back pain and MRI results

[JaKeB123]

hi,
i have just received my MRI results and go as follows, i would like to understand more about it and i am curios as to how serious the problems are.

Findings: there are bilateral pars defects at L5 with grade 1 spondylolisthesis of l5 over s1. signal of vertebral bodies and appendages is otherwise unremarkable. Reduced disc height and signal is seen at l3/4 and l4/5. reduced disc height is seen at l5/s1. visualised paraspinal soft tissues appear normal.

At l3/4 there is mild annulus bulging with a shallow posterocentral disc protrusion indenting the anterior aspect of the thecal sac.

At l4/5 there is annulus bulging with shallow broad based posterior disc protrusion touching the anterior aspect of the thecal sac and the anterior aspect of the right l5 nerve root sleeve. the l4 nerve root sleeve exit unencumbered.

at l5/s1 there is circumferential disc bulging. no evidence of neuro compressive disease.

appearances at other levels are unremarkable. the cord ends at t12. the conus appears normal.

[JaKeB123]

Thank you so much for taking the time to read my question and the very detailed response.. I will be having a look at those websites.

Thanks again

Jake

[philnoir]

OK Jake -- low back pain, right?

First, become familiar with spinal anatomy. There are plenty of resources online -- sites like spineuniverse.com or spine-health.com come with pictures and descriptions.

In general, you have signs of degenerative disc disease (DDD) with all the bells and whistles that implies. Discs are bulging and applying pressure to areas of the spine than cause pain.

The good news is in one line of this report: "[There is] no evidence of neuro compressive disease."

DDD is often a normal part of aging, seen in many films of people 50 and over. Many cases are asymptomatic for pain, but I imagine yours is not, which is what brought you to the doctor.

Right now the severity of your DDD is mild - moderate. Physical therapy will help. NSAIDs may help. Opioid pain medication may help.

Strenghtening of the so-called "core" muscles that support the trunk is important, as is losing weight around the waist. Pot bellies cause stress on the lower back and can exacerbate pain in DDD. Postural changes may help. A good physical therapist or even chiropractor with experience in treating DDD will help reduce inflammation and pain. I would not suggest chiropractic "adjustments" with DDD -- these can tear discs already at the bulging point.

One important feature here is the Pars defect noted. The Pars (pars interarticularis) is a bony extension of the spine that supports one-half of the facet joint. The spine has a 2 facet joints for each vertebra. These joints allow us to bend and twist our spine.

When there is a bilateral pars defect, either due to injury or congenital defect, it threatens the stability of the spine at that level, allowing one vertebra to slip over the lower vertebra -- in your case, L5 is slipping forward over S1 by 1mm. This is considered a mild "spondylolisthesis" (from the Greek: spondylo - spine, listhesis - slip).

Because of the unique anatomy of L5/S1, this pars problem may require surgical stabilization. However, you may have lived your entire life with this pars defect and only recently, with the pain, is it becoming a problem.

A lot of pain can come from those facet joints. If unstable, they develop osteoarthritic changes -- what doctors call spondylosis. If your pain is coming from these facet joints, there is an excellent, non-invasive procedure done by interventional pain specialists (advanced practice anesthesiologists), that can remove the pain of "facet syndrome" as this is called for up to a year. Then the procedure must be repeated. It is an outpatient procedure performed under mild anesthesia.

Investigate interventional pain medicine and seek the treatment called medial-branch neurotomy (commonly called RF ablation, nerve ablation, or nerve "burning.')

Those spine sites I mentioned have sections describing your conditions (DDD, spondylolisthesis), and treatment options offered. Let me also refer you to a surgical site with excellent graphics and videos of spine surgery. www.drdillin.com

Surgery should always be reserved as a treatment of last resort, except in cases where the spinal cord is in danger of immediate damage -- this is not true in your case.

What's your next step? Ask for a referral to an experienced board certified interventional pain and spine doctor. These docs are credentialed MD, DABPM.

Best wishes