QuestionHi. My husband has been experiencing severe lower back pain for approx. 3 months. He went to his gp who sent him to pt who made the pain worse who sent him to get an MRI. We can not interpret the MRI results and the doctor didn't seem to be able to either, as well as, recommending where he should go from here.
The report reads as follows:
Vertebral body height, signal and alignment is maintained throughout the lumbar spine and the conus medullaris is unremarkable.
There is disc desiccation and mild interspace narrowing at L4-5 with a broad based disc bulge and a dorsal peripheral high signal intensity zone consistent with an L4-5 annular tear. No significant spinal stenosis or foraminal narrowing. Other levels of the lumbar spine are unremarkable.
Please note that the L5 vertebra is partially sacralized and the L5-S1 disc interspace is a rudimentary one.
Mild disc degeneration at L4-5 with a central annular tear dorsally w/o significant spinal stenosis or foraminal narrowing.
Any help would be appreciated. Thank you.
Answerlow back pain, staten island low back pain, back pain, sacralization, annullar tear, spinal stenosis, disc degeneration, ddd, OA, DJD, staten island disc degeneration, conus medullaris, staten Island Chiropractic,
Hello Melany,
I am sorry to hear of your husband's pain, your husband's condition.
You state: "....My husband has been experiencing severe lower back pain for approx. 3 months.....", severe lower back pain (LBP) for three months, has he had back pain before? Is this current pain/ condition a progression of a CHRONIC back problem that has evolved/ progressed/ deteriorated into an acute condition, a more severe condition? Does his work, recreational activity cause this problem, worsen the condition?
Certainly back pain, especially lower back pain is a big problem here in America. Back complaints, back conditions are the NUMBER ONE reason for disability in America! One of the components of this problem is that we Americans look for the 'quick fix' or the easy way out.
USUALLY back pain has a progressive, deteriorative history. You talk to a sufferer and find out that their first bout of back pain was ten years ago,,,,, but it only lasted a few days and was not severe; then a year later- perhaps a recurrence; BUT the pain was a little more intense and lasted for two weeks instead of a few days. Then two years after that, just bending over to pick up a dropped pen- and >boom< the 'back went out- this time losing a week from work with a month of even more intense pain- this time with some Sciatica (pain down the leg, from the lower back); please notice increasing time period, increasing intensity, increased ease in aggravating the back, and increasing complication (the sciatica) as the condition progresses silently. The progressive degeneration can continue silently through the years.
Often people pay no attention to their low back condition EXCEPT during the periods of symptomatic episodes, pretending that the condition is NOT there when the pain is not there, denying the ongoing progressive deteriorative condition.
One of the problems with PAIN is that it is effectively quieted by 'pain management', effectively squelched by pain medications- whether over the counter or prescription drugs are used. Remember- Mom is always right, when Mom said beware of Drugs- she was RIGHT!- In my Staten Island Chiropractic office I hand out information sheets- perhaps this would be of interest to you:
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
Think you should listen??
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain,
pain in your body-
the 'red light on your body's dashboard'
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?
Pain Killing medication??? = 16,000 deaths ( probably under-reported )
DEATH ! ? ! ? better watch out on those medications!!!
NOTICES ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468 Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001) Motrin, Advil = NSAIDS
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine , Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
I hope you find those medical statistics interesting for future reference.
I would recommend seeing a local doctor for chiropractic evaluation and treatment. Your local
Chiropractic Doctor (DC) would be a good, appropriate, safe, effective, cost-effective avenue for this type of complaint. There are even specialties in Chiropractic (see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf ), of course I am partial to the 'Sports Chiropractor', and in your case I would perhaps also consider the ortho, neuro, or rehab chiropractic specialties.
After chiropractic evaluation by your DC, perhaps a regimen of chiropractic care could help ameliorate your pain, and just as important - get to the CAUSE of the condition, rather than just treat symptoms. If the Doctor of Chiropractic feels it appropriate, referral for concurrent or even complete treatment at a different doctor or specialty (ie: MD) could be made.
".....He went to his gp who sent him to pt who made the pain worse who sent him to get an MRI. We can not interpret the MRI results and the doctor didn't seem to be able to either, as well as, recommending where he should go from here.....", I am surprised the GP MD did not recommend a local Chiropractor that he(she) has dealt with before. Chiropractic handles back pain every day, almost all day; colloquially called the 'Back Specialist' by many lay people.
