Expert: Dr. Victor Dolan, DC, DACBSP - 1/2/2009

Question
hi,i was dignosed with tuberculosis in psoas muscle,now the reports says- there is a complete resolution of the right psoas abscess and adjoining myofasical edema with minimal asymmetric bulge and internal heterogeneity of the superior fibres of right psoas muscle.
Mild degenerative lumbar spondylotic changes are noted with tiny schmorl nodes at contiguous end plates of d12,L1,L2,L3.Broad based disc protrusion with focal cranially bent central disc extrusion at L3-4 indents the thecal sac and encoaches on the lateral canals without any nerve root impingement.Small Posterior disc protrusion at L4 -5 minmally indents the thecal sac....please suggest what it means and the cure.thank you

Answer
MRI Lumbar Spine


Hello Charu,

Thank you for your question.  I hope you are feeling better now.  I hope your ACTIVE tuberculosis has been treated and eradicated.

That is the first priority. TB can be detected and treated quite efficiently with modern medicine.  In answering your question(s), I will be discussing the orthopedic/ neurologic impact of the spinal changes noted on your MRI.  I am assuming your Tuberculosis has been detected, treated and resolved.

If your TB is not resolved, I refer you to the MEDICAL experts on this board (allexperts.com) for further information.

"""Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs. But, TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can be fatal. TB disease was once the leading cause of death in the United States.

TB is spread through the air from one person to another. The bacteria are put into the air when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected.

However, not everyone infected with TB bacteria becomes sick. People who are not sick have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But, some people with latent TB infection go on to get TB disease.

People with active TB disease can be treated if they seek medical help. Even better, most people with latent TB infection can take medicine so that they will not develop active TB disease.
http://www.cdc.gov/tb/faqs/qa_introduction.htm#Intro1  """

TB is usually a disease of the lungs.  But it can travel anywhere- including muscles and the spine.

You report: '....Mild degenerative lumbar spondylotic changes are noted with tiny schmorl nodes at contiguous end plates of d12,L1,L2,L3.Broad based disc protrusion with focal cranially bent central disc extrusion at L3-4 indents the thecal sac and encoaches on the lateral canals without any nerve root impingement.Small Posterior disc protrusion at L4 -5 minmally indents the thecal sac....',  Again, as long as the ACTIVE infection has been defeated, the above findings can be evaluated from an orthopedic/ neurologic perspective.

'Spondylotic changes'= roughly translates to OsteoArthritic type degeneration of the spine.

'Central disc extrusion at L3-4 indents the thecal sac '= this will probably be your biggest concern.  This disc is taking up enough space to 'pinch' the protective sac around the spinal cord and nerves.
You could experience 'pinched nerves' from this level downward- into your bowels, bladder, sexual organs, lower extremities.

Given this MRI, you could have back pain, lower back pain, sciatic type pain, weakness, tingling, numbness.

These types of findings are often encountered in the Chiropractic office.  I would recommend you ask your friends and neighbors about a good Doctor of Chiropractic in your neighborhood.  The Doctor will take a complete history- be sure to report your prior history, and bring any prior Xrays, MRIs, test, reports to this chiropractor.  The DC will examine you.  AS LONG AS THE TUBERCULOSIS is resolved, chiropractic could be very helpful in your orthopedic/ neurological complaints related to the (now) muscular imbalance in your low back (psoas muscle) and structural changes and alignment.

I think I have suggested what this possibly means.

Suggesting a 'cure'.
         I really do not know of a permanent cure of your MRI findings.  Medicine can give you painkilling drugs and muscle relaxants, it is best to talk to the MD about that approach.  A surgeon may recommend surgery for the extruded disc, surgery can be quite complicated, sometimes successful, sometimes not: a Surgeon would best comment on a possible surgical intervention.

