Herniated Disc Questions and Answers

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A: Hi Marianne, There are a tremendous number of reasons why stenosis occurs and various degrees for each. I do not have any of this info, so it is impossible to advise. If you want to send her MRI, I may be able to provide some thoughts. Best, Sensei Adam Rostocki

Q: My son is 30 years old. He suffers daily and is now almost unable to work as an accountant or karaoke DJ -professions. He has a herniated disc, 1 bulging disc and a pinched nerve in his L3,4,5. He takes 8 to 10 Vicoden daily, sometimes 6-8 zanex was taken 10 somas a day. nothing works. just tried cymbalta and acted like he was crazy. he also has degenerative disc disease. i am afraid I will come home one day and he will be dead from medication now he is 50mg morphine patches. is there anything you can advise? it has been a long 9 years for him, his dad and myself. April

A: Hi April, Well, I write extensively about the dangers of continuing use of meds for pain management. This is always a controversial topic on the site which stirs up lots of mail... Unfortunately, the diagnostic info you have provided for your son does not help me much to comment on his particular case. If you can send his MRI report, that would be great. Otherwise, I might recommend considering alternative means of pain control, such as acupuncture and TENS. Best, Sensei Adam Rostocki

Q: HI, I'm a 40 yr old female. I have been dealing with weakness in my entire left side, than two weeks ago I was standing and went to the ground with pain in my right hip. After 5 MRI's I was diagnosed with a L-4 herniated disk, they said it wasn't real bad but infringing on the nerve. I then had a epidural steroid injection, which has not helped at all. My question is I have been trying to take less Percocet and the last day or so I am so sore everywhere. Not only does my rt hip and leg hurt but my lf arm hurts and I often have a "cold" sensation in both arms with a little tingling. My neck also aches. Can this all be from the disk or possibly something else. I was told the L4 should not effect the arms. I don't have my lower lumbar MRI results just that it is L4-5 herniated Everything else was considered normal for my age. It seems like my other pains or tingling is worse than my actual back. Tracey

A: Hi Tracey, The L4/L5 disc will have absolutely nothing to do with any anatomical level above it, including the arms. Best, Sensei Adam Rostocki

Q: hi, the pain on my lower back started 4 months ago and I did a MRI the result was minor bulging L4-5 disc. insignificant bulging l5-s1 disc in left para center location. Lower facet joint arthrosis, can you please advice me on this. many thanks in advance, Ahmad

A: Hi Ahamd, Please send or type the complete actual report so that I may better understand the extent of the condition. Best, Sensei Adam Rostocki

Q: Hi I have had a herniated disc at L4/L5 for 3 years now and I coach gymnastics. But I recently felt numbness shoot down my left leg and my foot is weak. I was wondering if you had any clues to why this all of a sudden happened and what do you think might of caused this? Thanks Jim

A: Hi Jim, No idea. If the symptoms continue, I advise contacting your doctor for a follow up exam. Best, Sensei Adam Rostocki

Q: I am having slight pain in the right side shoulder back and gone for a MRI (attached). Please Suggest me if i need any Surgery or any other treatment and let me know the severity. Thanks, Jay

A: Hi Jay, The only finding on consequence is nerve root compression, but your symptoms are not consistent with the diagnosis, as C6 is generally the lower arm, not the shoulder. The pain may be related to the disc, but it may not. I advice clinical correlation with a neurologist . Best, Sensei Adam Rostocki

Q: Starting back in 1997 i had chronic lower back pain x-rays never showed anything so no doctors would do anything but tell me to take tylonol. on july 31 i woke up and wasn't able to move it took two hours for me to get out of bed! Sunday i was in so much pain i went to the er thinking i did something to my hip cause that was where most of the pain seemed to be on the fourth of august i was admitted to the hospital i had a ct scan, on 5th more x-rays, on the 6th an MRI. Mind you during all of this i could barely move and couldn't walk sit or anything! the MRI Showed at least 6 herniations in my lower back. I have been suffering now for almost a month. Unable to hardly walk, can only sit for maybe ten min, can't walk more then a few feet, my left butt cheek hurts all the time my left leg gets numb and tingly especially when sitting up,My left foot is totally numb and its gradually working its way up my leg. i can't bend over I can't do steps, i can barely twist to wipe after using the restroom. I'm in constant severe pain unless i am taking Vicoden for the pain every four hours. My concern i have seen an orthopedic surgeon and he wants to wait to see if it will heal on its own my concern is will waiting cause any permanent lasting damage! My daily life is ruined i can't do anything it is all i can do to write this now. My other concern is i have been taking vicoden now every four to five hours since the first of the month, i think that it isn't good to be on it that long but it is the only way i can function. I'm in so much pain all the time what can id do? My mom has to do everything for me as i can't do it on my own, i have to walk with either a walker or cane around my home, i have to use a wheelchair if out anywhere. i'm frustrated with my dr. for not doing anything I'm a big girl and his comment was that he doesn't have an operating table big enough for me and also that i would just herniate another disc if he does surgery, I can't afford to see another doctor, is there anything i can do any help or guidance would be helpful thanks. Stacey

