Dr. Muhammad Shoyab
Radiodiagnosis
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have lower back pain with radiation to my legs. The pain is constant and has been like that for years. If I change my position during my sleep at night, I always wake up from the pain. The pain is at worst for a couple of hours in the morning after I wake up and gets a little better during the day but gets worse again in the evening. Sometimes the pain is almost unbearable, and sometimes I lose muscle power in the left leg. I wondered if you could see anything wrong with the MRI pictures taken one week ago.
Hello,
Welcome to icliniq.com.
We feel sorry for the pain and distress you have been going through for years, and I note that your MRI (magnetic resonance imaging) shows some quite significant findings.
1. At L5 or S1 level: Retrolisthesis (that is, backward displacement) of L5 over S1 vertebra. Subchondral marrow edema involves facing end-plates at this level - due to all the stress produced by the abnormal situation. Reduction of disc height, with circumferential bulge with few mm downward migration (that is an extension), producing narrowing of lateral recesses and neural foramina on both sides, resulting in compression upon traversing and exiting nerve roots at this level on both sides.
2. At L4 or L5 level: Circumferential bulge, producing narrowing of lateral recesses and neural foramina on both sides, resulting in compression upon traversing and exiting nerve roots at this level on both sides.
3. Circumferential disc bulge is also present at L2 or L3 and L3 or L4 levels but not producing nerve root compression yet.
4. There is also widening of facet joints on both sides at almost all lumbar levels and thickening of flaval ligament, particularly at L3 and L4 levels.
I mean to tell you that there Is compression of nerve roots at the lowest two levels of the lumbar spine, and nerve root compression is the origin of all the pain, loss of muscle power, etc. The nerve root compression is in turn produced by the bulging discs and the retrolisthesis (that is, backward displacement) of L5 over the S1 vertebra.
I am afraid that the matters are neither very simple nor easy (though they may not be the worst of diseases). So, at this stage, you would need to consult an orthopedic or spine surgeon, and perhaps surgery is unavoidable. Success rates of surgery are quite promising. However, you may review this and any other concerns with the hospital and surgeon you would be working with.
We hope you get the appropriate treatment soon and be relieved of your pains. Thanks. Best wishes.
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Radiodiagnosis
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