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Radiology/Back pain and Diagnosis


QUESTION: Hello.  I have a back injury from 18 months ago.  Though the massive pain of the original injuy had gone and am still permanently in pain and stiff.  It seems I have tried everything.
Diagnosis from MRI says (I have clipped out some parts)

L4/5 level disc degeneration seen with mild right paracentral focal disc protusion.
Small osteophytes in L3-L5 vertebra
Small focal central intervertebral disc protusion at L4/5 level - possibly just contacting bilteral L5 transversing nerves.
L4/5 shows posteriot T2 bright focal signal due to annular rupture.....seen to minimally inden thecal sac without canal stenosis.

My main question is - will I ever recover from this?  I have tried many pain meds, massage, chiro etc etc.  I am exercising through the pain and try to walk 5 times per week.  Some of your posts mention not to exercise and so I am concerned about this.
I cannot sit for any length of time.  The pain (heavy dragging not sharp pain) wakes me in the night and I need to reposition myself.
I would be grateful of your opinion
Kind regards, Helen

ANSWER: Helen,

I am sorry for all the pain and discomfort from the back injury.  Back pain is one of the most complext multifactorial problems that we face in medicine.  One set of MRI findings may cause significant discomfort in one person and have no affect on the other.  By themselves MRI findings don't mean much and it looks like you have only mild findings and your pain and discofort is out of proportion to what we see on the MRI.  The pain may be from muscle spasms, facet joints and not necessarily be related to a small protrusion.  It is a very complex problem that needs to be addressed by several back specialists, one after another.  If you haven't seen a pain doctor (usually anesthesiologist) I would recommend doing so at this time.  They have a slew of tests and procedures to try and figure out where the root of the pain may be.  Sharp pain waking up at night points to perhaps muscles in spasm.  
Also, I don't think I have advised against exercise or for it in my posts - that would be out of my expertise and should be taken into consideration with specific injuries.  How long and to what degree the recovery will take you is very very very difficult to predict over the internet and without a physical exam.  If you have been to one specialist, I would highly encourage you to go and seek a second opinion.

I hope this helps somewhat although I certainly didn't give you any definitive answers to your question.

Michael K

---------- FOLLOW-UP ----------

QUESTION: Thank you Michael, I appreciate your quick response.
I had cortisone injections in both sides for inital pains going down my legs (this is a year ago now).  It did help for a few weeks and then I had to go on a long car journey which put me back to square one.
My most recent treatment was an epidural from a pain specialist, injecting cortisone into the disc under anaesthetic.  This didnt help at all. Both of these were expensive options.
I am thimking of trying prolotherapy but have not been able to get an appointment as yet and I guess it may not be appropriate.
I am worried that this pain has become due to over sensitised nerves or something, muscle memory. I am trying to think positively and keep active, but must admit concerned over a future when I cant even sit down to work.  On the odd occasion I get relief, usual via codeine, I feel sort of free and like the happy girl I used to be (I am 49).
Thank you so much for your response.  Best regards, Helen

Thank you for the follow up.
Back pain is certainly an aweful thing to live with. I hope you get better. If shots don't work then no reason for them.  I would be the last one to advise this but perhaps a visit to a chiropractor (a good one :)  may be useful.  may try physical therapy.   I think it will take a long time to recover but don't give up!!! :)



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Michael K.


Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...


12 year experience in the field of radiology

American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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