33 male with lower back pain. left leg pain stops at the knee and right leg pain goes to the foot. pain sometimes sharp most time dull. have weekness in both legs. have to live on pain meds and have done PT. PCP sent me to Nero Surg. Nero Surg dismissed right leg pain and gave more meds and advised to take Ibuprofen for three weeks and come back and see him. this is my problem I can not sit in a car and walking and standing cause pain in lower back and legs fill very week, bending fowards does help some but when I rise up sharp pains go down both legs. When bending backwards sharp pains down both legs worse in right leg. if anyone can give me some advised. I have asked my PCP to send me to another Nero Surg because I felt that he did not have time for my problems and rushed me and would not let me answer his ?. below are the results of my MRI 11/13/2003. Any advise would be help.
L5/S1: Broad-based disc protrusion with probable left paramedian disc extrusion compressing the thecal sac. Moderate to servere canal stenosis, Facet Hypertrophy. disc dehydration.
L5/L4: Circumfereential disc bulge and posterior disc ectrusion, facet hypertrophy and ligamentous thickening. Severe neural foraminal and moderate to servere canal stenosis. disc dehydration.
L4/L3: Circumferential disc bolt and broad-based disc protrusion. Facet hypertrophy and ligamentous thickening. Moderate to servere neural foraminal and canal stenosis.
IMPRESSION: Multilevel degenerative disc and facet joint disease with lower lumbar disc herniations most prominent at L5/S1. Moderate to severe canal stenosis at L5/S1 and L3/L4. Severe canal stenosis L4/L5
You deserve a surgeon who will answer your questions, that is my first response. Mine was very pushy as well but I was determined to make him listen to my concerns. It sounds like you know your situation and you are headed in the right direction. Make sure you get a surgeon who is willing to take the time to answer your questions because healing is jsut as much mental as it is physical. I laid in bed affraid to move for 4 months after surgery becausae my surgeon was so ambigious and quick to push me out of his office. I have since learned when it comes to your health the doctor should give you as much time as needed. Good luck and best wishes.
Chronic back pain for 6 years
Epidurals, PT, occasional relief
Hurt back severely during college football
Ruptured L5 S1 and nerve damage
Hemilaminectomy/Discectomy, medial facectomy on 2-20-03
Pain is getting better every week
Residual numbness and pain in foot, butt, calf
Rehabing at new PT and getting better
Still have numbness and occasional pain in leg
Eric Davis goes to the same PT as me! I'm in good hands!
Welcome to the Healthboards for Back Problems. I am very sorry to hear of all your pain and to read of your diagnosis. I pray that your neuro surgeon does take more time with you on your next visit and takes the time to explain things to you in more detail. I have also found myself to be in your same situation with my neuro surgeon. Thank God for the Internet as that is how I found most of my information through research. If your surgeon does not take the time with you then maybe you can demand that your primary doctor give you a referral to another neuro surgeon.
From what I have read your report does not look good but I am sure you already know that much. You do have the beginning stages of DDD (disc degenerative disease), Facet Hypertrophy Disease and also Lumbar Stenosis. And then you have 3 bad disc's. MRI's do show that these disc's are damaged and if a surgeon thinks that they will require surgery he will then usually order either a myleogram or discogram. This procedure does give a better picture of the disc as they insert a dye into it. But that is really not your question at this point. I will paste some info that I have posted before on another thread that might help you to understand some of the terminology used in the report.
The facet joints are part of the openings in the vertebral column called neural foramina that nerve roots have to pass through to get to the arms and legs. If the size of the hypertrophied facet gets large enough it may block the neural foraminal opening and pinch the nerve exiting through it.
Understanding Medical Terms
Disc bulge is due to radial tears in the annulus allowing disc material to increase the disc volume either centrally or laterally, depending on the area that has accumulated the most radial tears.
Disc herniation, also called subligamentous, is a situation in which the nuclear material has protruded into the radial tears in one area and has displaced surrounding anatomic structures, i.e., proximal spinal nerve, but has not passed the annulus.
