QuestionWhat is the prognosis for my situation? I am scheduled to see a neurosurgeon Nov 30, but I don't want to have surgery unless it is necessary. Are there other options for me? I am 42 years old. I have constant pain located in my lower left back, down my buttock, thigh - all the way to the left knee. Walking is becoming more difficult. Wondering if I'm going to need to file for disability soon. Still working full time for now.
My MRI:
The alignment of the lumbar spine is satisfactory. Degenerative disc changes are seen with disc space narrowing seen at L4-L5 and L5-S1 with mild vacuum disc phenomena seen at L5-S1. Endplate degenerative changes are seen with several Schmorl抯 nodes seen at the L4-L5 level.
There is mild bulging of the L5-S1 level which is slight asymmetric centrally and to the right with moderate facet degenerative changes seen. The central canal measures 8.5 mm with some inferior neural foraminal narrowing seen.
There is diffuse bulging of theL4-L5 disc which is asymmetric to the left with significant facet degenerative change and ligamentum flavum hypertrophy causing severe spinal stenosis with the central canal measuring 3.5 mm with some inferior neural foraminal narrowing seen bilaterally.
The AP dimension the canal is modest at the L3-L4 level with some mild facet degenerative changes. No lateralizing abnormalities otherwise are seen.
Small hemangiomas are seen at several levels. Distal spinal cord demonstrates no signal abnormalities.
Small disc protrusion seen to the left of midline at the T10-T11 level. No significant cord deformity is seen.
IMPRESSION: Degenerative disc changes seen at L4-L5 and L5-S1. Congenitally modest canal seen with spinal stenosis seen moderate in degree at L5-S1 and severe at L4-L5 Asymmetric bulging of the disc are seen to the right at L5-S1 and to the left at L4-L5. A small disc protrusion is seen to the left of midline at T10-T11 with no cord deformity or contact.
AnswerDear Angie...
First of all, thank you! You get the award for the most detailed history/exam and question! As a result, I will try and give you the best answer that I can.
You are suffering from a substantial degenerative disc issue, and your pain is most likely generated by the L4-L5 disc level, where the MRI says there is an "asymmetrick to the left" disc bulge, causing "severe spinal stenosis..."
In translation, this means that you have a degenerating and damaged disc that is also bulging. The combination of degeneration and bulging is pressing on your spinal cord.
I can understand that you do not want to have surgery. For me, it would always be the last resort. Unfortunately, since I have never seen you, and I do not know what you have already tried to do to help yourself, it is impossible to direct you specifically. At times, surgery is the ONLY option... after everything else has failed.
In my office, I try to take the patient through these steps before spinal surgery:
1) Chiropractic adjustments and physical therapy, including spinal decompression therapy and exercise rehabilitation. Acupuncture and EMS to help control the pain.
2) Epidural injections
3) Facet injections
4) Radiofrequency Neuroablation
5) Surgery
Please understand that if you decide to go ahead with the surgery, you STILL have to follow through with back exercises for the rest of your life. Surgery doesn't make you grow a new back. It doesn't magically cause a disc to stop bulding. What they will typically do is cut out a damaged disc and maybe even perform a laminectomy (where they cut off the back of your vertebra, opening up the stenosed canal).
If you are suffering from loss of bladder control or bowel control, or if you are experiencing significant loss of muscle function in the legs resulting from the stenosis, surgery might be your only option, and waiting could be devastating.
I hope that this gives you some ideas of things that you can consider. Again, thank you for the detailed question.
Keith Biggs, DC
Arrowhead Health Centers, Phoenix Met Area
http://www.arrowheadhealth.com
http://www.eastmesachiropractor.com