A: Hi Stacey, Please send the MRI report so that I can better understand the extent of your spinal issues. Best, Sensei Adam Rostocki

Q: can you help me to understand these mri scan results slight loss of lumbar lordosis / disc dehydration in lower spine / some loss of disc height L5/S1 broad posterior protrusions L3/4 L4/5 L5/S1 PLEASE, John

A: Hi John, There is not much info provided here, but basically it says that you demonstrate a decreased lower back curvature, have general disc dehydration and 3 herniated discs. Best, Sensei Adam Rostocki

Q: I had MRI last week below is report what should I do? IMPRESSION.Dessication and diffuse disc bulge noted at L4-5 causing thecal sac indentation to compromise of bilateral lateral recess and neural foramina. there is compromise of bilateral traversing l5 nerve roots. >Dessication and left paracentral disc bulge noted at L5-S1 level causing thecal sac indentation on the left side leading to compromise of left lateral recess and neural foramina. there is significant impingement on left traversing S1 nerve root. suggest clinical correlation and follow-up. Hossein

A: Hi Hossein, Please detail the exact locations for your symptoms. Best, Sensei Adam Rostocki

Q: I just came back from deployment, and being having back pain with sciatica that comes and goes. I had an mri done can you tell me what it means, my doc just told me i needed surgery. That really scares me. At L5 S1 there is 2mm of disc protrusion with mild bilateral foraminal narrowing. No canal stenosis is seen. Endplates degenerative changes are seen at L5 S1 and the disc is degenerated. Disc configuration are as described. Spondylitic changes as noted. The Conus is in the expect location. The description these finding assumes a normal count of 5 lumbar type vertebra. what does that mean? thanks....rudi

A: Hi Rudy, I see no significant issues here and certainly none I would consider for surgery. In fact your lumbar spine looks quite typical to me.Basically, you have some arthritic, some disc degeneration ( both normal and universal) as a small herniated disc at the most common location where they occur. Best, Sensei Adam Rostocki

Q: Hello, In April of 2009 I had a Lamenectomy surgery at L5 S1 and removal of a synovial cyst causing stenosis crowding lateral recess nerve roots. Per my surgery notes, the cyst was attached to my L5 nerve root so the rim could not be removed without damage to nerve. The cyst was drained. 01/2009 MRI Impression was: Prominent bilateral Facet Arthropathy at several levels which is prominent at L5 S1. Secondary lateral recess stenosis crowds and slightly displaces the lateral recess nerve roots. Mild foraminal narrowing on both sides. Abnormal signal in the pars and pedicle region of L5 is seen on both side but no distinct fracture noted. Pars defect on the left at L5 cannot be excluded given the degree of sclerosis in that area. 8 weeks after surgey I began to have the same symptoms, although not as intense, as before the surgery. MRI on 07/2009 impression: Prominent bilateral facet arthropathy with joint effusion at L5 S1 on left. Crowding of recess nerve roots is noted. Mild to moderate bilateral foraminal stenosis noted. Round hyperintensity in the lateral aspect of the left foramen abutting the facet joint measuring 6mm by 4mm suspect of synovial cyst exiting the L5 nerve root. My neurosurgeon advised scar tissue was causing my pain and treat with pain management. Pain continues to increase.11/2009 - EMG test conclusive with a left L5 S1 radiculopathy. Pain continues to increase in lower back, left buttock and left leg. Pressure, Tingling, numbness , burning, weakness and swelling in the above areas began in 06/2010.

MRI of 08/2010 impression is: Severe bilateral Facet Hypertrophy. Epidural scar seen along the thecal sac margins. Rim enhancing possible fluid collection dorsal to the thecal sac on the right admist the enhancing scar tissue which could represent cynovial cyst which effaces the right side of the thecal sac crowding the right side thecal sac nerve roots which are displaced leftward. Probable left synovial cyst noted on prior MRI is less evident but there is still a round structure in the same region that could represent an osteophyte or atypical smaller cyst. There is biforaminal stenosis. My pain management doctor says the pain is nothing to worry about and the additional symptoms of pain, pressure, burning, tingling, swellng, discoloration and numbness in my butt, left buttocks and legs are to be expected from scar tissue. Any ideas? Donna

A: Hi Donna, Not really. The surgery seemed to make things worse, which is no surprise to me, particularly for laminectomy. I wish I had a solution for you, but unfortunately, I am rather stumped here. Another surgery may help, may do nothing or may make things worse yet.... I do send my best, Sensei Adam Rostocki

Q: Hello...maybe u can help me with some advice.let me start by saying i am 32 year old female.I have been having pain for awhile and finally got an MRI.I dont really understand the report.I do have a appt with a neurosurgeon next week.But here is what it said: There is reversal of the normal cervical lordosis,centered at C5.There is a small lesion in the C7 vertebra which demonstrates bright T2 signal and slightly low T1 signal of questionable clinical significance.At C3-C4 there is a tiny bulge which effaces the anterior thecal sac but does not deform the cord.There is mild narrowing of the left neural foramen. At C4-C5 there is a small,broad-based disc/osteophyte complex which effaces the anterior thecal sac but does not clearly deform the cord.There is mild narrowing of the neural foramina,left worse than right.AtC5-C6 there is a broad based disc bulge with left paracentral protrusion that indents the central cord.There is moderate narrowing of the left neural foramen. At C6-C7 there is a broad based disc/osteophyte complex with a prominent right paracentral disc protrusion.This indents the right side of the cord and impinges on the right side of the thecal sac.there is mild narrowing of both neural foramina.Spinal cord siganl appears normal throughout.IMPRESSION: Multilevel disc/osteophyte complexes.There is indentation of the cord at C5-C6 and C6-C7,especially C5-C6.However,no cord abnormality is seen.There are varying degrees of foraminal stenoses as detailed above.the disc protrusion at C6-C7 severely impinges on the right side of the spinal canal. So....any thoughts? I am having severe pain in my neck and all the way down my right arm to the wrist.I also have numbness in my right hand.Thank you for any imput.I'm scared for my future. Amy

A: Hi Amy, I really do not see any dire issues here. The herniations which impinge on the spinal cord need to be monitored, but there is no indication that the foraminal stenosis is affecting any nerves. You will need to undergo clinical correlation with the neurologist to see if the structural issues may be causative for the right arm/hand symptoms. Best, Sensei Adam Rostocki

Q: My husband recently had neck surgery on C8-T1 from a bulging disk. His symptoms after surgery are the same as they were before surgery. He had about a weeks worth of relief right after surgery, probably from the medicine. He continues to have pain in the neck area, shooting through the shoulder blade and down the right arm. He feels tingling constantly. He has no control over his pinkie finger and ring finger on his right hand. My questions are:Is this normal after surgery? If yes, how long does it take to recover from the pain itself? Is the immobility of his fingers due to the pinched nerve from the bulging disk? Do the nerves recover from this type of injury or are they considered "dead"? Will he ever be able to have function in his fingers again? Thanks for all your help! Shelley

A: Hi Shelley, I can not answer any of your direct questions, as I have no info on his actual condition. No MRI report, nothing. I can tell you that most surgeries fail immediately or eventually and most are not even needed. If you can provide lots more info, pre and post op, I may be able to tell you lots more. Best, Sensei Adam Rostocki

Q: I injured my low back 10 days ago. I just had an MRI that read, in pertinent part: "At L2-L3 there is right lateral disc extrusion with severe narrowing of the right neuroforamen and likely impinging on the exiting L2 nerve. There is no central canal stenosis or left foraminal narrowing". I have severe pain/parasthesia in my right thigh. It is difficult to stand and walk although sitting is manageable. I am scheduled to see a neurosurgeon but would like to know what you think I should consider for treatment, at least in the near term. Thank you. Mike

A: Hi Mike, Is it the front or rear thigh? Inner, outer or entire? Best, Sensei Adam Rostocki

Follow up: Front of right thigh on the outer portion.

A: Hi Mike, Generally, the L2 is often the inner thigh, but it can be almost the complete front of thigh in some patients. Far lateral herniations can be tricky... I think seeing the surgeon is a good idea. See what they say about the need to address the issue. Time might be just what it needs, but it may warrant surgical intervention at some point. Just know that surgery is NEVER a guaranteed fix and many patients are worse off after. So, be careful... The usual non-surgical methods are virtually useless for extrusions. Best, S.A.R.

Q: Hello I came to your site in hopes of finding a forum of people with degenerative disc disease. Somewhere to talk to others dealing with the same problem. Do you offer that, as I could have just missed how to get there from the entry page on your site. I am about to undergo my second major surgery, and its big. Do you have any suggestions on a good forum/. Angella

A: Hi Angella, Try talking to anyone, since virtually every adult human on this planet has the structural changes called degenerative disc disease. I do not know of any specific forums... Best, Sensei Adam Rostocki

Q: Hi, like many others here I am wondering what my mri results mean in laymans terms. It states; Normal segmentation with a generalized lumbosacral hyperlordosis, a mild lumbar curve to the right, and specific findings as follows: 1. Moderate to advanced L5-S1 disc degeneration with chronic bilateral L5 spondylolysis, a 7 mm spondylolisthesis, and foraminal stenosis, moderately sever on the right and moderate on the left with right L5 neural impingement. 2. Mild spondylosis at multiple levels ath the thoracolumbar junction. 3. No distal cord lesion or intradural mass. 4. No osseous or paraspinous neoplasm or infection. Your help in understanding this is greatly appreciated. Thank you! Dawn

A: Hi Dawn, No problem. In layman's terms: You have arthritic changes at the location where the middle back meets the lower back. You have an exaggerated curvature in the lower back and slight lumbar scoliosis to the right. At L5/S1 there is disc desiccation and vertebral misalignment by a measurement of 7mm. This is narrowing the space through which the nerve roots exit the spine and causing nerve compression on the right L5 nerve root. All these terms are detailed on my sites if you need any additional information. Best, Sensei Adam Rostocki

Q: Hi Adam, i've suffered with sciatica for many years had a laminectomy at the L5-S1 back in 2000. An MRI Scan September 2006 was done with Gadalineum and showed some disc protrusion at L3-4 and L4-5 levels with some indentation on the cord but no significant compression of nerve roots. A Second Scan done 7 months later April 2007 confirms there was a Large diffuse posterior Disc Bulge at L3-4 and an annular tear causing moderately severe stenosis of the canal. At L4-5 there is a diffuse posterior bulge with a high signal consistent with an annular tear with mild to moderate stenosis of the Canal. At L5-S1 there was evidence of a previous right laminectomy with a small right paradiscal protrusion abutting on the L5-S1 nerve root with some loss of fat plane surrounding the nerve roots which are features suggestive of epidural fibrosis in this region. I had surgery December 2007 8 months after second scan and had to beg for this. I was originally informed there was no change between the first and second scan regardless of me telling doctors I had problems holding my urine and deep muscle spasms in both legs that are very painful. This was the reason why I had 2nd Scan. I continue to have these problems. I have been told epidural Fibrosis is the cause of the entire pain from L5-S1 surgery years previous not the Large diffuse posterior Disc Bulge at L3-4. Yet my problems only started after I had hurt my back in the few months between the two scans and it was a totally different pain affecting both legs. What would cause the problems I have holding my urine and deep muscle spasms in both legs if there was no change in the scans. Any information would help. Regards, Mark

A: Hi Mark, In order to really answer your question, I would need to see the original MRI pre-surgery and the 2 since. It seems that you have been poorly managed in the system and I have seen the epidural fibrosis diagnosis used as a scapegoat many times, particularly in cases such as yours when the surgeries have been obvious failures. Of course, there could be issues in the cervical spine which have never even been discovered which could explain all your symptoms as well. Best, Sensei Adam Rostocki

Comment: Progressive wedge compression fracture od T12 with a retropulse fragment demonstrating extension of the fracture to the posteriorbody consistent with a burst type component. There is extension of the fracture into the right pedicle and there also is splaying on T12-L1 facet joints raising the spectre of multi column injury and possible instability. In this regard, the finding may warrant orthopedic review because the potential for thoracic spine instability. The Neurosurgeon recommendation is a Thoracic extension Brace for a T12 80% compression fracture. Karin

A: Hi Karin, Thanks for sending in your comment. Wish you well with treatment and hope you will make a complete recovery. Best, Sensei Adam Rostocki

Q: I have pain in my low back, left buttock, and a little down the left outer thigh. I can't stand or walk for more than about 15 or 20 minutes without pain. My MRI report says "L4-5: There is a structure occupying approximately the left half of the central spinal canal that has both high and low signal with peripherally low rim on STIR imaging. The lesion appears to be extending into the proximal left neural foramen causing moderately severe to severe foraminal narrowing proximally. This lesion has approximate dimensions of 14 mm craniocaudal, 10 mm in maximum width, and 10 mm in maximum AP diameter. On T2 weighted imaging the central portion of this structure is dark with an intermediate signal rim and then a very low signal exterior. The exiting nerve root sleeve is compressed. The traversing nerve root is compressed and all of the thecal sac is displaced toward the right. The lesion is closely contiguous not only to the posterior margin of the disc but also to the medial margin of the facet joint. There is severe hypertrophic degenerative arthritis of both facet joints, left greater than right. There is moderately severe ligamentum flavum hypertrophy. This contributes to concentric narrowing overall of the spinal canal. The right neural foramen is only mildly narrowed due to the combination of hypertrophic facet arthritis and a slight disc bulge in the foramen of about 2 mm. . . .Conclusions . . . Moderate bordering on moderately severe central spinal stenosis at L4-5 apparently secondary to a chronically extruded fragment of disc material in the spinal canal. Given the proximity to a very arthritic facet joint, the differential diagnosis is expanded to include an unusual presentation for synovial cyst, and possibly a meningioma though this last possibility is considered by far the least likely." The orthopedic surgeon says the meningioma is very unlikely. He has recommended epidural steroid injections and physical therapy to start, but says he thinks that, ultimately, he will have to remove the fragment surgically. I really want to avoid surgery if I can. I am thinking of trying prolotherapy and decompression. Do you think non-surgical alternatives could help in this case? Do you think there is any danger in doing decompression here? Thanks so much for any information you can provide. Martin