Chriopractic, physical therapy, these disciplines work on Spinal Conditions such as those listed in your MRI.  I believe that when it comes to Spinal Conditions, conservative treatment is safest and most efficient in the hands (pun intended) of the Doctor of Chiropractic.

Your ortho/ neuro condition is very manage-able, not really very cure-able.

#1) See an MD with infectious disease credentials; manage and resolve the active infection of Tuberculosis.

#2) for the orthopedic/ neurologic consequences of the MRI report you cite, see your local Doctor of Chiropractic (DC) for evaluation and possible treatment or referral.

My Staten Island Chiropractic office treats patients with similar MRIs every day.  Most Doctors of Chiropractic will have similar cases.

I utilize informational handouts in my office- this one may help you in understanding cure-able and manage-able:

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     Treatment   Regimen

Why do I need to have treatment __________________ ? ! ??
( TWICE A DAY,  EVERY DAY,  3- 4x/week, 2- 3x/week, 1- 2x/week )     Depending upon your specific condition, your specific case, you may need to be seen many times in a short period.  If your condition is severe, complicated, particularly painful; you may need close, frequent attention.  Similar to medicine, usually the more severe the case the more often medicine is taken with larger doses.  The Doctor of Chiropractic works with hands and therapy in person to accomplish the goal, the MD can treat ‘long distance’ via medicine without actually seeing the patient for treatment.

Why do I need to have treatment for  (weeks,  months,  years!?! )  ?
Again, the Doctor using chiropractic techniques needs to get ‘hands on’ in person.   An MD can treat a patient without actually physically seeing the patient every day through medicine;  i.e.:   “…Here are 60 pills, take one a day every day, and I will see you in two months…”.   The dentist can say- “…here, wear these braces 24 hours a day, 7 days a week, for the next two- three years.  I will see you every two weeks, but I’ll be treating you every day, 7 days a week, 24 hours a day for the next few years…” .

People can wear braces and retainers for YEARS.  It can take YEARS to move the bones (known as teeth) into their proper position.  It can take years and years, and thousands of dollars !  But, those teeth (bones) have to be properly aligned to have a nice smile.  BUT you do not have to keep wearing the brace or retainer, you can take the brace off any time,,,, and let the teeth go back to their misaligned positions (habit).


Take medicine EVERY day.
For the REST of your Life.

Some people with certain conditions have to take a medicine every day, seven days a week, 365 days a year;  “…..for the rest of their life….” .   Sometimes someone can have a damaged heart, lung, liver, kidney, pancreas;   and they have to take a medicine, sometimes a FEW medicines, every day, sometimes for years,  sometimes “…for the rest of their life…” .   Similarly, a damaged neck or back, a damaged spine, a damaged nervous system can sometimes use treatment  “...for the rest of their life…” .

Most people who go to the Doctor of Chiropractic feel a difference in their pain in as little as two or three weeks.  Instead of taking years (like braces and the teeth) to make changes, the dynamic spine can start to feel better very quickly.  To maintain the proper position and movement of the vertebrae (bones) it can take a continued regimen of care (of course not as frequent as the initial schedule, but to maintain gains, maintenance has to be performed).  BUT you do not have to keep up with treatment, you can stop any time you want,,,, and let the vertebrae go back to their misaligned positions (habit).

It is a joke amongst Chiropractors that the DC is a magician-  first Chiropractic makes the pain disappear, and then the patient disappears as well !!,  BUT- pain is the last thing that comes in a problem, and the first thing that disappears under treatment,,,, but the disappearance of pain does NOT mean correction of the underlying health problem.


Dr. Victor E. Dolan,   Doctor of Chiropractic;   Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST  Chief of Chiropractic  in  a  Hospital  in  New York State (DHSI);  As  Seen  in  PREVENTION  Magazine
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I hope this helps.  If you need further information, do not hesitate to re-contact me here at AllExperts.com  
( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm )

The ortho/ neuro findings a common to chiropractic. See your local DC.

Thank You,

Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com       (Email Newsletter)