Another term commonly used to describe this finding is disc protrusion. A herniated disc is still considered a contained disc as long as the protruding nuclear material is contained by the posterior longitudinal ligament-disc capsule complex.
Radiological reports often use the terms disc protrusion and disc herniation indiscriminately to describe an abnormal bulging of the disc. These terms are confusing as they may be defined in different ways by clinicians. Disc protrusion generally signifies anatomically a focal or diffuse protrusion of the disc with an intact annulus fibrosus. The diffusely bulging disc is broad-based or slightly asymmetric and reflects disc degeneration. The term protrusion is used to define this radiological aspect of the a diffuse disc bulging.
disc dehydration = intervertebral discs normally contain water
Degenerative disc disease refers to a syndrome in which a painful disc causes chronic low back pain. The condition generally starts with a torsional (twisting) injury to the disc space. The injury weakens the disc and creates excessive micro-motion at the corresponding vertebral level because the disc cannot hold the vertebral segment together as well as it used to. The excessive micro-motion, combined with the inflammatory proteins inside the disc that become exposed and irritate the local area, produces low back pain.
Unlike the muscles in the back, the disc does not have a blood supply and therefore cannot heal itself and the painful symptoms of degenerative disc disease can become chronic. While it is rare that low back pain from degenerative disc disease will progress or increase, the pain will tend to fluctuate and at times may become significantly worse.
A fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position
For most people, degenerative disc disease can be successfully treated with conservative care. Most patients will experience low-grade continuous but tolerable pain that will occasionally flare (intensify). The frequency and intensity of the flares can be managed with an exercise program that consists of:
dynamic lumbar stabilization exercises
low-impact aerobic conditioning Non-prescription medications, such as NSAID's and acetaminophen, may be helpful in alleviating low back pain, and stronger therapies, such as oral steroids or epidurals, may be prescribed to treat severe flares.
For patients who are unable to function because of the pain, or who are frustrated with their activity limitations, lumbar spinal fusion surgery is an option. Fusion surgery works because it stops the motion at a painful motion segment.
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
What Causes Spinal Stenosis?
Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50. In these patients, stenosis is the gradual result of aging and “wear and tear” on the spine during everyday activities. There most likely is a genetic predisposition to this since only a minority of individuals develops advanced symptomatic changes. As people age, the ligaments of the spine can thicken and harden (called calcification). Bones and joints may also enlarge, and bone spurs (called osteophytes) may form. Bulging or herniated discs are also common. Spondylolisthesis (the slipping of one vertebra onto another) also occurs and leads to compression. When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.
Symptoms of Stenosis
The narrowing of the spinal canal itself does not usually cause any symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems. Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, calves or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down. Cervical spinal stenosis may cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances can also occur. In some patients the pain starts in the legs and moves upward to the buttocks; in other patients the pain begins higher in the body and moves downward. This is referred to as a “sensory march”. The pain may radiate like sciatica or may be a cramping pain. In severe cases, the pain can be constant. Severe cases of stenosis can also cause bladder and bowel problems, but this rarely occurs. Also paraplegia or significant loss of function also rarely, if ever, occurs.
The thecal sac is a thin walled tube filled with cerebrospinal fluid (CSF) that surrounds the spinal cord. CSF is the cushiony fluid that protects the brain and spine and helps distribute nutrients to these structures.
Disks in the spine can push out wards and compress the thecal sac. The compression of the thecal sac can go on to cause the thecal sac to compress the spinal cord or the roots of nerves near the spine. The compression of the spinal cord and the roots of nerves can cause significant symptoms, such as back pain. However, it is possible for a disk in the spine to stick out and compress the thecal sac, but for the thecal sac not to compress the spinal cord or nerve roots. Thus, a compressed thecal sac may or may not account for a person's physical symptoms, depending on whether or not the spinal cord or nerve roots are compressed.
A persistent opening in the thecal sac with a buildup of CSF in the surrounding soft tissue is known as a pseudomeningocele. The thecal sac in the spine is also known as the subarachnoid space. Thecal sac comes from the Greek word "theke" meaning "a box," and the Latin word "saccus" meaning "a bag." Put the two words together and you get "a box a bag."