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MRI Report Shows Moderate To Severe Disc Space And Height Loss And Moderate Diffuse Disc Bulging. Treatment?

Posted on Mon, 24 Jun 2013

Question: I am a nurse and I know what my MRi report means, what I don't know is what the treatment is.

1L--L5 normal
L5-S1 there is moderate to severe disc space and height loss. There is moderate degenerative endplate signal changes. There is moderate diffuse disc bulging with minimal retrolisthesis of L5 relative to S1. There is post operative findings in the right side. No evidence of recurrent disc, there is no spinal stenosis foraminal not compromised.
No abnormal enhancement, Conus normal, paraspinal tissue is normal

Follow up: Dr. S K Mishra (4 minutes later)

Daily activities for the first 2 hours are excruciating and takes about an hour to feel my feet after waking, 3 hours for my back to ease even with vicodin 7.5/500, voltoren gel, and a XXXXXXX it is agony. stride is half what it used to be do to pain. sitting too long, standing more than 20 minutes or sitting in a chair where butt is lower than knees is excruciating. I often need the head board to help me roll over in the morning to get out of bed. on a pain scale1-10 first thing in morning I am a 9,I force myself to move to walk even if its five step steps and then sit down again leaning forward. as the day progresses if I stay moving I am an 6-7 on pain meds, at night right back 9. getting up from standing and using stirs my R leg shakes.
Laying on my stomach causes instant searing pain, increased numbness and

All images I posted are up loaded under reports side view of MRIs c and s contrast, and xray s c oblique's.

Physical therapy said he could not help me

Answered by Dr. S K Mishra (1 hour later)

Hi,

Thanks for query,

I read your complains and observed MRI and X-ray films you loaded. The key points are you are 35, you have significant pain, operated for L5-S1 disc 18 yrs back and now you have L5-S1 listhesis.

In this circumstance, if I were to be your treating doctor, I would order for Xray of lumbosacral spine lateral view in flexion and extension and see for mobility between L5 and S1. Alternatively dynamic MRI is another entity which can reveal problems in listhesis not seen on simple MRI or Xray can be considered. Surgical fusion is best option if the reports are not favorable.

If surgery is not the option, try conservative measures such as reduce weight, change of job (a desk jop preferably) and physiotherapy can be considered.

You should consider discussing with your spine surgeon about these options. Plan the test under their guidance.

Hope this answers your question. Let me know if you need clarifications.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. S K Mishra (2 days later)

Thank you, I will definitely ask my MD for the imaging you suggest.

I am aware there is artificial discs, however given I am young how long do they last ( I know there no set time. However, I read that it is difficult to treat when they go bad due to scar tissue around the spinal cord). Also, I heard of butterfly spacers. Not familiar with this one, given this portion of the of the back bears most of the weight would it be a viable option, or does the same problem apply with wear and tear and scar tissue. Forgive me, I am a nurse in family practice. Also, my mother suffered from OPLL in her hey never discovered what caused her OPLL as it is mostly found in oriental heritage and we do not have that demographic in our family.

What is the standard recovery time for a fusion?

Thank you, XXXXXXX

Answered by Dr. S K Mishra (1 hour later)

Dear XXXXXXX

I shall answer your questions in specific points:

1. Artificial disc is not done routinely for lumbar listhesis. This is an option for cervical disc problems.

2. Butterfly spacers are again not viable options. Lumbar fusion would be the ideal option if dynamic X-ray / MRI scan results are not favourable.

3. Following lumbar fusion surgery we mobilize patients 48 hrs after surgery. However you would be able to return to work after 3 to 6 weeks.

I hope I have answered all your questions.

Regards

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad