Question
QUESTION: Background:I am a 25 year old female who started experiencing severe pain and debilitating fatigue about a year and a half ago in my sacroilliac area, buttocks and hips.  I tried all sorts of treatments such as physical therapy, diet change, and nsaids and stretching and heating pads, etc.  They provide very little relief and It always gets worse after standing and walking for long periods of time and is relieved only somewhat by laying down or sitting and resting.  I had an MRI done at first showing only minimal facet degeneration in the lumbar area and I have had a herniated disc in my c-4,c5 disc since I have been imaged as well.  I had posterior fossa decompression surgery in August 2011 to relieve my Chiari 1 malformation symptoms.  I am also on 4mg prednisone daily because I have stopped producing my own cortisol. My testosterone, estrogen, progesterone, fsh and lsh are also low and prolactin 5.0. I have not been tested for any arthritis or anything like that but have ruled out celiacs and limes disease.  

In the past 3-4 months I started getting much worse and the pain is now radiating down both of my legs it wraps around my legs and groin area and goes all the way down to my calves. I cannot stand more than an hour before I am in excruciating pain even on 60mg of ms contin and percocet for breakthrough pain. I have a constant deep ache or pressure feeling in my very low back/hip area and buttocks even when I have not been active, but it is tolerable until I am walking or standing for more than 30 min to an hour.  It is partially relieved when bending forward, sitting down or lying down or bringing knees to my chest while lying down.I was finally able to get a second MRI since it had been 9 months since my last lumbar MRI and the results are significantly different they are as follows:

L1-L2: There is minimal facet joint degeneration without thecal sac or foraminal stenosis
L2-L3:Facet degeneration and slight disc bulge are present, without thecal sac or foraminal stenosis.
L3-l4:Facet degeneration and bulging disc are present,without thecal sac stenosis or definite nerve impingement.The l3-l4 foramina are mildly stenotic.

L4-L5: facet joint degeneration is present at l4-5. A concentric l4-5 bulging disc is present, with moderate left and mild right degenerative foraminal stenosis. The thecal sac is also mildly narrowed.
L5-S1: There is slight facet degeneration witout thecal sac or foraminal stenosis.
Impression:  Relatively mild mulitlevel disc space and facet joint degeneration is described in detail above. at l4-l5 , this leads to mild narrowing of the thecal sac with moderate left and mild right degenerative foraminal stenosis.No discrete disc herniation or areas of thecal sac or severe foraminal stenosis are identified.


So my question is , what does this mean? Nobody will tell me why my back mri has this, from what I read only older people should have stenosis, I am only 25 and have had no injuries or any trauma at all.  Is this a degenerative disc disease, arthritis, just something that wont get worse or better or what can I expect? Can the above mri results cause such severe pain? I just want to know what I can expect.  I also was fired from my job recently due to inability to be at work, and don't know how I am going to be able to work if I am in this much pain all of the time and am thinking about filing for disability, but is this something that would qualify me for disability is this fixable? I just need some more information on how my back went from just mild facet arthritis to all of these changes in less than 9 months?

ANSWER: Dear Jennifer,

I am not sure that I have all the answers for you either.  I will tell you what I can, but since I have never seen you, my thoughts are of limited value. I will also talk speculatively regarding some things... so remember, these are just thoughts.

First of all, yes, you are very young to be going through spinal degenerative changes. Yes, the MRI results could be describing the sources of your pain.  You can call it arthritis, if you like.  There are two major kinds of arthritis.  The first is degenerative, which is what you have. It is usually the result of injury or trauma to the spine, or perpetual/ongoing stresses to the spine, due to weight, injury, repetitive injury, etc.  The second major type of arthritis is something like Rheumatoid, which is an auto-immune disease, which in a nutshell, is that the body is attacking itself through its own immune system.  There are many other less common causes of "arthritis".

Arthritis, by definition, is simply joint inflammation.  It is better to think of your condtion as a degenerative joint disease, or a mechanical dysfunction resulting in pre-mature wearing out of the discs and joints in the back.

Why you are getting it at an early stage, I can only speculate.  Some thoughts are:  1)This is a family/genetic tendency.  2) You are taking drugs that can be very destructive to bone, joint, and other tissues (cortisone), 3) Your lifestyle (eating, exercising, etc) is less than optimum.  4) Are you overweight? Extra weight equals extra work and stress forces on the joints.  5) Have you had prior trauma to the spine?

More important than the "why me" question is the "what can I do now?" question.  Continued use of drugs just masks the pain, and may actually increase the degenerative changes over time.  You need to find somebody that can help you to make good lifestyle changes and get you on a good exercise program to stabilize the back.  You also need to continue with your medical doctors, who can do tests to try and find other causes for your condition.  They should be able to rule out psoriasis, rhuematoid arthritis, ankylosing spondylitis, etc.  This can take time and lots of blood tests.

I hate to see you on disability at such a young age. There is much that you can contribute.

Is degenerative spinal condition fixable... no, but it is manageable.  In other words, there is nothing that will make you grow new discs, but there is a lot that you can do to make what you have left stronger.

Good luck. Hope that you are able to get some good answers.

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

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

QUESTION: I an only taking replacement Cortisol because I am producing none and I would die without it, and I exercise by walking regular and I only weigh, 120 lbs 5'5 and I an continuing to lose weight due to gastro paresis  and who knows what else. I have always been at a healthy weight and my heaviest was 165 due to thyroid and hormones but only for a short few months. the only time I was ever over weight was the one time my hormones went crazy and through my pregnancies which is expected and I was always eating right and was very active. In high school I was in 4 varsity sports at a time. Again I have never even injured myself falling or had any previous trauma to my spine, should I consult a Rhuematologist or who do I turn to, I obviously want to fix the problem, but I cannot handle the pain I'm in right now and the pain medicine I'm on barely covers the pain so I can't imagine how I will so well off of it, but if there was a way, that is the way I would prefer.

Answer
Dear Jennifer,

I would consult a number of specialists:

First of all, a rheumatologist is not a bad idea.
I would also consider an Endocrinologist.
Perhaps even a good quality internal medicine specialist.

I can understand how frustrating this is to you.  It is not normal to have so much spinal degenerative changes at such a young age.  It makes me think more along the lines of undiagnosed underlying medical conditions, instead of normal wear and tear of joints.  A chiropractor might help you with symptoms, but would not be my first choice for helping to get to the bottom of possible causes.

Good luck Jennifer.  I know that this is frustrating.

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