Perhaps your MD has not developed any relationships with local chiropractic colleagues, in that cse I would recommend going online- looking at comments, asking your neighbors about their family chiropractor.
The MR report reads:
".....Vertebral body height, signal and alignment is maintained throughout the lumbar spine and the conus medullaris is unremarkable...."
This is all good. 'Unremarkable' is a good thing on the medical report.
".....There is disc desiccation and mild interspace narrowing at L4-5 with a broad based disc bulge and a dorsal peripheral high signal intensity zone consistent with an L4-5 annular tear. No significant spinal stenosis or foraminal narrowing. Other levels of the lumbar spine are unremarkable....."- again the parts of the spine that are called 'unremarkable' are the 'happy', 'good' parts of the spine. Of particular importance- 'No significant spinal stenosis or foraminal narrowing'- this is important; your spinal canal, your spinal cord, your spinal nerves have enough room where there is not any pressure or compression upon the cord or nerves; there is less chance of a 'mechanical' involvement.
"Disc dessication....narrowing....high signal intensity....L4-5 annular tear...."- these are all findings of a disc in trouble, of intervertebral disc problems. This injury is very focal, >boom< right there- Did your husband have some trauma?, lift something heavy?, fall, MVA ( motor vehicle accident ) ? Of note- the report does NOT use the words 'disc herniation', 'disc protrusion', and the LACK of these words is good; but the annular tear is a significant problem.
( see annular tear: http://www.chirogeek.com/000_Anular_Tear_1.htm
http://www.chirogeek.com/003_IDD-Tutorial.htm )
The annular tear, the herniated disc (HNP), the degenerative disc; all of these can of course come about with a sudden trauma. But, just as common is the slow, prolonged process of disc degeneration- predisposition to HNP and tear due to minor misalignments, hence increased wear and tear upon the disc due to postural or segmental misalignments. these misalignments in chiropractic jargon are termed Vertebral Subluxations (VSC). Chiropractic, by more properly aligning the joints can slow or stop the degeneration. When joints are in a more proper position, the joint can withstand increased demand, increased stress- this is what chiropractic patients mean when they tell of the PREVENTIVE aspects of chiropractic care.
".....Please note that the L5 vertebra is partially sacralized and the L5-S1 disc interspace is a rudimentary one....", in anatomy, anomaly is the rule. Even I have a Spina bifida Occulta- an anomaly, a peculiarity, an ABNORMALITY. People hear 'abnormality' and panic, get upset, get stressed out. I prefer to use the term anomaly or peculiarity. EVERYone has peculiarities in their anatomy; again 'In anatomy, anomaly is the rule'.
We usually have five (5) freely moving lumbar spinal segments. You have four instead of five. This is not particularly good or bad. Five segments is the normal, and allows for more movement over more joints; but four is not 'bad'. Since your L5- S1 disc space is NOT there, it does transfer some of it's work to the space above, which will make that the focal point of your husband's lower back pain- IF and when he has low back pain.
Just having that sacralization does not absolutely predict that he will have back pain. IF he practices proper postures, has good movement patterns, is active- particularly with yoga type or pilates type activity, if he sees a doctor of chiropractic to maximize proper alignment and segmental movement, IF he does these things, his back should move, function, support him trouble free.
Having that sacralization does place increased stress upon the L4- L5 joint (disc) space, and IF he does not move properly, maintain proper posture; then he is likely to have a problem right at that focal point.
".....Mild disc degeneration at L4-5 with a central annular tear dorsally w/o significant spinal stenosis or foraminal narrowing....."- sounds like the summary paragraph. Very good that there is no spinal stenosis or foramninal narrowing= the cord and nerves have room to play with. The disc degeneration shows a long term segmental misalignment causing increased wear and tear (degeneration = DDD, DJD, OA; degenerative disc disease, degenerative joint disease, osteoarthritic degeneration). That annular tear may have come about suddenly from some type of trauma. Given the degeneration in the area - the MR notes the degeneration, there may have been a long term subluxation, this subluxation may have weakened the area to the point where even a simple sneeze caused the annular tear.
I highly recommend your local Doctor for Chiropractic treatment- usually very effective in cases such as this.
