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Thread: CT results - How serious is this??

  1. #1

    Question CT results - How serious is this??

    Hi, I am 27 and I have had at least 6 years of back pain, ranging from discomfort to being imobilized and unable to stand upright. My brother has several problems with his back picked up by a scan, so when it flared up last week I got booked in for a CT scan earlier this week. These were the results:
    the L5/S1 disc is mildly narrowed. Further mild disc space narrowing an end plate irregularity above L2 suggests past Scheuermann Disease. No vertical compression or lysis defect or evidence of sacroilitis is apparent. Mild osteoarthritis is noted in the L5/S1 facet joint, L4/5 facets bilaterally, the right L3/4 facet.
    Soft tissue windows demonstrate small broad based central dorsal disc protrusions at L4/5 and L5/S1. The former mildly indents the anterior margin of the thecal sac. The latter is associated with slight deformity on the exiting right S1 nerve root.
    Conclusions: mild facetal osteoarthritis with small dorsal disc protrusions at L4/5, L5/S1.
    The Dr (a GP) focused mainly on what I can't do anymore: run, impact or jarring sports, lift anything over 2 kg. Said when the pains gone to walk, find a pilates class that will take me with my back problems (could be difficult apparently), do back strengthenig exercises and go to a physiotherapist. She said I would have been born with some of these problems and they've just gotten worse over time. She implied it's going to keep getting worse, and said I would need back surgery one day. She also said back surgery could/should only be done twice in your life time so it's best to push it off as long as possible.
    I've looked up a lot of the rest of it and I think I understand what most of it means, but what I don't know is how serious this actually is?? Is it serious now or just in the future?? The restrictions the Dr gave, plus the future back surgery make it sound quite serious, but when I read it, it all says "mild" or "slight", so that makes it sound not so serious....
    I don't know how serious it is, how serious it's likely to get, or how quickly it could get worse. Is there anyway of telling this?
    I also didn't ask what the back surgery would be likely to entail? Any ideas??
    Should I see any other specialists about this, besides the physio? Is that needed now or not really? If I should see someone else besides the GP and the physio, who should that be, and what would they be able to do for me?
    Right now I'm managing the pain ok with antiinflams and tramal, but I would really like to have a clearer idea about how serious this is and what to expect in the future.

  2. #2
    I'm just the village idiot, but I'd try to talk to a specialist and see about an MRI.

  3. #3
    Helen27,

    At least 85% of adults suffer from back pain before age 50. Some 15-20% of adults have at least one episode of back pain per year. The onset of back pain is most frequent between the ages of 30-50 years. In terms of lifestyle, smokers have back pain more frequently than non-smokers, particularly in young adults who start smoking in their adolescence. Obesity is a major risk factor.

    The most common cause is age-related degenerative disc disease. The first stage is pain. The second stage is the presence of disc degeneration, disc herniations, and spinal stenosis. The third stage include increasing stiffness, bony degeneration, and often the "failed spine syndrome" resulting from multiple surgeries.

    The treatment should be conservative, relying mostly on physical therapy and anti-inflammatory treatments, surgery to remove herniated discs that are pressing on spinal cord or roots, and avoidance of fusions that would limit flexibility of the spine. Exercise, good posture, and protection of the spine help slow the progress of the disease.

    If you have major risk factors, i.e. smoking and obesity, you should stop smoking and lose weight. Actually, it would be a gift of sorts if you are a smoker and overweight because this means that you can do something about the back pain. If you are not a smoker and not overweight, there may be other genetic causes but there is not much you can do about them.

    One word of caution. Because you are young and of the age to have children, limit the number of lumbosacral x-rays that you get. Don't get them just to see what is going on unless some kind of therapy is being planned. You don't want to expose your internal organs to so much radiation unless absolutely necessary.

    Your doctor is correct about the limited number of surgeries that you can have to fix problems and it is best to push off the surgery as long as possible, unless of course you have neurological loss associated with a herniated disc pressing on your spinal cord and spinal roots. In that case, a discetomy without fusion would be preferred, done before the neurological loss becomes permanent.

    Wise.









