Question
"dear doc.Anzalone what to do? hurt on job will i be able to go back to physical
work in your opinion and what has to be done to get there?(bending,and packing
out freight)im 54 years old? here are my mri results- there is disc hydration
loss, disc space narrowing and disc bulging with anterior disc extension at
L2/3with a superimposed central subligamentous disc herniation and redial
annular tear that impresses on the thecal sac. AtL3/4 level is disc hydration
loss and a diffuse bulge that has peripheral components left greater than right
that extend into the neural foramen with anteriour disc extension.At L4/5 disc
hydration loss and posterior disc bulge that impresses the thecal sac.it has
peripheral components that extend into the nuural foraman.L5/s1 disc hydration
loss disc space narrowing and bulging with anterior disc extension and spur
formation.there is a subligamentous disc herniation and radial annular tear that
is impressing on thecal sac. a grade I spondylolisthesis is present.there is no
prominent facet arthrosis and underlying L5 spondylolysis. benign hemangioma
involves the right aspect of L4 inferiorly.what to do  once again THANK YOU"

Answer
Joe,

Thanks for your question.

Your MRI results show that you have degenerative disc disease and degenerative joint disease of the low back (lumbar spine). In a word, this combination of joint deterioration, bone spur formation, and disc degeneration is commonly referred to as osteoarthritis (OA).

The hemangioma noted in the MRI is a non-cancerous tumor of blood vessels. Usually, they do not produce symptoms, but when they do, they can cause back pain, radiating pain into the legs, spinal cord compression, compression fracture of the vertebrae, and hemorrhage. These complications are fairly rare. Hemangiomas are fairly common.

The spondylolisthesis noted is a forward slippage of a vertebrae, usually due to degenerative changes in the spine, injury, or possibly a genetic defect, resulting in a separation of the front part of the vertebra (called the body) from the back part of the bone (called the pars interarticularis) in the area that makes up the joint. Most of the time, spondylolistheses do not produce symptoms, but when they do, they can cause or contribute to lower back pain and disc herniations.

Click on these links to read a patient article from the American Family Physician on what to do when you have a herniated disc and low back pain for additional information:

http://www.aafp.org/afp/990201ap/990201a.html

http://www.aafp.org/afp/20000315/1789ph.html

I can't give you specific treatment advice via the Internet, but I encourage you to sit down with your doctor to discuss how your MRI results relate to your present symptoms. MRI is an excellent tool for visualizing anything that deviates from normal, but many people have abnormal findings in their spine without symptoms, so it's important to correlate what the MRI shows to your overall condition. The doctor managing your condition is in the best position to answer your specific questions about what to do and how your present condition may impact your daily activities.

In general, people with back problems who keep mobile rather than sedentary do better in the long term.

Back pain can usually be effectively managed non-surgically with a combination of manual therapy (chiropractic and/or physical therapy), rehabilitative exercise, and appropriate drugs for pain control, inflammation, and muscle spasms when needed. Stretching and mild forms of yoga are often very helpful.

A recent article (April 2010) in the Journal of American Family Practice on disc surgery states that surgery (usually reserved for severe cases of lower back pain with radiating leg pain and/or loss of leg function that was not responsive to aggressive non-surgical treatment) may enhance pain relief initially, but no evidence exists to show that surgery gives long-term benefit over conservative (non-surgical) management of low back pain due to disc herniations.

Another excellent patient resource is a book written by the Australian physical therapist Robin McKenzie (Treat Your Own Back), who developed a system of patient exercises designed to improve low back pain due to disc herniations. I highly recommend it. You can buy a used copy for just a few dollars on the Internet.

I hope that this helps to answer your question.