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.

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?

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.