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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does my lab test report indicate?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Mon, 22 Aug 2016 in Back Pain
Question: What is meant by diffuse annular disc bulge with superimposed left subarticular/foraminal disc protrusion measuring 3-4mm at L1-L2. Left facet arthropathy. Left foraminal narrowing and impingement of left L1 nerve root.
At L2-L3: Same as above with bilateral facet arthropathy. Lateral recess and central canal stenosis.
L3-L4: Decompression laminectomy at this level. Diffuse annular disc bulge w/superimposed central disc protrusion 3-4 mm. Severe bilateral facet arthropathy which worsened since prior study. Moderate left& severe right foraminal narrowing with impingement of exiting right L3Nerve root. Displacement & probable impingement of traversing bilateral L4Nerve roots. AP elongation of thecal sac.
L4-L5: Fixed grade 1 anterolisthesis ofvL4-L5 with pseudo-bulge at 4-5 mm. Hypertrophy of facet joints and moderate bilateral foraminal narrowing. Decompression laminectomy.
L5-S1: Diffuse annulardisc bulge with superimposed central disc protrusion. Enhancing granulation tissue in epidural space. Decompression laminectomy. Significant hypertrophy of facet joints. Worse on right. Impingement of exiting left L5 nerve root. L
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern in front of that long description.

It seems that indeed your spine has undergone advanced degenerative changes. They are present at every level. They are present in the form of facet arthropathy, which is arthritis involving the small joints between the vertebral arcs as well as several disc bulges, displacement of the discs situated between the vertebrae. That can lead to local pain due to inflammation or radicular pain due to compression of nerve roots exiting the spine, compression from the bulging discs or from the inflamed, thickened joints, or from both these factors together.

As I said there are changes at all lumbar spine levels. In terms of noninvasive treatment you can have physical therapy and pain killers. Pain killers may be non-steroid anti-inflammatory medication like Naproxen, Ibuprofen etc , and regular chronic pain treatment like Gabapentin or Pregabalin. I wouldn’t be surprised if you have already tried those. Of course the pain killers only alleviate the symptoms do not reverse the chronic changes.

Whether more invasive action is needed depends on symptoms, since there are changes at several levels it must be identified which are responsible for the symptoms. The nerve roots likely compressed are the left L5, right L3 and left L1 but imaging doesn't always correlate with symptoms so it is significant only when it is confirmed that the symptoms correspond to that compression. For that a detailed description of the symptoms, distribution of pain and sensory changes as well as a neurological physical exam is needed. When not clear nerve conduction studies testing may be done to determine which nerve roots are suffering more. Only after that has been done may other methods like local injections at the more critical sites be tried. I see you have had already surgery, that can be tried as a last resort only after a precise responsible site which can profit from decompression is identified from the above tests.

I remain at your disposal for further questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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