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I'm a 33 year old male in otherwise good health.

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Posted on Tue, 19 Mar 2019
Question: I'm a 33 year old male in otherwise good health.

For a little over a week, I've had mild dull pain in my lumbar area. On the first day or two, it was significantly more severe, such that bending was exceedingly painful, as was extension of the spine backward.

It has dulled down, but has remained stable for the succeeding week. It is a 3/10 in intensity, and is hard to describe. Perhaps a bit more on the right side. I don't feel any numbness or radiating pain elsewhere. I have been treating with a heating pad.

I cannot remember anything that would have caused an acute injury. I do go to the gym frequently, but did not feel as though I had any particularly painful episode prior to the lumbar pain.

I went to a chiropractor who took several x-rays, which are attached. I don't find chiropractic treatment particularly helpful.

Because I cannot recall any specific cause of injury, and I am not historically prone to having lower back pain, I would like to know the likelihood that there is something more serious than a "mere" musculoskeletal strain/sprain/disc bulge as the cause for the discomfort. Specifically, I would like to rule out tumors on/around the spine/vertebrae that could be causing the pain.

I realize that soft tissue is not readily visible on plain film x-ray, and that MRI would be required for complete visualization of the area. Still, with the available clinical description above and the attached x-rays, I wonder (1) whether there is any visible evidence of a cancerous process causing the pain (there is an attached image with a red circle--I was particularly curious if the circled area is normal spinal structure or if it is some abnormality), (2) whether I would expect the pain to get progressively worse rather than stabilize or improve if a cancerous process were the cause, (3) whether I would also expect to see other neurological symptoms if there were some ominous cause, and finally (4) what the most likely cause of the discomfort is, in light of the above.

Thanks kindly for your time.
doctor
Answered by Dr. Praveen Tayal (28 minutes later)
Brief Answer:
Back muscle spasm likely.

Detailed Answer:
Hello,
Thanks for posting your query.
I have seen the attached X-rays. There is a mild reduction in disc space at the level of L4-L5 but it is not likely to cause any nerve root compression and is likely to be related to a muscle spasm only. This can be related to poor posture also. The red circles area that you have marked is a normal bony variation. It is not suggestive of any cancer.
If it were a cancer then the pain was likely to worsen and there will be no relief with pain killers or oral muscle relaxants. It would have affected nerves also.
Cancer if becomes prominent then affects nerves also and even vertebral bodies are collapsed due to thinning of bone.
The most likely cause in your case is a muscle spasm. You can get oral muscle relaxants prescribed from your orthopedician for relief.
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.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Wishing you good health.
Regards.
Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal (2 hours later)
Thank you very much for your quick response.

Should I be any more concerned that I can still feel mild discomfort toward the lumbar and buttock area when I'm laying down in bed? Is this still consistent with a muscle spasm?

There also seems to be recurrent references around the internet to tumors or lymph nodes affected by lymphoma pressing against the nerves of the spine and causing lower back pain. Might I expect that if a tumor adjacent to the spine were so large to cause this, there would be other symptoms, perhaps systemic (fever, weight loss), as well?

doctor
Answered by Dr. Praveen Tayal (11 hours later)
Brief Answer:
Best to get an MRI scan done.

Detailed Answer:
Hello.
Thanks for writing again.
Mild discomfort is normal in muscle spasm. This can be relieved with oral muscle relaxants.
It is best to get an MRI scan done to rule out all the doubts in your mind. It is not necessary to have other systemic symptoms.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Praveen Tayal (7 hours later)
Dr. Tayal:

Thanks again for your prompt and thorough reply. I had a lumbar MRI performed (w/o contrast).

Obviously, I will await the report of the radiologist. However, for the purposes of my question here, I have attached 4 exemplar images from the MRI. Toward the base of the lumbar spine (I'm not sure how the vertebrae are numbered, and I've been told I have 6 lumbar vertebrae), there appears to be a protrusion of the disc. On these images, does this appear to be a disc herniation? Could that cause the symptoms I've described?

Thanks again for your thoughtfulness and patience.
doctor
Answered by Dr. Praveen Tayal (26 minutes later)
Brief Answer:
Disc protrusion at L4-L5.

Detailed Answer:
I have seen the attached MRI images. There is a mild disc protrusion at the level of L4-L5. This can cause the lower back pain and discomfort that you are having.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12082 Questions

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I'm a 33 year old male in otherwise good health.

Brief Answer: Back muscle spasm likely. Detailed Answer: Hello, Thanks for posting your query. I have seen the attached X-rays. There is a mild reduction in disc space at the level of L4-L5 but it is not likely to cause any nerve root compression and is likely to be related to a muscle spasm only. This can be related to poor posture also. The red circles area that you have marked is a normal bony variation. It is not suggestive of any cancer. If it were a cancer then the pain was likely to worsen and there will be no relief with pain killers or oral muscle relaxants. It would have affected nerves also. Cancer if becomes prominent then affects nerves also and even vertebral bodies are collapsed due to thinning of bone. The most likely cause in your case is a muscle spasm. You can get oral muscle relaxants prescribed from your orthopedician for relief. 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. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal Wishing you good health. Regards. Dr. Praveen Tayal.