Maggot Dr. call - Degenerated Discs

[Gman64]

Looking for a somewhat legit medical opinion. I've got an appt. for the back specialist in a month or so, but they sent me the MRI results and I'd like to get a layman's explanation of the findings:

“MRI, Lumbar spine, 3/2/05,
“Multi-level disc degenerative changes are seen at essentially every lumbar level, most marked at the L1-2, L2-3, and L5-S1 levels. A foraminal HIZ is noted on the left at 4-5. Foraminal stenosis is seen bilaterally at 5-1. Facet arthropathy is noted throughout the lumbar spine, most marked at the 4-5 and 5-1 levels. There is a right-sided 3-4 foraminal disc protrusion without nerve compression.
“The MRI would suggest a multi-level disc degenerative process. I would recommend a trial of bilateral 4-5, 5-1 facet joint injections as initial diagnostic, therapeutic intervention. Future discussions could be carried out with regard to the possibility of discography with an eye toward intradiscal procedures such as IDET or nucleoplasty.”

I’d really like to know what all of this means. I last had an MRI in1994, and knew some degeneration had occurred, but it sounds like it’s getting worse?

TIA

[L7]

L3-4 looks good. Might as well focus on the positive. It means you need to do a whole lot more core work and you should figure out is putting so much pressure on the low back. Muscle imbalance, work ergonomics, lack of flexibility, pelvic torsion or all of the above?

I would guess you have surgery in your future either way but maybe Vinman can flesh it out much more.

[Mrs Roo]

“MRI, Lumbar spine, 3/2/05,
“Multi-level disc degenerative changes are seen at essentially every lumbar level, most marked at the L1-2, L2-3, and L5-S1 levels.

A foraminal HIZ is noted on the left at 4-5. HIZ is high intensity zone on the scan which may relate to the disc
Foraminal stenosis is seen bilaterally at 5-1. The foramen is the space the nerve comes out from (see diagram below) and a stenosis is a narrowing that can occur with wear/degeneration
Facet arthropathy is noted throughout the lumbar spine, most marked at the 4-5 and 5-1 levels. "facet" refers to the facet joints (see diagram) and arthopathy is arthritic changes, i.e. degeneration
There is a right-sided 3-4 foraminal disc protrusion without nerve compression.This suggests that one of the discs is pushing into the foramen but it is not hitting the nerve
“The MRI would suggest a multi-level disc degenerative process. ”





This is a PT interpretation. There are others more qualified on the board but I think that is the essence of what it is saying. Hope that helps. This site may help and yes, core stability exercises are a very good idea.

http://www.back.com/causes-mechanical-facet.html

[Gman64]

Thanks for the replies.

I've been doing core (abs and lower back) stability and strengthening exercizes nearly every day since I was diagnosed in 1994. There are some days when I physically cannot work out due to the pain, but they do help relieve the pain somewhat. I'm not a six-pack guy, but there aren't many with stronger abs and lower back muscles.
L7: Nothing short of disc replacement can be done to stop the degeneration process. I was told it is either hereditary or the result of a injury in my younger years

[Vinman]

Well basically L7 and Mrs. Roo covered the based there. Basically there is something taht you are doing the is causing arthritic changes in the vertebrae and degeneration of the discs. Like L7 said prolly related to some kind of repetitive movement or poor posture, combine this with weak core muscles and too much pressure gets placed on the spinal structures when it should be taken up by the muscles.

Expect your Doc to want to put you into therapy combined with some injections. I'm guessing they would be injecting anti-inflammatory into the facet joints(pure guess, I usually don't work with chronic backs).

Good luck.

[irul&ublo]

1. the fact that an mri shows degenerative changes is not unusual...depending on age, most people by mri would have such changes, but no symptoms.

2. facet injections are guided injections using an anti inflammatory. sometimes in a series. pretty common.

3. dicography is a process where they inject several discs to provoke a pain response; the idea is to narrow down the pain source. most docs i deal with dont do it unless surgery is planned.

4. nucleoplasty is a fairly new treatment where a cathater is used to remove disc material and decompress a nerve. dont know too much about it.

5. idet is a process where the disc is heated w/ the idea this will cause it to shrink. its done, but several docs i deal with are highly skeptical of the success rates. apparently some pretty big studies poo-pooed it. if your doc is suggesting this, you might want to consider a second opinion.

[L7]

Thanks for the replies.

L7: Nothing short of disc replacement can be done to stop the degeneration process. I was told it is either hereditary or the result of a injury in my younger years

Fusing the joint used to be one approach but not a preference. I'm not suggesting it would get better just keeping things functional as long as possible.

I've been fighting the same sort of crap for a similar amount of time but yours sounds more advanced. The core work does tons but it's sooooo hard to keep up when it feels good and it's soooo too late once it feels like crap.

I found a very good chiropractor/ athletic therapist who did a ton of work on my hip which helped a great deal to keep my pelvis aligned. He also hammers me to keep up muscle balance to undue the harm of many bicycle miles and many ski miles. That in turn helps to keep things flexible if I keep up the core stregthening AND stretching all the connective tissue and muscle.

[Gman64]

I’m sure that much of the new degeneration is due to the running mileage I’ve racked up since the first diagnosis. I was pretty out of shape and overweight at the time, so along with core work, I ran (and still do when my back allows) a LOT. It actually helped with the pain. Though I’m not sure if it was the weight loss producing less stress on my back, or the strengthening I’ve been doing.

So, it’s going to be the walking, the bike, roller blades, and hockey this summer and not so much running. We’ll see if that lessens the stress

I’m also thinking acupuncture may help as well. My GF is a holistic wellness believer and knows some chiros that do acupuncture as part of their treatment process. Any one had experience with acupuncture? I’d be interested in your thoughts

TIA

[L7]

I've had acupuncture a couple of times. Pretty cool really. What I anticipated was pretty much immediate relief of the muscle spasms. That's not the case, apparently it takes a couple or more sessions. Hell they relieve themselves over the couple of days it takes to keep going in for treatments.

Running really tends to shorten the hamstrings and IT band. This can cause the pelvis to be pulled out of alignment and add stress to the back, not too mention extra weight you started with.

Again Vinman and I'm guessing Mrs Roo can give you more on this stuff.

[Vinman]

the weight is the real issue. All that weight pulling forward on the spine tends to arch the spine more forward than it should normally be placing pressure on the ligaments, discs and facet joints. Hamstring tightness is also a big issue just as L7 said.

If you can loose some weight, lengthen the hammys and strengthen your core you will go a long way towards having a back that feels good or at least better.

[Gman64]

Thanks again. I probably wasn’t clear on the weight issue. I'm not carrying the weight any longer I dropped 20lbs about 10 yrs ago so I'm a comfortable 5'8" 170. Not a stick, but I'm "big boned" (the can of worms is officially opened!).

I stretch my hamstrings and quads as much as possible but that’s really never enough until I can do a Rodney Yee (he is the yoga guy right?). Especially before and after hockey. I could probably use to step up the core strengthening a bit. Sitting here typing, it dawns on me that I can’t remember the last time I relaxed my abdominal muscles when I was awake. Man, that would be nice…

The pain is manageable most days with an occasional narcotic on the bad days

[irul&ublo]

gman...how old are you? And do you have pain which radiates either or both legs? Any numbness or tingling in the legs associated w/ back pain?

[Gman64]

3010 (my kids say forty). Occasional tingling/numbness down the left leg. It used to go somewhat numb back in the early 90's which is what prompted me to see the back specialist in the first place.

I'll not be happy if you take me out to the pasture and show me the glue factory

[irul&ublo]

Be really circumspect about getting a discogram, unless the doctor suggests surgery. I deal with a lot of neuro and orthopedic surgeons, some conservative and some not. Virtually all say there is no reason for a discogram, which is diagnostic only, unless you are seriously contemplating surgery. Sounds like you are a long way from that.

At 40, the presence of increased degenerative changes compared to a 10 yr old MRI isn't surprising. The changes shown may very well not be contributing to your symptoms.

[Mrs Roo]

I’m also thinking acupuncture may help as well. My GF is a holistic wellness believer and knows some chiros that do acupuncture as part of their treatment process. Any one had experience with acupuncture? I’d be interested in your thoughts

TIA

The likelyhood is that because this is a long term problem, your pain is chronic. What happens over time is that movements etc cause you to experience pain even though no actual tissue damage is occuring (that's what acute pain is afterall, a warning mechanism). This is because the pain centre of the brain over time has set up new pain loops and pathways devoted to the pain in your back. Nice. Acupuncture can be very helpful in treating chronic pain because it can reduce it through something called the "pain gating mechanism".

Where I used to work we had a chronic pain programme where the majority of people had low back pain. The over riding principle was to not let chronic pain dictate your activities. Chronic back pain is much more than the mechanics (although this is very important for reducing further degeneration as discussed by my esteemed colleagues) but also your overall behaviour. You are keeping active and that's important and expect the odd twinge (dodgy pain centres etc) but you know what is sensible. Keep at it.

[splat]

Gman - good to hear someone thinking outside the bun on this one.

Mrs. roo - Acupuncture is good. Rolfing can help. Orthobionomy is the absolute shit. Core exercises rule. St. John Wort oil, applied externally every day for a year can help rebuild discs. And if I see you, remind me to teach you the disc fluff, a daily spinal and total nervous system exercise that will change your life and eliminate spinal pains.

[peterslovo]

Not trying to jack the thread, just add some of my own personal experience with disc degeneration and ask some other questions.

I have pretty much the same diagnosis as Gman64, but in my thoracic (T4-5) and cervical (C7) spine, not lumbar, along with something called "end plate disruption", which is apparently the cracking of the end plates between the discs. I also have no nerve impairment, though I do get numbness into my left arm and down my left outer fingers after heavy exercise. My disc degeneration and end plate damage resulted from a mountain biking accident 2 years ago. I still have daily pain and numbness in the back and neck.

After a long time of MRIs, xrays, and 1 rehab program, a specialist from Boston's Spine Center signed me up for a specialized intense spine rehab program run by US Health Works. It really focused on core strength and helped a lot in terms of my overall strength (but didn't do that much for the pain) - until I pinched a nerve doing the rehab, which set me back again! But the core strengthening has been key to me feeling like I can do all my activities without injuring my back further. From my experience, I highly recommend getting a specialized workout that is lower and mid-back and core specific.

I've tried steroidal injections to no avail - they only worked for about 3 weeks, though I've heard they work better on lumbar injuries than thoracic/cervical. Also tried cranio-sacral therapy, which put me to sleep very quickly, but did nothing for the pain.

Anyone know if end plate disruption predisposes one to quicker disc degeneration and eventual slipped discs? I've gotten mixed answers from my doctors. Is there anything else to do for it other than core exercises?