A: Hi Martin, In your case, from the info provided, I partially agree with the orthopedist. I believe surgery may be the way to go. Physical therapy and injections are a waste of time here, in my opinion. Spinal decompression is not wise when talking about extruded fragments. I think surgical intervention may be the best form of treatment, but that is not to say that it is necessary. If you do decide to go ahead with an operation, make sure they get the entire fragment, as another patient just went through it recently and the outcome was only a bit better structurally than the original condition and no better symptomatically. The fragment remained and was just a hair smaller. What is the point to this??? Best, Sensei Adam Rostocki

Q: Hi Please could you help as im very worried -my MRI STATES: L5 /S1 THERE IS A PROMINENT FOCAL POSTERIOR RIGHT PARACENTRAL DISC EXTRUSION OBLITERATING THE RIGHT LATERAL RECESS & IMPINGING ON THE S1 NERVE ROOT. I AM IN AGONY IS THIS DANGEROUS - DO I NEED SURGERY?? AS I CANNOT HAVE SPINE INJECTIONS UNTIL MY BLOOD DISORDER IMPROVESTHANK YOU, Sonia

A: Hi Sonia, Could you please detail the exact locations of all symptoms? Best, Sensei Adam Rostocki

Q: I had xrays of my right hip and lower spine on 7/27/10 and an MRI on 7/29/10. Previous to the MRI, I was experiencing right hip joint pain and right thigh muscle pain. There were two separate occurrences, 1 week apart and lasting 5 days, of severe, excruciating pain in both thigh muscles and right hip. There seemed to be weakness in my right leg and at times, my right foot would suddenly jump, so as to stabilize myself from falling. I have had no injuries to cause this. Since these episodes, I am having continuing mild pain in my right thighs and occasional pain down my front left leg to my ankle. On two occasions I have had mild, short-lived sciatica, once on the left and once on the right. Below is my MRI results, Please advise. Disk degeneration is present at the L6-S1 level corresponding to plain film findings. Diffuse disk desiccation is present on examination. Anatomic alignnment of the lumbar spine is identified. Ar. L2-L3, there is a left posterolateral herniated nucleus pulposus {HNP) with prominent lateral recess narrowing seen on image number 7 series 3 and image number 27 series ?. There is inferior migration of the disk material at 5 mm along the posterolateral aspect of the vertebral body towards the left at L3 . There is not overall significant central canal narrowing in the anteroposterior (AP) dimension of midline. L4-L5 there is mild bilateral facet degeneration, Broad-based disk bulge at the L5-S1 level is present.IMPRESSION:Left posterior lateral HNP at the L2-13 le-^el with prominent left. lateral recess narrowing. This abuts the left LI nerve root with some displacement. Marlise

A: Hi Marlise, Your symptoms do not at all seem to correlate to the structural findings, which seem to be nothing to fear anyway. I do not think they are related from the info provided. Best, Sensei Adam Rostocki

Q: I was just told today that i have a 6mm bulging disc at l5/l6 facing towards the spinal cord which the Dr says is troublesome. I don't have hardly any pain other than occasional in my lower back hip area. He wants to do the epidural/steroid shot which I am familiar with since I had hip replacement and a few of these for diagnostic purposes. I imagine he is hoping steroid injection will take the swelling down and get the disc to go back in place or better position . My question is......... is a 6mm bulge of a disc in l5/l6 going toward the spinal cord a big worry? or is 6mm a very small bulge and not too worrisome. Sherry

A: Hi Sherry, I would need to see the MRI report to answer this question. Best, Sensei Adam Rostocki

Q: Technique:T1,T2 weighted images-sagittal planes.T2 WEIGHTED IMAGES-AXIAL PLANES.*STATUS POST SURGERY. *FAINT FORWARD SLIP OF L4 OVER L5. *L4-5 DISC HERNIATION IS NOTED WITH THECAL SAC INDENTATION. *MILD D12-L1/L1-2/L2-3 DISC BULGES ARE NOTED. *LINEAR HYPERINTENSITY IS NOTED IN THE CONUS MEDULLA. *PRE&PARA VERTEBRAL SOFT TISSUE SIGNAL INTENSITIES ARE WITH IN NORMAL LIMITS. IMPRESSION:*STATUS POST SURGERY. *L4-5 DISC HERNIATION IS NOTED WITH THECAL SAC INDENTATION. *LINEAR HYPERINTENSITY IS NOTED IN THE CONUS MEDULLA-"CONSISTENT WITH MYELOMALACIA" I FACE ABOVE PROBLEM IN SPINAL CORD 3 YEARS BUT ANY TREATMENTS,I AM NOT ABLE TO WALK WITH OUTSUPPORT ANY BODY, PLEASE HELP ME. Kullai

