What can I do to address my back issues? MRI results included.

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imhavingissues

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33 years old, 6'1", and 260+ pounRAB. I've had back problems at least once a year for the last few years. The last time was 27 days ago when I was opening up a closet door. I threw out my back and was completely useless for 10+ days. Getting in and out of bed or in an out of a chair was an issue. I took Zanaflex and Relafen for a while and then did 3 days of Prednisone followed by a Medrol Pack. Shortly thereafter I was able to get back into the normal grove of things. However even know my back feels weak and I don't trust it at all. This morning I had a hard time getting out of a chair due to weakness/pain. This hasn't been the case for the last 2 weeks.

Here are the results of an MRI I had back in May -

MRI OF THE LUrabAR SPINE: Images are obtained in the sagittal plane with T1 proton and T2 weighted images. Further, stacked axial T1 images extend from L1 through S1. Angled T2 axial images also are acquired through each lurabar intervertebral disc space.

The T2-weighted sagittal images show decreased signal intensity at the L4 and L5 interspaces. There is mild posterior protrusion of disc at L4, a large posterior protrusion with what appears to be extruded fragment migrating caudad at L5-S1. The conus and cauda equina appear normal.

The axial images show widely patent canal Ll through L3. Nerve roots and neural foramina appear normal.

At L4.5 there is slight posterior convexity of disc but the canal al is widely patent and nerve roots and neural foramina appear normal.

At L5-S1 there is large central protrusion of disc. This shows a high intensity zone within the annulus, typical of annular tear. The extruded fragment has migrated almost 1 cm or more caudad along the posterior margin of S1. It mainly remains near midline but extenRAB a little to the left and it does contact the S1 root and displace it posteriorly and laterally. This is on the left. The right lateral recess and both neural foramina are unremarkable.

IMPRESSION: Disc degeneration at L4. At L5 there is disc degeneration with a posterocentral annular tear and herniation with extruded fragment. The large extruded fragment is almost a cm in transverse diameter and extenRAB for over a cm cephalocaudad extent. It is in full contact with and displaces the S1 root on the left.​


What exercises should I be looking into for lower back straightening to mitigate future issues/episodes?
 
imhavingissues,

Based on what is said here, you need to see a spine surgeon ASAP! You have an extruded fragment which basically means part of the inside of your L5-S1 disc has blown out and is now touching and pinching your S1 nerve root. The spine surgeon will review your symptoms, MRI, and other information and determine if you need surgery and how quickly. My guess is that you will likely need to have at least a discectomy, possibly a fusion, at L5-S1 to remove the disc fragment and possible fuse the L5-S1 level. It's possible for this disc fragment to move around and possibly pinch your nerve worse than it is now which could lead to temporary or permanent nerve damage. I'm surprised you weren't referred to a spine surgeon back in May when you had this MRI. You really need to talk to one ASAP!

Talk to your primary care doc, explain how severe your symptoms currently are, and ask to get into a spine surgeon ASAP. If your severe pain continues, just go to the ER as you may need surgery soon and you don't want to have permanent nerve damage.

Let us know how things turn out for you. Take care!
 
The MRI was from back in May. This new episode happened shortly after Christmas. Between June and Noveraber, I had zero pain and was able to do everything as normal. My issue is the 2-4 weeks after I mess it up. Once recovered, I have always been ok when it comes to activities and pain. However, it seems this time it's taking a bit longer to recover.

Its happen about 6 or 7 times since 2003...
 
Just because you have been able to recover fairly quickly in previous times you have had similar pain issues doesn't mean it will happen this time. The extruded piece may be jammed in a way it can no longer move now. You may have a large enough spinal canal that in the past you still had enough room for your nerves plus the floating piece based on the location of the floating piece. I still strongly suggest you see a spine surgeon ASAP to prevent nerve damage. Just because you see a spine surgeon doesn't mean you need spine surgery - however, they can help determine if you are in danger of nerve damage if you don't have surgery, and they can give you the best physical therapy exercises to do if they think you can avoid surgery.
 
I agree with the previous poster. I think it important to see either an orthopedic spine specialist or a neurosurgeon who specializes in spinal issues. You have a fragment of a blown disc that is severely affecting the nerve at L5-S1. There really aren't any exercises that will do much good; in fact, if you aren't careful, it could make matters worse.

Seeing this kind of dr. doesn't automatically mean you will have to have surgery. It does mean that you will be seeing someone who is well trained in reading MRI's, and is able to give you the options that will be helpful. If this dr. recommenRAB surgery, then get a second opinion so that you can be sure in your own mind that it is the best thing to do.

Please let us know how you are doing.

Carol
 
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