Please help me to understand CT lumbar results

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sadbhoy

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I'm new on here so hi to everyone, I hope this is not a stereotypical annoying question, but my back health is pertinent to my employment.

For the past 10 months I have been struggling with lower back pain. I can bend forward fine, it's areal problem however when I try to go the other way.
If I move certain ways I get what is like an electic shock in my back which sometimes knocks me to my knees,I also get pain when I sneeze.
I am very stiff getting out of bed.
Today I went for a CT scan to get things rolling.

Here are the results of my scan:

L4-5 mild broad based posterior disc protrusion.
The posterocentral region of the disc is relatively hypodense suspected annular fissure.

L5-S1 Intervertebral disc height is significantly reduced, small broad based posterior osteophyte bar.
The L5 exit foramina are moderately narrowed due to loss of disc height and and the osteophytes.

Conclusion: There is evidence of disc degeneration and a small broad based protrusion at L4-5,with possibility of annular fissure.
Moderate stenoses of both L5 exit formania, mainly due to loss of L5-S1 disc height and endplate osteophytis lipping.

Any help in understanding this terminology and possible treatment would be much apprciated, I'm a 38 year old male.

Thank you.
 
L4-5 It says that the disc between these vertebra has moved out of place, which can cause a lot of pain, though I'm not quite sure about the "hypodense". With the "annular fissure", I assume it means it is less dense than it should be and that they suspect that the disc teared and the internal fluid-like part partially seeped out, also causing a lot of pain.
L5-S1 This says that the disc between these vertebra has lost height. Lost height means the bones are closer together which means more pain. It also says you have a bone spur (I believe that is what the osteophyte is referring to) , which cause pain as well and are usually not seen until moderate to sever arthritis, though I can't tell which because I do not know the osteophytes severity or the severity of the disc degeneration...It also says that the disc degeneration and osteophytes are causing a narrowing, I believe, of the nerves that protrude from the spine (another great pain causer).

Osteophyte lipping probably means that your L5 (and maybe your S1) have started adding on extra bone. This actually looks pretty cool when you see it on the bone itself, but it can cause extreme pain. If I could hazard a guess, I would assume you are probably nearing or in the severe arthritis stage.

Hope that helps!
 
Hi, sadbhoy, and welcome to the forum. I think you need to make an appt with either an Orthopedic Spine Specialist or a neurosurgeon who specializes in the spine. That doesn't mean you have to have surgery, but it does mean you would be under the care of a professional who is best equipped to diagnose your test results and offer you treatment plans best suited to you.

It does appear that you have nerves impinged at the L5-S1 area of your spine caused by osteophytes (bone spurs). Also, you may have a tear in your L4-5 disc. The gel inside the disc may be leaking out which is irritating to the nerves. I'm not comfortable saying much more than that about the MRI results.

You should try to get at least 2 opinions and 3 is better, especially if surgery is indicated by the lst dr. you see. I know things are different in Australia, tho, so I don't know if that is an option.

Please feel free to ask more questions as there are some very knowledgable people on this board.

Best wishes,

Carol
 
Newbie,

Thank you for your reply.

I have had blood tests done for arthritus but with a negative result.

The specialist will no doubt want me to have an MRI done, I'm terrified that this condition will put an end to my life in the emergency service.
 
Also, you might want to ask for a flexion/extension X-ray. There is a condition called spondylolisthesis where one vertebra slides over the top of the adjoining vertebra. It is an instability that is most common at the L5-S1 segment, followed by the L4-5 segment. It is not unusual to find it in someone who has done a lot of gymnastics, diving or any activity where the back is extended, or arching backward. When you mentioned your back hurting when you bend backwarRAB, it made me wonder if possibly you have this slippage.

A spondylolisthesis can result in nerve compression, with pain running down the leg and sometimes into the foot.

Several conditions mentioned in the "Conclusion," point to nerve compression -- there are several things that resulting in narrowing of a passage that neeRAB to be open for the nerve to move freely --

To get an accurate understanding of your radiology report, you will want to see a spinal specialist. He/she can help you understand your issues and can come up with an appropriate plan of treatment.
 
As you know, we are not trained physicians, and as "lay" merabers of a forum, are simply sharing our impression of your radiology report. So keep that in mind. For an accurate reading your doctor is the guy!! However, I know we are all curious to know what's in our reports and it is hard to wait until that appointment.

The other poster has given you a good idea of the issues. Generally speaking, there are several things that are leading to a narrowing of passages that need to be open for the spinal nerves to pass freely. Due to arthritic changes that cause the openings (foramina) to become more narrow, the spinal nerves end up being compressed. This can result in the sciatic type pain that radiates out from the lower lurabar area down into the hip, leg and even foot.

Obviously I don't have any idea what your functional capabilities are, but from the report, it looks to me like your ability to work will be determined by your level of pain. It doesn't look like there is anything in the report that indicates a mechanical problem that would keep you from working...but, again, I'm NO DOCTOR and am just speculating....I hope you will be able to soon see a spinal specialist who can answer all your questions and provide some treatment options that will hopefully resolve your pain.
 
I have these bone spurs (osteophytes) in my back as well. How common are they? And, how much pain do they cause? Sadbhoy seems a little too young for bone spurs, doesn't he? I'm much older...janiee
 
Thank you very much Tetonteri and Maltlover, I have been referred to a back specialits here in Australia but as I don't have health care cover it will be on the public system and that will take a couple of months.
I work in one of the emergency services and I need a strong back, this has me really worried.

Thank you both again for your time and help, I really appreciate it.
 
Bone spurs in and of themselves do not necessarily cause pain. They are an indication that there is some degeneration in the spine. They are fairly common in anyone over a "certain" age, like most writers seem to focus on over age 60...but it is certainly possible for them to form any time the conditions are right.

They can form as a result of poor posture and body mechanics; poor nutrition; trauma and/or sports-related injuries and motor vehicle accidents and it can also be something the patient is born with or inherited.

Just like in any arthritic condition in the joints, ligaments loosen and there is excess movement in a particular joint. The body's response to this is to lay down more collagen in an attempt to tighten up those ligaments, thicken them so they will hold the bones together. Eventually this thickened material begins to calcify. With more time, these thickened, calcified areas turn into bone and you end up with osteophytes. When this happens in the foramina and in the central spinal canal the patient can end up with stenosis...which causes the compression of one or more spinal nerve roots and results in the pain we feel running down from the back out into one or more lirabs.

Osteophytes are actually small round lumps that are the body's attempt to make a "stopper" to keep the degenerating joint from moving too far. They sound like they should be jagged but are in fact very smooth.

This process can begin at any time...but generally is a very slow process that most people do not notice until later in life. However, the events mentioned above can speed up the process causing it to happen much earlier.
 
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