Meds and PT are indicated for arthritis and herniated disks
Dear Dr. Roach: Iam44 years old and female. Nine mont hsago,Isuddenly experienced severe low backache without any associated physical activities. Iw as bedridden for five days, though during that time I experienced severe spasmodic lower backache jus tinmyb ack.Mybowel and bladder function were normal. I had pain on lifting my right leg. With treatment, including a musclerelax a nt,analgesicand physiotherapy, I was painless within five to six days. Seven months after my first pain attack, I again experienced simila rpai n while I wastry i ngtotakeastepin staircase. I had no history of trauma or severe physical activity. It has already been 15 days ,a nd I still feel discomfort and feeling of pressure in my back. But was able to walk after three days with the same medication I took previously.
IMy MRI rep ortsays
“focal central disk protrusion with posterior annular tear at L4 L5 level without any neural or spinal canal stenosis.” I also have tuft of hair at my sacrum area. What is my diagnosis and treatment? Am I suffering from spina bifida? I feel as if I have slipped vertebrae in mybackwithe ach attempt to bend. Still now, I cannot bend my body. — R.K.
Dear R.K.: After going over your entire MRI report, let’s first review the problem with your disk. The intervertebral disks act as shock absorbers and spacers between the bones of the b ack.Thes pacing allows then erve roots the room they need to come off of the spinal cord. These disks consist of a gelatinous c enter, the nucleus pulposus, which is held in place by the tough annulus fibrosis .Aher niate dd i sk( sometimes still called a “slipped disk,” which is a misnome r) is wh en the center part pushes out through a tear in the annulus fibrosis. Sometimes, the disk material presses on the spinal cord or on the nerve root, causing pain, numbness or weaknes s i nt he areas supplied by that nerve. Youhaveaherniateddisk, although the disk mate- rial was not pressing on the cord or nerves at the time of the MRI.
Ther e porta lso found multiple areas o f degeneration and bony abnormalities ,andt hese ar econsi stent with the diagnosis of osteoarthritis of the spine.
As for your question of spina bifida, that is a whole spectrum of conditions involving abnormal development of the “neural tube,” parts of which will become the spine, and which sometimes involves skin and other structures. Incomplet efo rms of spina bifida are called “closed spina l dysraphisms,” and some of these might not be diagnosed until late in life. A tuft of hair at the sacrum, the base of th e spine, is a clue that this might be going on. However, there is no evidence on your MRI of a neural tube defect.
Y ouhavesympt oms that are a combination of both herniated disk and spine arthritis. Medicines and physical therapy are the right treatment. Surgery is occasionally necessary, but I see no need for it in your case.