A: Hi Kullai, The structural issues presented here do not seem serious. The myelomalacia obviously is incredibly serious, but does not seem to be the result of any findings noted here. Did you injure your back when the condition began? The notation says you already had surgery. Was the operation for the myelomalacia or did it cause it? You should be under the care of a spinal neurologist, so I hope that is your present path. Best, Sensei Adam Rostocki

Q: I had a MRI but do not understand the results. It reads, at the L3/4 level there is mild disk space narrowing. Posterior bulging Of the disk is seen with bilateral foraminal encroachment. At the level L5/S1 level there is moderate disk space narrowing. Posterior bulging Of the disk is seen with spondylitic changes and bilateral foraminal encroachment. Is there anything I can do to help my pain in my back? Paolo

A: Hi Paulo, There is no indication from the small amount of data provided that these structural findings are the cause of any symptoms. You have degenerative disc disease and 2 small bulges which are narrowing the space through which the spinal nerves pass, but there is no mention of any nerve compression or even suspected nerve contact. There is also some minor arthritic change. Not really enough info to tell anything more...Best, Sensei Adam Rostocki

Q: I have already undergone two cervical fusions, and I am pretty worried about another. Please help me with these MRI results to see if surgery will be needed, this time in my lower back. Thank you for your help! T12-L1,L1-2,L2-3: Mild disc bulge and facet arthrosis. No associated findings. L3-4: Broad-based right posterolateral disc protrusion is noted resulting in mild mass effect and dorsal displacement of the right L4 traversing nerve root. Mild central canal stenosis. L4-5,L5-S1: Mild lobulated disc bulge, with mild contact with the S1 traversing nerve roots at the L5-S1 level. Mild facet arthrosis. No significant associated findings otherwise noted at these levels. Prominent high-signal intensities are identified within the right renal collecting system, which may represent parapelvic cyst versus hydronephrosis. Renal ultrasound would be valuable for further evaluation. If you could give me your professional opinion on whether or not surgery is a must. There is significant pain in my right SI joint and is present 24/7. Thank you so much for taking the time to help me. Dianne

A: Hi Diane, Is this the only location you have pain? If not, please detail all locations, as specifically as possible. Best, Sensei Adam Rostocki

Q: I have had serious pain in my rear end for about a year now It hurts to sit or lie down but not when I stand. I can't stand the pain and I am going to a chiro that has a spinemed for decompression on Tuesday. I am hoping and praying that this will reduce or eliminate the symptoms because it is driving me nuts. Could this be the cause? Please let me know you have read so many of these and people's symptoms. I am hoping that there is a match somewhere in the past with others experiencing the same thing. The closest thing I can find to explain it is Levator Ani Syndrome or LAS/Rectal Floor Spasms. Desperation for relief is an understatement. I would rather loose an arm then live with this for the rest of my life. I am only 38 years old. MRi report findings: Heights of the lumbar vertebral bodies are maintained The STIR sequence reveals no underlying bone marrow edema. There are generalized degenerative changes of the lumbar discs most marked at l5-S1. The region of the conus medullarius appears normal. There is a small grade I/IV central subligamentous disc protrusion at L5-S1. This is slightly indenting the ventral thecal sac. Small focus of increased signal within the posterior disc at L5-S1 is in keeping with a small radial tear in the posterior annulus. There is no canal stenosis. The perineuronal fat is maintained in the lateral foramen.There is no compression of the dorsal root ganglion. Your input is greatly appreciated.Thank you for your time. Jack

A: Hi Jack, I see no causative structural issues here. As for the other conditions you mention, I see them mostly as expressions of TMS in my own experience. I would consider this possibility if I were in your shoes. Best, Sensei Adam Rostocki

Q: Hello there~ I just had an x-ray on my lower back, & the medical assistant to my PCP called & told me I had a degenerative arthritic joint between my L4 & L5. Didn't she mean that I had DDD? I'm 43 & have had on-again, off-again (usually mild)pain in my lower right back for about 25 years from a tennis injury of overreaching for a shot. I always thought it was a muscle or ligament that got inflamed from time to time because it was on the right side of my back, but according to this x-ray it's a degenerative arthritic joint between my L4 & L5?? I don't know of any joints in my spinal column, & if there are, is this different than DDD? Who knows, maybe this assistant doesn't know the right lingo. Any advice would be greatly appreciated ... Bryan

A: Hi Bryan, Your spine is full of facet joints. These are the "fins" at the rear of the vertebral bodies which actually connect the individual bones together. She may have meant these, but these are typically known by their vertebral numbers, not in between... Referring to space in between vertebrae (L4/L5) a disc nomenclature. I suggest you clarify the issue with her, since she has all the diagnostic info and I have none. I also suggest to you the fact that x-rays are virtually useless for diagnosing any back pain condition and are only truly useful to monitor or measure spinal curvature or vertebral alignment issues. Best, Sensei Adam Rostocki

