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Low Back Injury
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Low Back Injury


  Thank you in advance. While at work I suffered an injury to my lower back
  while lifting, which caused a paralyzing electrical pain. I had to be
  taken to the hospital and have been off work since. I have constant pain.
  The neurosurgeon who is seeing me has used an oral steroid treatment which
  seemed to worsen the pain? Next up is a lumbar epidural steroid injection.
  Is this the right course of action? What is the prognosis for returning to
  work at my present position which involves daily lifting of objects
  from 5 to 150 lbs and standing 7 to 8 hours daily as well as lots of
  bending and twisting of my body. I am an auto repair technician.  
  Activity restriction is not a long term option in my position. My low back
  has hurt daily for over three years. What is the normal course of healing
  and am I likely to suffer a recurrence from this type of work?
  Below is my recent MRI report:
  
  TECHNIQUE:  Sagittal T1 and T2 with axial T1 weighted images were done.
  THE T1 weighted images were obtained pre and post contrast.
  FINDINGS: The sagittal images are reviewed first. There is mild disc
  space narrowing at each lumbar interspace. Schmorl's nodes are present
  in the lower thoracic spine and in the upper lumbar spine. These
  represent herniations of the nucleus pulposus through the vertebral end
  plate. The conus medullaris is identified at the level of L1 and appears
  grossly normal. There is no indication for vertebral compression fracture.
  A very minor anterior listhesis is present at L5-S1. At L1-L2, there is
  a mild bulge of the annulus without significant stenosis. At L3-L4, there
  is also a minor bulge of the annulus without significant stenosis or
  foraminal encroachment. At L4-L5, there is facet arthropathy and
  ligamentum flavum hypertrophy that narrows the thecal sac. The presence
  of a mild concentric disc bulge results in a mild degree of central canal
  stenosis. There is minimal bilateral foraminal narrowing.
  Images that extend through the L5 vertebral body demonstrate bilateral
  pars defects with resultant aclerosis and degenerative change at the
  bilateral pars regions. There is a mild narrowing of the thecal sac at
  this level, due to degenerative change along the pars interarticularae.
  At L5-S1, there is a small central disc herniation that extends to the
  thecal sac but does not compress it or displace the S1 nerve roots.
  There is slight lateralization of the disc material toward the right so
  that it extends to the transitting right L5 nerve but does not compress
  it.
  IMPRESSION: There is a minor spondylolisthesis at L5-S1 and associated
  spondylolysis. There is degenerative change at the pars defects providing
  mild mass effect on each lateral border of the thecal sac.
    The presence of the mild spondylolisthesis creates a disc pseudo-bulge
  but there may be a seperate central herniation that is confined to the
  ventral thecal sac. Disc material comes close to the transitting right
  nerve and may provide irration.
    There is a mild central canal stenosis at L4-L5 due to a combination of
  factors.
_______________
_______________
Dear Dave,
The good news is that it doesn't sound like you need surgery.  The description of the MRI simply states that you have mild degenerative changes in the spine, a common finding in patients.  About 90% of patients with back pain do not need surgery and can be managed with conservative treatments.
The issue with your disability and recurring pain is a bit more difficult.  What you need at this point is time and rest.  The steroids and epidural injections are to get you over some of the discomfort while your back is recovering from the injury.  During this time, and perhaps indefinitely, you should avoid overexerting yourself and clearly you should not lift heavy objects at work.  It will only aggravate the situation.
What you need to do is discuss the problem with your employer and have your physician write a letter to your employer stating your situation.  Often another less strenuous position is acceptable to the employer.  Most employers are willing to work with employees if things are done in a reasonable manner.
Good luck.









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