How to treat disc bulge at L3–L4, L4–L5, and L5–S1?

Question

Hi doctor,

I have lower back pain and right buttock pain. I have consulted a doctor for this, but I am not satisfied with the explanations. I have undergone MRI as per advice and here is the result. Posterior disc bulge with annular tear, moderate to severe stenosis of both neural foramina and mild stenosis of both lateral recesses at L3-L4.

Disc desiccation and posterior disc bulge with moderate to severe stenosis of both neural foramina at L4-L5. Posterior disc bulge with mild to moderate stenosis of the left neural foramen, moderate stenosis of the right neural foramen and mild stenosis of the right lateral recess at L5-S1. Straightening of the lumbar lordosis most likely due to muscle spasm. Apparent posterior convexities are noted at C3-C4, C4-C5, C5-C6 and C6-C7. Disc desiccation is seen at C4-C5, C5-C6, and C6-C7.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

You have mentioned that you have pain in the lower back region with radiation of pain to the right buttock region. Along with this, you have also mentioned your MRI reports (attachments removed to protect patient identity), which show degenerative disc disease at multiple levels. Actually, I need your clinical details, after which it can be correlated with MRI images, and then I can advise you accordingly.

Please tell me in detail the intensity of your back pain on a scale of 1-10.

What, in your opinion, was the cause of the onset of the lower back pain? Did you lift something heavy?
Or was it due to something else that you can remember? Is your pain localized to your back region?
Or is there any pain radiating down your legs while walking?
Is your leg pain more than your lower back pain?
Do you also have any other associated neurological symptoms like numbness, weakness in legs, or paresthesias, such as electric shock-like sensations in legs?
How much distance can you walk on a daily basis?
What are your analgesic requirements on a daily basis?
Did you suffer any other systemic symptoms like fever, weight loss, loss of appetite, etc., during the past two to three months or before the onset of your pain?

I would like to see your detailed neurological examination, if possible, that includes assessment of motor power, sensory examination, and evaluation of deep tendon reflexes. This can be done either by a qualified physical therapist or an orthopedic or spine surgeon. That will give me an insight into whether there is any compression of nerves, etc.

I also want to see your MRI scan and dynamic x-ray anteroposterior and lateral - flexion and extension views of the involved region of the spine. This can tell us whether there is any dynamic instability in the involved region or not. Kindly also enclose any recent blood tests if you have done them, your past significant medical history, etc. Once I have this information, I can clinically correlate and let you know the treatment plan.

I hope this helps you.

Take care.