Question
Hi,
I am 35 years old,& in normal weight. I am suffering from back and right leg pain started in last year(1& half Year).These are
my MRI findings.
Vertebrae: Partial loss of lumbar lordosis is seen. Schmorls node
impression are seen at all dorso-lumbar vertebrae. Mild degenerative lumbar spondylosis is seen. Endplate degenerative changes are seen at L2-L3 and L4-L5 levels.
spinal canal: AP canal diameters from L1 to L5 are 15,15,15,14,14,mms.
facetal joints, ligaments, soft tissues SI joints are normal.
spinal cord : No signal alterations are noted.
Intervertebral discs: Disc dehydration is seen at L2-3,L3-4 &
L4-5 levels.

L3-4 : diffuse annular disc bulge without significant impression on thecal sac. or nerve roots.
L4-5 : Posterior central and bilateral para central chronic disc
extrusion causing moderate impression on thecal sac, bilateral
preforaminal exiting and foraminal traversing nerve roots. Extruded disc is 6.0 mms thick and is lifting PLL.

IMPRESSION : POSTERIOR CENTRAL AND BILATERAL PARA CENTRAL CHRONIC
DISC EXTRUSION (6.0 MMS THICKNESS AT L4-L5 LEVEL CAUSING MODERATE
IMPRESSION ON THECAL SAC, BILATERAL PREFORAMINAL EXITING AND FORAMINAL TRAVERSING NERVE ROOTS.

MILD DEGENERATIVE LUMBAR SPONDYLOSIS WITH SCHMORL'S NODE IMPRESSIONS.

Dr. could you please explain this report and tell me how serious this problem is and how long could it take to recover. Also could you suggest me about right treatment in my case.(without surgery).


Answer
to explain your Mr in lay terms.
you have beginning stage of arthritis (lumbar spondylosis). You have a chronic disc protrusion (disc Herniation) chronic meaning this is not a new injury but is now just getting painful or symptomatic for you.
L4-5 posterior herniation is pressing on your nerve roots exiting from the spine. this can cause radicular symptoms to radiate pain or numbness into the legs. It can also cause muscular weakness in the legs. This herniation is also putting moderate pressure on your thecal sac which is located in front of your spinal canal/cord.
L3-4 disc is bulged. A bulge can correct itself over time with chiropractic care, but is not always a guarantee. Disc bulges can also get worse and herniate like you have at L4-5.
disc dehydration is also noted at levels above your herniation. you need to increase your water intake and stop putting stress on your spine.
mri also says you have endplate degenerative changes which are due to the Schmorls nodes, schmorls nodes are incidental and will not cause you any problems in most cases. I have schmorls nodes and it is associated with scoliosis in many cases.
Do you have scoliosis? xray can tell you that as long as you are standing when xray is taken.
Loss of lumbar lordosis can add to your back pain by pushing the disc protrusion further posterior into the spinal nerves. Lordosis is the curve in your lower back and can be built up with physical therapy or exercising on your own. superman exercise and pelvic tilts are generally good exercises for most people with reduced lumbar lordosis.
for a person your age its a little early to develop arthritis. my guess would be that you have had a heavy labor job lifting a lot of heavy materials for some time or you had an accident.
regardless of how it occurred you need to strengthen your core muscles (pilates is great for this)
the best non surgical treatments would be Cold laser or Low level laser therapy coupled with chiropractic care. Make sure your chiro checks your ilio-psoas muscle and releases it if necessary. the cold laser is very effective in reducing inflammation and healing and repairing soft tissue.
many people have this condition and have no pain at all. So, do not get discouraged. Each case is different and yours may take longer to heal depending on many factors (to name a few) your job, posture, muscular weakness, daily activities, etc...
i would also consider anti inflammation drugs such as : naprosyn, ibuprofen. A more natural one is boswellia root. Do not take ibuprofen or naprosyn if you are doing cold laser treatments.
if you want more info on why and how cold laser works go to my website under our services then chiropractic then click cold laser.
good luck!

David Kulla, DC
chiropractor
www.SynergyWellnessNy.com