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Done with MRI after bending deeply and feeling severe pain. What are the findings from the report and suggest the treatment?

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General & Family Physician
Practicing since : 2009
Answered : 5129 Questions
I had an mri after bending deeply and feeling severe pain at work. The mri results were as follows: L3-L4 50-75% bilateral foraminal stenosis, L4-L5 bulging disc, as well as hypertrophy of facets and ligamentum flavum causing severe central canal stenosis, nerve roots clustered, 75% or greater bilateral stenosis. And L5-S1 disc bulge with superimposed central and left paracentral tear or disc annulus with facet hypertrophy causing mild to moderate canal stenosis, bilateral foramil stenosis estimated at 50%. I am not savvy on all of this and this is part of a workers comp test result. Can you break this information down for me and give me some idea of the severity and/or treatments for my back, as well as activity reccomendations. Thanks Much, XXXXXXX
Posted Sat, 31 Aug 2013 in Back Pain
Answered by Dr. Chobufo Ditah 1 hour later
Brief Answer:
severe, consider surgery if pains are very severe.

Detailed Answer:
Hi XXXXXXX and thank you so much for this query.

I am rather surprised with these findings observed as you bent severely at work. Bending alone cannot explain these findings but suggests that you had a lot going on either silently or with mild symptoms.

The results in a nut's shell are suggestive of low spinal stenosis contributed to by bulging disc, hypertrophy of facets and ligamentum flavum, etc. The real problem with this is that they tend to compress the spinal cord and nerve roots as they traverse through. This causes back pains which move down the lower limbs following the trajectory of the impinged nerves.

If the symptoms are mild and not disabling, then you may want to try physical therapy for now. However, if they are severe, then considering back surgery to decompress these nerves and relief you of symptoms would be a good option.

I hope this addresses your query fully. If you have any follow up related questions, please address them and I would gladly respond. I wish you well and the best of possible outcomes.
Dr. Ditah, MD.
Above answer was peer-reviewed by
Follow-up: Done with MRI after bending deeply and feeling severe pain. What are the findings from the report and suggest the treatment? 7 hours later
I have had physical therapy for this condition, the more extension of the spine, the more disabling the pain becomes. heat and electrical stimulation seems to work the best, with the least amount of pain afterwards. Should the PT cause me to feel huge amounts of pain several hours later, or are we pressing the PT to aggressively?
Answered by Dr. Chobufo Ditah 8 hours later
Brief Answer:
PT should be progressive and not aggressive

Detailed Answer:
Thank you so much for this follow up.

PT has two main goals. Relieving you of the symptoms and helping you regain your maximum possible range of movement.

Heat and electrical stimulation accomplish relaxation and relief of pain symptoms. They would generally be very welcoming. However, then only have short term benefits and no long term benefits which is to resolve the problem.

Extension, tried to add a gain every day to your current possible range. As such, the already fragile structures are pull apart and provoke pains. However, gentle stretching will cause small discomfort but if you want to achieve a great gain in a day, then the symptoms can be very disabling. This is discomforting in the short run but has long term benefits that warrant their continuation. Your therapist should however know when the limits are attained and not force you into another concerning state. Talk with him or her and let them understand what your thoughts and feelings are. They may not know that is how concerning it is already.

I hope this helps and addresses your query. If you have more questions, feel free to ask me.
I wish you the best of health.
Dr. Ditah, MD
Above answer was peer-reviewed by
Follow-up: Done with MRI after bending deeply and feeling severe pain. What are the findings from the report and suggest the treatment? 3 hours later
It seems that surgery would be an appropriate choice, how are the success rates of this surgery? And being that I am diabetic (insulin dependant) does that affect success rates, or pose higher threats to my spinal health. Thanks again; XXXXXXX
Answered by Dr. Chobufo Ditah 5 hours later
Brief Answer:
Get evaluated by a neurosurgeon

Detailed Answer:

Back surgery is a very complicated procedure. there are no unanimous clear cut guideline as to who need surgery or not. Examining the patient to evaluate on the intensity of the back pain and neurological deficit before surgery and projecting what are the possible gain of surgery is very important. A complete clinical evaluation is warranted and based on this and the prospects of successes, the decision to operate or not is made. As such, success rates are very very variable and are determined on case by case basis. Please, get evaluated by a neurosurgeon.

Possible complications of this surgery include Infection poor wound healing, bleeding, blood clots, injury to blood vessels or nerves in and around the spine.

Diabetes presents another challenge but if the decision to do surgery is reached at, intensification of blood glucose control would greatly reduce the chances of diabetes related complications. Medicine has improved a lot over the years and this is no longer a real threat to surgery especially when planned and adequate control achieved.

Hope this helps. I wish you the very best of outcomes. Feel free to continue the exchange if need be.
Dr. Ditah, MD

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