I have a continous left lower back pain after an injury. Please help.

Hello,

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Your iliolumbar ligament is completely visualized and is free from any pathology in the MRI (attachment removed to protect patient identity). Your vertebra, intervertebral disc, spinal column, and spinal cord are also grossly normal. However, there is early facet arthropathy at multiple levels, prominent at L5 with mild ligamentum flavum hypertrophy, which is the cause of your lower back pain. I suggest you consult with your specialist doctor and try taking a muscle relaxant and short wave diathermy along with physiotherapy for pain relief. In the case of no assistance with this conservative treatment, local Cortisone injections can be applied to individual facet joints.

Thank you.

Hello,

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I have discussed your case with a radiologist, according to both of us, facet arthropathy can be the cause of your back pain. You should consult an orthopedic surgeon for clinical evaluation if the pain is not resolving for the past three years. Besides your MRI reports are taken a long time back, so we do not know for sure if your condition is the same or worsening now. You should get both clinical and radiological evaluations done again. To help you out with your condition, please let me know a few things. Since how many days has your problem worsened? Do you have any tingling, numbness, or radiating pain in the lower limbs? Does the pain aggravate on bending backward, coughing, sneezing, or bending sideways? Was there a period of increased activity or unaccustomed lifting heavy weights before the worsening of pain? Are you involved in any sports? Have you taken any supplements, steroids, or recreational drugs of abuse?

Thank you.

Hello,

Welcome back to iclinq.com.

Any spinal pain that is refractory to six to eight weeks of conservative treatment requires clinical and radiological evaluation. The first investigation is always an X-ray spine to rule out the gross bony pathology even if we suspect nerve root irritation or disc prolapse, which will be evident only on an X-ray. The second investigation is usually MRI if we suspect disc prolapse or nerve-related symptoms and a CT scan if there is a bony pathology. Clinical examination has a vital role as at times MRI gives false positive results which are ruled out by the clinician. You have been suffering from lower back pain for the past three years, and my recommendation is to visit your local orthopedic surgeon for clinical evaluation before going for any investigation. Sometimes pathology in the sacroiliac joint (SI) or hip may also give rise to lower back aches, which is also determined by clinical examination before ordering X-rays. At times young males with early morning stiffness of back or lower back pain, on clinical examination, pathology is detected at the SI joint level as sacroiliitis or ankylosing spondylitis which is entirely different from the lower spinal pathology. You do not have any specific symptoms to point towards a provisional diagnosis apart from an aggravation of pain on sneezing, which is present in patients with posterior intervertebral disc prolapse and ankylosing spondylitis. But, if you are reluctant to go to an orthopedic doctor, but can get an x-ray done, then you can follow up with the following reports.

1. X-ray of the lumbosacral spine - anteroposterior and lateral view.
2. X-ray of the pelvis with sacroiliac joint - anteroposterior view and oblique view.
3. HLA B27 testing.
4. MRI might be required later.

Thank you.