Expert: Gerald Anzalone, D.C. - 4/20/2011

Question
hi there,i had back pain problem from last three months.i went to a G.P he said i have muscle spasm and gave me some muscle relaxers but didnt help.I went for a massage and it helped a lot.but after two weeks my back started paining again,the sharp pain goes down in the right hip and under the knees.The GP reffered for a CT LUMBAR SACRAL SPINE TEST.the findings are as below:
1) the lumbar spine is tilted toward the left side,minor arthitic change is present in the L5/S1 FACET JOINTS
2) AT L4-L5 mild to moderate broad based disc bulge.the disc is indenting the anterior part of thecal sac.spinal canal is narrowed at this level due to combination of disc bulge and ligamentum flavum hypertrophy
3) at L5/S1 there is minor broad based disc bulge.it is abutting anterior part of thecal sac and proximal portion of both S1 NERVE roots.end plates osteophytes and intervertebral disc are causing minor narrowing of exit foramina bilaterally.these structures are abutting both L5 nerve roots within their respective exit foramen.
4) spondylotic change is present .

Answer
Hi Kiran,

The CT scan findings you've detailed essentially described degenerative changes of the lumbar spine, which may not be fully amenable to manual therapy.

The most significant findings in the CT report which could be related to radiating leg symptoms are the combination of disc bulging with osteophytes (bone spurs) narrowing the neural foramina (the openings where the spinal nerves exit the spinal column).

Lumbar epidural spinal injections may be a viable alternative to surgery. In this procedure, an anesthesiologist uses local anesthesia to numb the back, and then injects a steroid under fluoroscopy (motion picture x-ray) into the symptomatic area of the spine. This reduces inflammation, which usually is the cause of pain.

The sacroiliac joints (below the spine, in the back of the pelvis, about the area where your back pockets of your pants would be) are also capable of producing pain that radiates into the groin, hip, and leg.

Nerve compression itself (by a disc or arthritic changes of the spine) does not cause pain; it causes loss of sensation and loss of limb function.

I have included two links below explaining in detail lumbar degenerative disease and lumbar epidural spinal injections, which should give you additional information to discuss with your physician to help determine if you might be a candidate for this procedure.

Following steroid injection, it is typically essential to undergo a dedicated back rehabilitation program with a physiotherapist, emphasizing proper body mechanics and ergonomics, and stabilization of the spine and pelvis with specific exercises. Core stabilization (and in particular, strengthening of the abdominal muscles) and increasing the flexibility of the lower limb muscles is critical to preventing low back problems from worsening or returning.

You may always have some degree of low back discomfort due to the degenerative changes in the spine, but I do not see anything in the CT findings you provided which suggests the need for surgery. However, your physician needs to correlate the CT scan findings with your physical condition and examination.

I hope this helps to provide you with additional information regarding your condition.

Lumbar degenerative disease:
http://emedicine.medscape.com/article/309767-overview

Sacroiliac joint pain:
http://emedicine.medscape.com/article/103399-overview

Lumbar epidural spinal injection:
http://emedicine.medscape.com/article/325733-overview