That annular tear sends out chemicals of inflammation, as well as possibly allowing some irritating nucleus pulposis disc material leak towards the sensitive nerves. I have another handout sheet that I give to my Staten Island Low Back Pain patients:
Lower Back Pain
揚inched Nerve? ( Also Known As- neuritis, neuralgia, brachial-neuritis, sciatica )
損inched nerve??is only ?a diagnosis, WHAT is causing the 憄inch? Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers, severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.
Sometimes we can wake up with a 憄inched nerve? or a muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a 憄inched nerve? Very often - the true c a u s e of the pinched nerve, painor numbness in the: neck and/ or shoulder and/ or arm and/ or hand; pain in the back and/ or buttock/ hip/ leg/ knee/ foot - is a misalignment, a 慿ink?in the neck or back - more properly termed a Vertebral Subluxation.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment. For good health-
Treat the Cause, not just the Symptoms.
揚inched Nerve? ( Also Known As- neuritis, neuralgia, brachial-neuritis, sciatica )
損inched nerve??is only ?a diagnosis, WHAT is causing the 憄inch? ?That 損inch?has to be taken care of FIRST! Is disc material irritating the nerve??????????
As the 損inch??the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of through Chiropractic treatment, perhaps additional help would speed your return to health:
Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support. High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy. Vitamin B-6 reduces the glycosylation that can cause nerve damage. Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health. Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet. Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity. Glucosamine is effective in relieving joint pain associated with osteoarthritis. Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties. These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness. Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent. White willow was used as far back as the Middle Ages to reduce pain and fevers. The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects. Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs. Curcumin may have similar action to aspirin.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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Your condition needs help at home- besides seeing the chiropractor, exercising as instructed, aovoiding certain movements/ activities; i believe and recommend the P.R.I.C.E. protocol:
P.R.I.C.E. =
P protection. R rest. I ice. C compression. E elevation.
Hurt yourself ?? injury/ trauma/ bruise/ not even sure - - a broken bone ??
You should certainly get to the Doctor or trained health professional to be examined if you think it is bad enough.
BUT in the meantime, some simple steps may help.
PRICE.
The PRICE protocol will usually help just about any musculoskeletal injury.
P = Protection; protect the area from further injury- stop what you are doing, can you
pad or bandage the area ? Tape the area? Do something to protect the area !
R = Rest; rest the area as much as possible, if a part is damaged, give the body time to
repair the area
I = Ice; ice is a potent anti-inflammatory; it will slow swelling, help with pain control
(ice is analgesic), place ice over cloth over the injured area for 5, 10 minutes, off the
injured area for 30 minutes; then back on again
C = Compression; to help prevent swelling compression may be helpful- for example
if it is an ankle, wrap the ankle with an ace bandage and ice the area. Many body
parts may not be applicable to compression.
E = Elevation; again to fight swelling and pain, raising the injured body part above the
heart may be helpful- ie raise an ankle or knee, you lay down, raise the injured part
PRICE may help : Sprains, Strains, musculo-skeletal injury, bruise, contusion
Sometimes a slip, trip, fall, heavy lift, athletic injury, or a motor vehicle accident can cause a bump or bruise, sprain or strain. Sometimes also involved with the injury is a vertebral subluxation (or other joint subluxation) (subluxation is a mechanical problem- of any joint- and requires a mechanical correction). In the spine, a sprain/strain is a misalignment, a 慿ink?in the joint, a stretch of the muscles, tendons and/ or ligaments:- more properly termed a Vertebral Subluxation. Sometimes symptoms can come immediately, sometimes days, weeks or even months later!- Well after the actual trauma !!!
Spinal = Vertebral Subluxation Complex (a.k.a. 憇ubluxation? ; ( subluxation COULD be any joint )
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment. For good health- Treat the Cause, not just the Symptoms. Sprain/ strain/ bump/ bruise?= may result in subluxation of the nearby joint. CORRECT the subluxation !!!!
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
I hope this all helps.
If you need further information, please do not hesitate to REcontact me here at all experts!
Your Staten Island Chiropractic Friend,
Dr. Victor Dolan
http://drvictordolan.chiroweb.com ==== Email newsletter
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); Manipulation Under Anesthesia Proctor, Certified Emergency Medical Technician - NYS and National Registry , FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine , Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
