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Q. My lower back hurts on touch and bending forward. Please interpret my x-ray findings.

Answered by
Dr. Manav Gupta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 10, 2020

Hello doctor,

Since May, I have been suffering from pain on my spine in my lower back. It is located around the T11 vertebrae of the thoracic spine, and it feels sore and tender to touch. It is painful and tender when I bend forward or sit back. I visited a GP and she said that she thinks it is a muscle insertion that causes the pain but she is not sure. She did a neurological examination and all was normal.

Two weeks ago, I visited the GP again who ordered x-ray of the thoracic spine and I also did some blood tests FBS, CRP, ESR, RH factor, anti-CCP antibodies and all came back normal.

The radiology report of the x-ray shows:

There are minor irregularity and a limbus vertebra at the anterior superior endplate of the T10 (most likely) vertebra body.

Further minor sclerosis and iregularity of the anterosuperior corner of the T9, T10, and T11 vertebral bodies. This might indicate some developmental apophysitis and minor degenerative changes.

No acute body injury.

If pain continues MRI of the thoracic spine might be useful.

I am worried a lot as I also suffer from anxiety and panic attacks. I think of the worst and I am scared in case it is something very serious like cancer. (worth to mention that a rheumatologist six months ago told me that there is a possibility I have fibromyalgia as all my investigations were normal but had muscular pains). At the follow up with the GP he told me not to panic and that it may be linked to my fibromyalgia and to wait for a few weeks to see if pain settles. He said that if it was to worry it would have shown in the x-rays and blood tests.

I would like you to advice me as an expert what you think of the above please. I decided to do an MRI scan. I was told that I could wait until next month to have it done.

Dr. Manav Gupta

Orthopedics And Traumatology
#

Hello,

Welcome to icliniq.com.

You must have had injured your intervertebral disc (disc bulge) (disc provides a cushion to the vertebrae) and due to this the nerve gets irritated and hence the pain and reflex muscle spasm. Usually, the pain aggravates on bending forwards and lifting weight. Other reason could be weak, strained muscles and relatively weak bones for which you will have undergo rehab for back strengthening.

The findings on your x-ray are not to be worried about at all. Limbus vertebrae mean that some part of your bone has not ossified. Anterior is almost never symptomatic.

There are a few questions I want you to answer. Is there any radiation of pain to your legs and feet? Is there any numbness or tingling sensation in your legs and feet? Is there any history of trauma or lifting heavyweight? Is there any history of diabetes or hypertension or thyroid issues? Do you have a lot of sitting work in front of a laptop/desk?

It is a good thing that all your tests are normal. So you do not need to worry about it. It will get better soon.

Do not lift heavyweight. Do not strain. Do hot fomentation.

Revert with the info so that I can advise you further.


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Thank you doctor,

Some days there is radiation of pain to the left leg. (In the past, when I visited an orthopedic consultant he told me I had sciatic pain. It lasted for six weeks and then it went. I was prescribed Meloxicam tablets at that time). Pain radiates to left leg today and starts in the evening. No tingling sensation in legs and feet. No history of trauma or lifting heavyweight. No thyroid, diabetes, or hypertension issues.

My shifts are 12 hours and quite often so I spend most of my time at work and when at home I am in front of the laptop. I do have quite a bad posture that has been mentioned to me by the doctor. I do my project work at home and spend hours sitting on the sofa with a laptop on my lap. Do I need to strengthen my core with specific exercises? Thank you for your reassurance that it is not to worry.

I have lost my sleep over this at the moment. I am sitting on the sofa and try to lean on my right side as my left is aching it feels like sciatic pain all the way down and at the back of my leg.

Dr. Manav Gupta

Orthopedics And Traumatology
#

Hello,

Welcome back to icliniq.com.

Well, from the history you have given, it seems to be a disc bulge causing irritation to your nerve, hence the radiation of the pain. Reason for this could be bad posture and strained back muscle, so it is likely that these two things are interlinked. It is a very common problem nowadays and almost everyone recovers, so do not worry about that.

Take anti-inflammatory medication like Naproxen or Ibuprofen or Aceclofenac 100 mg BD for five days (to break the pain cycle). Use Diclofenac based ointment for local massage of the back. Take muscle relaxants like Thiocholchicoside 4 mg BD for five days. Also, add Methylcobalamin 1500 mcg OD for two months.

In case of radiation, you can ask your GP to add Pregabalin 75 mg (causes sedation) for three weeks. I am not sure whether you will be able to get these medicines over counter or your GP can prescribe them to you. Once pain-free/tolerable pain, start with basic back extension exercises. Basic core exercises like planks and straight leg raises.

Do not try to overdo in the beginning. Gradually try increasing the hold time. Try correcting your posture (do not have long sessions where you sit). Get your vitamin D3 levels tested. Gradually you will strengthen your back and you will definitely feel much better. Also, try to keep your bowel movements regular (constipation exaggerates your symptoms).

Revert with the vitamin D3 reports and a follow up after seven days.


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