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Having back pain. Walking hurts. Report shows bulging disc with tiny annular tear and mild ligament flavum. Suggest?

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Orthopaedic Surgeon
Practicing since : 1994
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Need help have an mri and need a spine specialist to decipher the radiologist report and why I continue to have back pain and want to know if its permanent damage. I am scared and I can walk sometimes it hurts and sometimes its doesn't. Im a 26 year old male that got hurt bending over 600 times and picking 20 pound brakes from a pile and twisting and turning and stacking them. I have the report. Please answer if your familiar with this type of injury (l5s1) bulging disc with tiny annular tear. mild ligament flavum etc.

the lumbar spine is in anatomic alignment. vertebral body heights are maintained. Theconus terminates at the t12 level and is grossly normal in signal intensity and morphology. Bone marrow is within normal limits.
l12:patent central canal neural foramina
L5s1:Chronic disc desiccation changes with anular disc bulging, slightly worse to the right with mild imprinting on the lateral root and lateral aspect of the right traversing nerve. Mild ligamentous hypertrophy noted with mild facet arthropath. There is a tiny annular tear at the midline withour significant canal stenosis.

L5s1 disc disease with a tiny focal annular tear at the midline. No significant central canal stenosis. There is mild annular disc bulging that is more focal to the right posterolateral aspect, resulting in minimal imprinting of the right traversing root laterally.
Remaining lumbar disc levels appear intact.
No acute bony abnormalities. Alignment is anatomic.

I have pain when I get up from the floor where I sleep to an upright position. Is this naturally going to go away? Is this a herniated disc? Is a tiny anular tear a big deal? At the midline? Mild ligamentous hypertrophy is this permanent? My butt always feels sore when walking like I did squats but not glutes but lowback/top of but area, or sacrum area you can call it. I think its not muslcles but its the nerves.

Posted Sat, 12 Oct 2013 in Back Pain
Answered by Dr. Praveen Tayal 26 minutes later
Brief Answer:
These are minor changes and improve on treatment

Detailed Answer:
Thanks for posting your query.
Let me explain the report to you. There is a vertebral disc between each vertebra, it acts as a shock absorber, it is composed of two parts, the outer part called the annulos fibosis (your report mentioned a tear in the annular ring at the midline) and the inner aspect , that is normally fully surronded by the annulus, called the nucleus pulposus.
Because the lower back has more motion than the thorax and carries all the weight of the torso, it is more commonly injured.
The lower disc L4-L5 and L5 to S1 take the most strain and are more likely to herniate. Due to the mild tear, there is mild disc bulging with minimal compression of the nerve roots that are causing you the symptoms.

There is no narrowing of the space between L5 and S1 which is usually due to degeneration of the disc.

Treatment of such mild cases is conservative (pain medication, steroid injections, physiotherapy and muscle relaxants). This is gradually likely to improve in 4-6 weeks with proper treatment.
The disc herniation in your case is minimal and is not a big deal. The changes can be reversed with proper treatment.

I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: Having back pain. Walking hurts. Report shows bulging disc with tiny annular tear and mild ligament flavum. Suggest? 6 minutes later
Its been 7 months. I rehabbed conservatively by walking everyday on the track for the first 3 months. The first 2 weeks was the worst. Then I had an indian (I am indian by the way) massage lady come over to my house and rub I think my piriformis and straighten my spine somehow (don't remember). I thought it would go away but its been 7 months. Just got my mri last week if that helps. So a tiny annular tear, not that bad huh? And ligamentous flavum that is mild is that like really bad?

I self diagnosed myself so many times before I got the mri from piriformis to psoas problems etc. Stretching made it worse for obvious reasons because I just found out of the bulge.

Please give me a some advise, I help others by volunteering my time and I need this back problem fixed. Can you give me statistics on my injury as far as recovery percent, will I be able to run again without a severe pain in my buttocks?

