female that has been having lower back problems for 6 months. I have recently had an MRI and i am finding it difficult to understand the report and my GP wasn't much help either.
Vertebral alignment is normal. There is loss of signal in the L4/5 disc and to a lesser extent in the L3/4 disc. At L3/4, there is a moderate diffuse disc bulge most marked centrally. There are mild/moderate degenerative changes in the posterior joints. The bulging disc is indenting the thecal sac but no nerve root compression is seen at present.
At L4/5, there is a moderately large focal disc protrusion in a central right paracentral postition; there are alos moderate degenerative changes in the posterior facet joints. The disc protrusion is causing narrowing of the central canal and also of the lateral recess on the left and is likely to impinge/compress the traversing left L5 roots.
Conclusion: There are degenerative changes at L3/4 AND L4/5. In particular at L4/5 there is a moderately large focal disc protrusion centrally and on the left which is likely to cause nerve root impingement/compression of the traversing roots.

I would be grateful for your help of understanding this report and what this means for my future and treatments?

Many Thanks

Nina

ANSWER: Hi Nina,
I have successfully treated a large number of patients with very similar if not identical problems over my 25+ year career.
I will address the most significant conclusions of the report. I want to point out that a review of the actual films with a Chiropractic Physician who is experienced reading films may be the next step for you to understand treatment options. The large focal disc protrusion at L4/5 is the most significant finding. A herniation is caused by the failure of a containing circumferential ligament called the annulus fibrosis. This annulus is the outer fibrous band around each intervertebral disc. The central portion of the disc is a soft fibrocartilaginous material that provides shock absorbing qualities to the spine. The report describes the L4-5 herniation that extends centrally and to the right. The report has a seemingly contradictory statement where the disc herniation is reported to narrow the "left" lateral recess and compress the traversing left L5 roots. The disc herniation may be quite large extending both to the right and left of the spinal canal.  I have a few unanswered questions.

1. Do you have pain or numbness in your left leg? Is the pain shooting or electric like?
2. Do you have weakness in your leg?
If the answer is no to these questions, your treatment may be shorter with better prognosis.  

The report comments on loss of signal in the MRI, that is a finding suggesting disc degeneration. There are other findings of facet degeneration as well. This is a common finding, but less common in your age group.

Treatment should be careful and cautious. It may require months of therapy. Only certain types of Chiropractic care are appropriate: Decompression, Class 4 laser therapy, Instrumented adjustments and very specific low force adjusting technique. There are many types of supportive chiropractic care that are beyond the level of discussion for this venue. If the physician has a Class 4 laser, that doctor is certainly a first choice for care.

All the best,

Dr. True

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

QUESTION: Dear Dr. True,

Thank you ever so much for your reply. To answer your questions.
1. When i do have pain, it does go down my left leg considerably. Infact most of the time the pain starts at the top of the left buttock. The pain is hard to describe, its quite a constant pain, but i would say its like a static/elecrtic type pain.
2. I dont believe i have a weakness in my leg, however i dont know how i would notice.

I am just extremely worried that i am only 22 and having these problems, what does this mean for my future? I am currently studying to become a midwife and it just worries me that all my hard work for my career is going to be short lasting.

Also, do you know why or how these issues can or would occur? I will say i have been overweight since i was about 10, would this be the problem?

Many Thanks
Nina

Answer
You are describing classic signs of sciatic radiculopathy or sciatica. You need to find a doctor with a class 4 therapy laser.  Decompression is also a potential help.
Proteolytic enzymes (pancreatin) can help as well.
Avoid lifting and twisting.

All the best,
Dr. True