Q: Hi. I had an injury back in March and after CT I was diagnosed with Bulging annulus at L3-L4 with slight narrowing of spinal canal. L4-L5 bulging annulus with a paracentral disc abutting the dural sac. L5-S1 right sequestered disc displacing the nerve root posteriorly and extending posterioly 7.5 mm. I had sciatic pain down right side and was hospitalized for one week. After taking meds, physio, and acupuncture for several weeks there was not a huge improvement and it had actually spread to the left side. After 18 weeks of this I had surgery, laminectomy and bilateral microdiscectomy on L5-S1. It is now 5 weeks post surgery and I still have mild pain and numbness down back of right leg and into my foot. There is pain in lower back on each side and hip and pain gets moderate to severe in left hip and lower back when walking any distance. The lower back pain on the right side feels to be going out across from right at the top of my L5-S1 discectomy scar. I'm wondering if they should have done another MRI or CT pre surgery and if I need another surgery. I see my surgeon again on the 25th for a checkup but I would like another opinion. Can you explain the pain in these areas please? I am still unstable and weak and wondering why. Jim

A: Hi Jim, Surgery rarely provides a cure, immediately or eventually. Many are worsened by it. This is a constant theme I warn against throughout my site. Most patients acquiesce to an operation out of desperation and misleading hopes for positive results from their practitioners, when the real statistics for recovering from back surgery are grim. I do suggest staying on top of this, so there may be some correctable issue in your case. I hope so. Unfortunately, in so many cases, the surgeon says "everything is fine" and suggests time will make things right. Time passes, the pain worsens, the surgeon stops returning the calls. Hope this is not the case for you. Best, Sensei Adam Rostocki

Q: I was involved in a head-on car accident back in 02-04-10 and lost 15 % of my hearing in my right ear. I have horrible headaches and dizziness, ringing in my ear and pain up and down my head and neck. So I had two MRI's , the first was an MRI Cervical Spine without contract, the second one was an MRI brain with and without contact. Impression; MRI Brain, no significant intracranial abnormality identified on MRI of the brain. Impression ; MRI Cervical Spine, mild to moderate degenerative disc disease and unconvertebral joint hypertrophy resulting in multiple levels of neural foraminal narrowing as described without central canal stenosis. What does that mean and was it cause by my car accident> Thank you for your time and I look forward in hearing from you soon.... Cole

A: Hi Cole, The brain scan was negative and a non-issue. DDD in the cervical spine is universal and part of spinal aging. The arthritic change noted is not due to the accident, as it would not develop that quickly, but the condition may have been exacerbated by the accident. You only included a tiny bit of info here, so it is difficult to draw any useful conclusions. Best, Sensei Adam Rostocki

Q: Hello, I am 41 and I have been having sciatic pain in my right leg for 2.5 months. It started from too much physical work without letting my back recover. I was working full time as a tradesman during the day then working every night and days off building a building for myself. I was doing this for about 2 months. The pain came on gradually and progressed to the point that I am off work now. The pain is mainly in the right buttock, behind the knee, and deep in my ankle making walking very painful. These are the findings from a CT Lumbar Spine: "Degeneratve disc disease is seen at multiple levels, most marked at the L4-5 and L5-1 levels. Some degenerative vertebral endplate change is seen at the L4-5 level. No fracture of listhesis is seen. From the axial images, at the L4-5 level, broad based posterior central disc bulging is seen effacing the anterior theca but no significant thecal compression or focal lumbar radiculopathy is seen at this level. At the L5-S1 level, there is a right paracentral disc protrusion noted measuring 12mm in width and 5mm in depth. This clearly compresses the S1 root in the lateral recess and is the most likely explanation to the patients right sided radiculopathy symptoms. No lateral disc herniation or lateral radiculopathy is seen at any level on either side. Conclusion: DDD is seen at the lower two lumbar levels. The most significant lesion I feel is a right paracentral disc protrusion at the L5-S1 level which clearly compresses the right S1 nerve root in the lateral recess."I had this same problem about 6 yrs ago although not as severe and it eventually worked itself out. The next step is a referral to neurologist. I would appreciate any comments you might have. Trever

A: Hi Trevor, I usually recommend MRI, as it is far superior to CT, but in this case, the report is quite solid. The only issue here is the one noted by the radiologist at L5/S1. As before, time may resolve the complaint without treatment. You might consider non-surgical spinal decompression or surgery. Just be very careful with the latter, since there is a very good chance that it will not provide a permanent fix, or any fix at all for that matter. Best, Sensei Adam Rostocki