Took iboprufen for 1 week straight about a month ago, did not feel any pain, but I don't know if that was due to inflammation reduction or pain signal blockage. I don't think it would help discs or ligaments from bulging/inflammation. After I got off, it came back. Also, I noticed after my injury, my knees make clicking noises and when laying on my back and if I raise my right let straight up, it makes a noise, like a guitar noise. From your experience, do you know why?
Answered by Dr. Praveen Tayal 13 minutes later
Brief Answer:
You need to consult a neurosurgeon for treatment.

Detailed Answer:
Thanks for writing again.
The hypertrophy of ligamentum flavum is also a minor change after the unusual stress to your back.
The following measures will help with the pain
• Lie on a hard bed.
• Anti -inflammatory drugs like Tablet Motrin 1 tablet as and when required ( dont repeat a dose before 6 hours) with food.
• Avoid forward bending.
• Correct your posture while sitting
• Avoid prolonged sitting
• Avoid strenuous activity & lifting heavy weights.
• Apply diclofenac gel on the affected area. Warm compresses will also help.
Get some muscle relaxants prescribed from your orthopedician.
In case all the above treatments do not help you much then consider getting an epidural steroid injections for relief.
The recovery in such cases is usually complete in almost 70% cases. Some patients may need a surgical treatment if the symptoms are severe.
Hope my answer is helpful.
If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health.
Above answer was peer-reviewed by
Follow-up: Having back pain. Walking hurts. Report shows bulging disc with tiny annular tear and mild ligament flavum. Suggest? 9 minutes later
My sypmtoms are not severe. Steroid injections, I don't know if that is more of a pain management thing but I don't need any pain management because I can handle hit. Is this a herniated disc? How do herniated/bulging discs go back in place? I don't know, its depressing to the point you almost want to cry because your legs are almost useless.

How about ice? And its been 7 months, is that normal?

Also, I had muscle spasms in my butt and right ribcage, but now appear gone for the time being.

Why is there so much popping noises in my knees? Like my body is misaligned or hips misaligned now. Has this disc problem caused other issues like these also? How?
Answered by Dr. Praveen Tayal 19 minutes later
Brief Answer:
Steroids decrease the inflammation.

Detailed Answer:
Steroid injections will decrease the inflammation in the area and muscle relaxants will decrease the bulging disc ( herniated disc) thus allowing the annular tear to heal. Adequate rest will speed up the healing. Warm compresses will hasten the healing rather than the cold compresses.
Muscle spasms will also be relieved by muscle relaxants.
The popping noise in the knees is not related to the back injury. This can happen due to a decrease in joint lubricants. Proper supplements will help in decreasing the symptoms.
Do keep me updated regarding your progress.
Take care.
Above answer was peer-reviewed by
Follow-up: Having back pain. Walking hurts. Report shows bulging disc with tiny annular tear and mild ligament flavum. Suggest? 2 minutes later
I have a feeling that your right and you hit the hammer on the head. I will keep you posted tomorrow, Im taking tylenol and going to bed. Good night.
Answered by Dr. Praveen Tayal 11 minutes later
Brief Answer:
Will wait for the updates.

Detailed Answer:
I wish my suggestions will help with your early recovery.
Good night.
Above answer was peer-reviewed by
Follow-up: Having back pain. Walking hurts. Report shows bulging disc with tiny annular tear and mild ligament flavum. Suggest? 45 hours later
Took tylenol 1 in morning and night last 2 days, when I take it and subsequent time (lasts about 12 hrs) I feel no pain. So I havent felt pain since last 2 days or any spasms in the buttock/low back area. Should I keep this up for a month? Will my body gain a tolerance to tylenol? Should I switch up to iboprufen every now and then?
Answered by Dr. Praveen Tayal 18 hours later
Brief Answer:
No need to switch to ibuprofen if pain is not ther

Detailed Answer:
It is good that your symptoms are relieved with tylenol. It is mildest pain killer and very safe. Tolerance is not likely to develop even on a long term use. You can continue with this schedule.
Bets regards.
Above answer was peer-reviewed by
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