Q. Please have a look at my MRI and explain the treatment for back pain.
Hi doctor,
Previously, I contacted you with the following issue. I got a back muscle spasm with lumbosacral spondylosis. Posterior central disc bulge at L4-L5 and L5-S1 causing thecal sac indentation. Also, bilateral neural foraminal narrowing. I am having groin, LBA and leg pain for the past two months. More details about the presenting complaint are as follows. I have groin, hips, coccygeal and lower back pain. The pain started after starting yoga two months back. The pain has been there even after discontinuation of the same. I am also having pain and stiffness in the neck as well. I am doing desk job and walking for around 150 minutes every week. My USG and MRI pelvis show small multiple fibroids. They are not likely to cause LBA as per gynecologist consultation. I am on SOS anti-inflammatory, calcium and vitamin D3.
For the above posted query, the answer given by you was the following. What is the intensity of back pain on a scale of 1-10? Apart from pain in the back region, is there also associated pain radiating down into the legs? If yes, which leg and what is the intensity? Is there any associated numbness or weakness in legs? How much distance can you walk on a daily basis and what are your analgesic requirements on a daily basis? Ideally, before prescribing you any medications, I would like to know your neurological examination in the form of assessment of motor power, sensory examination and evaluation of deep tendon reflexes of your lower limb. Also, I would like to see your MRI images and one x-ray (LS spine lateral - flexion and extension views) to look for any bony instability, if present. Once I have all this information, I can then make an idea and prescribe you on what needs to be done.Also, you said that a lot of patients have a degenerative disc, but that may not be very symptomatic. So, we prescribe gentle anti-inflammatory medications, intensive physical therapy and adequate calcium and vitamin D intake to keep bone metabolism healthy. Anyways also briefly let me know about your medication history and any associated history allergy, etc. Now, my complaint is lower back pain and pain in the coccyx, buttocks and groins radiating to the legs for the last two months. I have attached the MRI spine and pelvis here for your reference.
Hello,
Welcome to icliniq.com.
You have sent me your MRI images (attachment removed to protect patient identity), which show mild degeneration in a few of your discs. But, there is no great compression anywhere. So, I presume you would also be fine neurologically. Although, I would request you to kindly send me other investigations as well as I had asked. A thorough neurological examination can be performed by any physical therapist, so you can get it done and send that to me along with your dynamic X-rays as had been suggested by me. Start daily walks for 2 to 3 km per day; this would keep your body flexible. Intensive physical therapy initially under the supervision of a trained physical therapist and you can initiate with LASER therapy for localized back pain and TENS (transcutaneous electrical nerve stimulation) as a modality for radiating leg pain. Once you get better, then appropriate exercises for strengthening back muscles will be initiated. I suggest a gentle anti-inflammatory medication like Etoricoxib 60 mg twice a day for 10 to 15 days after meals, but make sure that it suits your body. Consult your specialist doctor, discuss with him or her, and take the medicine with consent. I also suggest tablet Neurobion forte one tablet once a day for three to four weeks and calcium supplements like Gemcal Plus one tablet once a day for three months and Vitamin D 60,000 units sachet once a week for the same duration of time. Also, take adequate precautions like not bending forwards acutely, especially in the morning. Do not travel on uneven surfaces for a long duration of time. Also, start with isometric exercises for your neck to make your neck muscles strong along with special emphasis on ergonomics while at work. It has been seen that most of the patients improve significantly with good physiotherapy, maintaining posture at work, and some supportive medications. If you do not feel better after two to three weeks of treatment, then we will get a few blood investigations for you and dynamic X-rays. Meanwhile, get your thorough neurological examination and send it to me.
Thank you.
The Probable causes:
1. disc degeneration.
2. Improper posture at work.
1. X-ray lumbosacral spine (anteroposterior and lateral - flexion and extension views).
2. Blood investigation includes CBC (complete blood count), ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), serum electrolytes, serum vitamin D and B12 levels.
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