Q: At L5-S1 mild disc desiccation and height loss, more at L5-s1. Tiny shallow rt. side posterlateral disc protrusion change. Patent central canal and mild rt. neural foraminal narrowing. L4-L5 there is disc bulge and annular tear @ rt. side. Mild neural foraminal encroachment w/patent central at left neural foramen. I'm having really bad pain in back and leg, my rt foot tingles alot and sometime the rt. leg feels like there's live wires in it. What can be done to help. I am scared of surgery i am only 44 yrs old..Can you help me understand ..Thanks for you time.... Kelli

A: Hi Kelli, Please detail the exact locations of your symptoms, as specifically as possible. Best, Sensei Adam Rostocki

Q: Hi there, My mum have been having this knee pain for a long time. She has been seeing the doctor and they have been telling her that she has osteoarthritis. Recently, i took my mum for a MRI and the results were : The last unfused vertebral body above the promontory is presumed to be the L5 vertebral body. The height and alignment of the lumbar vertebral bodies appear normal. There is normal lumbar lordosis seen. The bone marrow shows normal signal intensity on all the sequences. Intervertebral disc spaces of L3/L4 and L4/L5 are reduced.The L2/L3,L3/L4 and L4/L5 disc show loss of normal high signal intensity on the t2w images. Generalized discs protrusion seen at L2/L3,L3/L4 and L4/L5. They are causing indentation on the thecal sac.No narrowing of the exit foraminas demonstrated. What does this mean?? is her condition bad? who like a clear explanation? Thanks alot, Seetha

A: Hi Seetha, You have the normal signs of degeneration in the lumbar discs and 3 mild herniations. I see no reason to believe that these issues are causative of any symptoms nor requiring any particular form of treatment from the report enclosed. I send my best, Sensei Adam Rostocki

Q: I am having constant pain/burning sensation on my left lower shoulder area. I had an MRI - MRI results Desiccation changes are present. AT the T3-4 level, there is a left paracentral focal disc herniation. This mildly effaces the canal. It come in close proximity to the cord which does appear slightly displaced. AT4-5, there is a small central protrusion of the annulus. At T6-7, there is a minimal disc bluge present. At T7-8, there is a left paracentral disc herniation present. This effaces the canal and comes in close proximity to the cord as well, which appears slightly displaced. At T8-9 level, there is a mild disc protrusion in the central left paracentral region. What does this mean and is there any type of treatment? I am in pain all the time. Thanks for your insight. Caryn

A: Hi Caryn, You have several bulging and herniated discs in the middle back. There is no definitive evidence that these are the source of any symptoms from the report enclosed. I advise clinical correlation with a qualified neurologist. From the small amount of info here, I see no reason to believe that any treatment is needed. Best, Sensei Adam Rostocki

Q: My mri report reads, FINDINGS L1-2 L2-3 no evidence of herniation or canal stenosis. L3-4 mild circumferential disc bulge causing impression on thecal sac without evidence of central canal stenosis. L4-5 there is a focal broad based herniated disc measuring appox. 1 CM, centrally and to the left, causing impression on the thecal sac with moderate spinal canal stenosis, likely impression on exiting L5 nerve root on left at this level. L5-S1 mild circumferential disc bulge causing impression upon thecal sac without evidence of central canal stenosis. IMPRESSION focal herniated disc at L4-5 level, centrally and to the left, causing moderate spinal canal stenosis with likely impression on exiting L5 nerve root on the left at this level. I have seen a neural surgeon, and was told surgery to trim the disc was the best option and that other options probably would not work very well. Is this a good option,. After the surgery, will I be able to do same things as before? I appreciate any input you have and thanks for your time. Bill

A: Hi Bill, The procedure recommended is called a discectomy. It is well detailed on my sites. This is certainly an option for you, but I recommend you read much more about it to understand the many risks, including recurrence of the original herniation and the very real possibility for misdiagnosis of the actual source of pain. I do not now what symptoms you have, so it is difficult to determine the best course of action, but other considerations include conservative care, such as non-surgical spinal decompression or simply allowing time to pass and see what happens. Best, Sensei Adam Rostocki

Q: got my results yesterday from my Mri trying to figure out what everything means 1. disc degeneration L3-4 and L4-5 manifested by loss of disc signal and height and to a lesser extent L5-S1 2. L4-5 there is facet arthrosis resulting in mild anterolisthesis and triangulation of the dural sac neural foramina are patent 3. L3-4 mild facet arthrosis and small disc bulge 4. L5-S1 there is facet arthrosis 5. diffusely diminished T1 marrow signal for age, likely due to red marrow reconversion. Leslie

A: Hi Leslie, You have some disc degeneration, a small bulging disc and some osteoarthritic change in the lumbar spine. You also have a minor shift in typical vertebral alignment. There is no indication of neurological involvement or definitive symptomatic expression. Best, Sensei Adam Rostocki

Comment: More info here than anywhere else. Thanks for the site. Reading your other site now too. Thanks, Kellie

A: Hi Kellie, Thank you for the kind words. Best, Sensei Adam Rostocki

Herniated Disc Q & A Archive