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    Old 11-03-2015, 02:15 AM   #1
    estellecjj
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    nerve pain

    Hi, have been diagnosed with degenerative arthritis 2 years ago and had another CT scan yesterday after experiencing pain for the past 3 days in right lower back and hip
    my ct results says:
    L1/2: No significant disc protrusion. The central canal and exit foramina appear adequate

    L2/3: Minor disc bulge. The central canal and exit foramina appear adequate. Early facet joint degenerative change

    L3/4: Mild disc bulge and ligamentum flavum hypertrophy. Minor encroachment on the central canal. The exit foramina appear adequate

    L4/5: Disc bulge. Ligamentum flavum hypertrophy. Mild central canal stenosis. Minor encroachment of both exit foramina

    L5/S1: Marked disc space narrowing, endplate osteophytes, endplate sclerosis and vacuum phenomenon, consistent with degenerative disc disease. Disc bulge. Mild central canal stenosis. Abutment of the origins of both transiting S1 nerve roots. No overt evidence of nerve root displacement or flattening. Moderate left and mild right exit foraminal stenosis. Abutment of both existing L5 nerve roots. Mild Bilateral facet arthropathy

    Just seen a GP and have put me on Mobic but the pain is unbearable
    Any advice please?

     
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    Old 11-03-2015, 06:42 AM   #2
    teteri66
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    Re: nerve pain

    Welcome to the board.

    My suggestion is to make an appointment with a spine specialist. This would be either a fellowship-trained orthopedic SPINE surgeon or a neurosurgeon whose practice is limited to the neck and back. Any pain medication is not going to help much because you have some nerve compression at the L5-S1 level. Do not be thrown off by the label of "surgeon" in the title. These two specialties have the most education, training and experience in the mechanics and diseases of the spine, neck and back. I feel it is important to get an accurate diagnosis at the beginning of your journey and a plan for treatment rather than trying to "manage" symptoms through medication.

    After an evaluation that should include a physical exam, a basic neurological exam, after reviewing your tests like this scan and after listening to your description of your symptoms and how they affect your daily life, you may be referred for a course of physical therapy, a series of epidural steroid injections or various other conservative treatments. Surgery would only be considered as a last resort.

    The report would indicate you have "degenerative disc disease" throughout the lumbar spine. This is not a disease but a collection of symptoms and it would be worth your while to read up on it online just so you understand the general disease process. It is a cascade of symptoms caused primarily by wear and tear, and daily living.

    Briefly, intervertebral discs are composed of something like 90% moisture but there is no direct supply to replenish them. What nutrition they get comes from absorbing it from the end plates of the bones of the spine called the vertebrae. As we age, this process becomes inefficient and the discs tend to lose moisture and flatten. This brings the vertebrae closer together and sets off a series of other changes that include the arthritis that you mentioned...facet arthropathy, osteophytes, ligamentum flavum hardening, etc.

    Since L5-S1 is the most symptom-causing, I will try to explain what is going on there....
    First I find it helpful to know that most radiology reports of the spine use specific words to give some idea of "how bad" a particular issue is. They are: minimal, mild, moderate and severe...progressing from not at all bad to pretty bad to can't get much worse! Luckily nothing is judged to be severe in your report.

    There is some disc drying out, flattening, which brings the bones closer together, narrowing the disc space. This leads to the formation of little bony spurs on the ends of the vertebrae, along with the bulging of the disc itself.

    There is a small amount ("mild") of narrowing of the central canal. There are two main areas where spinal nerves can become irritated or compressed....the neuralforamen and the central canal. When anything causes these areas to narrow or lose diameter, the result is that there is less room for the nerves to function normally. This narrowing process is referred to as "stenosis." It can cause anything from mild pain to tingling, electrical type zapping feelings, to numbness and even loss of muscle function. Also the pain can be at the location of the origin of the nerve or it can radiate anywhere along the path of the nerve as it runs out to innervate a specific part of the body. (For example, if one has pain in the great toe, it most likely stems from a L4 nerve issue.).

    The MRI indicates that while there is no obvious evidence of nerve compression, there is what is called abutment of the spinal nerves at this level. This means pushing into the nerve...which you can think of as an early stage of nerve compression. At the moment it is just touching, but if the disc bulges more or the facet joints enlarge more, the abutment will change to pushing into the nerve or taking up most of the space that is needed by the nerve to function normally.

    It is interesting that your pain is on the right side. Just reading the report I would think that you would have pain more on the left side.

     
    Old 11-03-2015, 11:09 AM   #3
    estellecjj
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    Re: nerve pain

    Thank you so much for your reply, it made it so much easier to understand what my report said as the GP is saw had a heavy accent and could not explain to me in terms I could understand

    My pain is definately on the right sight just above my buttocks moving into my right hip. This pain specifically I have only had since Saturday
    I work an office job with lots of sitting and I have found that currently sitting is more bearable for me, when I stand the pain worsens to the extent that I have to find somewhere to sit down, by the it is very bad in my hip joint
    Previously before this started I found that when I have been seated for a while at work and try to stand up I would get a sudden pain and my legs would give way. I have not had this since Saturday
    My GP asked me to see him again in a week, I will ask him for a referral
    Thank you again
    [QUOTE=teteri66;5390649]Welcome to the board.

     
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