Back pain

Hi

I am 37 years old and i am suffering from back pain for the last couple of years. i had taken many pain killers and got some sort of relief from the pain. but now a days the pain killlers are not effective. so the doctor advised me to take an MRI. I had attached the findings below. please advice what could be the reason of the pain and what is the solution and what is the impact in future.

INTER-VERTEBRAL DISCS:
L5 and S1 inter-vertebral discs are desi cated. The rest of the inter-ve11ebral disc
show normal signal characteristics on ai I the sequences. I I
L4-L5 INTER-VERTEBRAL DISC
Poserior focal central disc herniatio~ is seen at this level with significant
indentation on the thecal sac. No indentation or impingement on the nerve root is
noted.

MRI SPINE LUMBAR WIO CONTRAST
Back ache .
Protocol:
Sagittal:
Axial:
Coronal:
t 1-tse- sag,t2-tse-rst-sag, t2-tinll- fs-sag
t1-tse-tra-msma,t2-tse-rst-tra-' sma,t2-trufi3d-tra
t1-tse-cor ,t2-tirm-fs-cor
Utilizing a 0.35 Tesla Siemens Magnet01TIC, rvIRimaging system, the lumbar spine
was imaged with the above described pJlse sequences without contrast. I
VERTEBRA :
I
The alignment of the vertebrae is normal. A focal hyperintense ignal intensity is
seen at the L3 vertebral body on T 1 werghted sequence. It remains hyperintense on
IRTSE fat sat and isointense on T1. chmorl's nodes are seen along the supe60r
anterior of L2, L3, L4, L5 vertebrae and S I vertebra. Pedicles, lamina, spin0us and
transverse processes are normal. Fluid is seen in the facet joints bilaterally at L 1-
L2, L3-L4 and L4-L5. The rest of t e articular facets and the facet joints ',are I I normal. Hypertrophy of the flaval ligaments are seen postero-Iaterally at L4-L5.
The conus medullaris is in normal posihon. Pre and para-vertebral soft tissues are
normal. The canal diameters are as foIl ws:
Canal Measurements:
L1 - 1.71cm, L2 - 1.45 cm, L3 - 1.3 cm, L4 - 1.41 cm, L5 - 1.71 cm and are
normal.
L5-S1 INTER-VERTEBRAL DISC
Posterior left para-central disc bulge is seen at this level indenting the thecal sac.
No indentation or impingement of the n rve root is seen. I
The rest of the inter-vertebral disc are n6rmal.
The sacro-iliac joints appear normal.
IMPRESSION:
, ;
1. Vertebral body hemangioma at L3.
2. Schmorl's node along the superior end plates of L2, L3, L4, L5 and S1 vertebrae.
3. Fluid in the facet joints as described bbove.
4. Hypertrophy of the flavalligaments bostero-Iaterally at L4-L5.
5. Desiccated disc at L4-L5 with posterior focal central disc herniati~n with
significant indentation on the thecal sacl
6. Desiccated disc at L5-S 1 with postetior left paracentral disc bulge indenting the
thecal sac.


Regards

Srj

[S. Kaul, MD]

Hi there!

Well, the MRI describes a haemangioma (benign tumour) at L3, disc herniation at L4/L5 and L5/ S1 which indent the outer layer of the spine (theca), Schmorl's nodes (disc cartilage indenting into the vertebral body) at multiple vertebral levels, degeneration of the facet (intervertebral) joints and inflammatory changes around the lower spine. Well, all these could individually be the cause of backache and yours is likely to be due to a combination of factors. At this stage conservative management is advisable with physiotherapy aiming at strengthening of back muscles, anti-inflammatory medications and pain management. If conservative measures fail or there is further deterioration, interventional/ surgical measures may be considered. Also the intravertebral haemangioma may need to need observed over a period of time or actively managed depending on the size. I would suggest consulting your orthopedician for an evaluation with the MRI report for an appropriate management plan.
Hope this helps.

Take care!

[S. Kaul, MD]

Hi there!

Well, the MRI describes a haemangioma (benign tumour) at L3, disc herniation at L4/L5 and L5/ S1 which indent the outer layer of the spine (theca), Schmorl's nodes (disc cartilage indenting into the vertebral body) at multiple vertebral levels, degeneration of the facet (intervertebral) joints and inflammatory changes around the lower spine. Well, all these could individually be the cause of backache and yours is likely to be due to a combination of factors. At this stage conservative management is advisable with physiotherapy aiming at strengthening of back muscles, anti-inflammatory medications and pain management. If conservative measures fail or there is further deterioration, interventional/ surgical measures may be considered. Also the intravertebral haemangioma may need to need observed over a period of time or actively managed depending on the size. I would suggest consulting your orthopedician for an evaluation with the MRI report for an appropriate management plan.
Hope this helps.

Take care!