    Quote Originally Posted by Helen27 View Post
    Hi, I am 27 and I have had at least 6 years of back pain, ranging from discomfort to being imobilized and unable to stand upright. My brother has several problems with his back picked up by a scan, so when it flared up last week I got booked in for a CT scan earlier this week. These were the results:
    the L5/S1 disc is mildly narrowed. Further mild disc space narrowing an end plate irregularity above L2 suggests past Scheuermann Disease. No vertical compression or lysis defect or evidence of sacroilitis is apparent. Mild osteoarthritis is noted in the L5/S1 facet joint, L4/5 facets bilaterally, the right L3/4 facet.
    Soft tissue windows demonstrate small broad based central dorsal disc protrusions at L4/5 and L5/S1. The former mildly indents the anterior margin of the thecal sac. The latter is associated with slight deformity on the exiting right S1 nerve root.
    Conclusions: mild facetal osteoarthritis with small dorsal disc protrusions at L4/5, L5/S1.
    The Dr (a GP) focused mainly on what I can't do anymore: run, impact or jarring sports, lift anything over 2 kg. Said when the pains gone to walk, find a pilates class that will take me with my back problems (could be difficult apparently), do back strengthenig exercises and go to a physiotherapist. She said I would have been born with some of these problems and they've just gotten worse over time. She implied it's going to keep getting worse, and said I would need back surgery one day. She also said back surgery could/should only be done twice in your life time so it's best to push it off as long as possible.
    I've looked up a lot of the rest of it and I think I understand what most of it means, but what I don't know is how serious this actually is?? Is it serious now or just in the future?? The restrictions the Dr gave, plus the future back surgery make it sound quite serious, but when I read it, it all says "mild" or "slight", so that makes it sound not so serious....
    I don't know how serious it is, how serious it's likely to get, or how quickly it could get worse. Is there anyway of telling this?
    I also didn't ask what the back surgery would be likely to entail? Any ideas??
    Should I see any other specialists about this, besides the physio? Is that needed now or not really? If I should see someone else besides the GP and the physio, who should that be, and what would they be able to do for me?
    Right now I'm managing the pain ok with antiinflams and tramal, but I would really like to have a clearer idea about how serious this is and what to expect in the future.

  4. #4

    Any more info?

    Thank you for the info.
    I've looked up moat of thing things, and understand them, but what I'm really still unsure about, and would like to get a better idea of, is the long term prognosis. Is there anyway of telling how quickly it could progress? My brother had his back scanned about 11 yrs ago, and he had disc wearing, but nothing else. Now only 11 yrs later he has severe osteoarthritis, bulsging discs, completely missing discs, etc etc etc. Some fairly similar things I'm seeing as a mild case for me. Since I've been told it will get worse, will it likely also progress this quickly? In these years he did put on a lot of weight, how quickly can that speed things up, if at all? He was told he could very well be in a wheelchair by 50, is this a possible outcome for me based on my results, or is it impossible to tell?
    What about having children, how easy will carrying them be with my back, which normally gets sore at the best of times? Will having kids make my back worse long term?
    Just wondering....

  5. #5
    Howdy Helen,
    It is difficult to determine your prognosis - it is like predicting the future. It is based on your genetic propensity for spondyloarthritis like your brother. Not much you can do about your genetics except possibly curse your parents.

    Then there are the things you can do to promote good spinal health. Foremost is not gaining weight. Maintain a really low BMI. Then develop a strong core musculature which will protect your spine - discuss this with a knowledgeable trainer how to do this. Next it depends how you use your spine in the next 10 years. Will you be doing lifting /carrying items weighing 50 lbs ? That will hurt your back and accelerate the destructive process.
    Kids - it could get worse and be uncomfortable but it is not going to be a major decision breaker for having or not have one. So you will find out. But keep your weight down.
    After having a kid, you will have to be careful with lifting as they start to weigh more and it may not be wise to lift them once they are 30 lbs.

    I hope this information helps. I would concur with Dr. Wise about delaying surgery until one of 2 things happen, you are losing neurologic function or the quality of your life and need for increasing strong pain management worsens to a point that the risks of the surgery are worth taking compared to the alternative.

  6. #6
    Quote Originally Posted by Helen27 View Post
    Thank you for the info.
    I've looked up moat of thing things, and understand them, but what I'm really still unsure about, and would like to get a better idea of, is the long term prognosis. Is there anyway of telling how quickly it could progress? My brother had his back scanned about 11 yrs ago, and he had disc wearing, but nothing else. Now only 11 yrs later he has severe osteoarthritis, bulsging discs, completely missing discs, etc etc etc. Some fairly similar things I'm seeing as a mild case for me. Since I've been told it will get worse, will it likely also progress this quickly? In these years he did put on a lot of weight, how quickly can that speed things up, if at all? He was told he could very well be in a wheelchair by 50, is this a possible outcome for me based on my results, or is it impossible to tell?
    What about having children, how easy will carrying them be with my back, which normally gets sore at the best of times? Will having kids make my back worse long term?
    Just wondering....
    Helen,

    Your brother needs to lose weight. If he is a smoker, he must stop now. The rapidity of his spinal degeneration at such a young age suggests a genetic predisposition for spinal degeneration. He needs to protect his spine as much as possible. The above is all common sense.

    The fact your brother is going through this suggests that you need to protect your spine as much as possible now. As Arndog pointed out, strengthening your core is important and doing the correct exercises is important. Avoid exercise that increase your back pain.

    I find that swimming is the best way to exercise to lose weight while protecting your back. As I pointed out earlier, this is a "gift" to you because you can do something about it now before your spine deteriorates further. You have 60 or more years ahead of you with your spine. Protect it.

    Having pregnancies is stressful to the back. Most women I know have back pain during their pregnancies. On the other hand, pregnancies also have remarkable effects on women. The hormones and stem cells coursing through your body during pregnancy may help.

    So, if I were you, I would not avoid pregnancy but I would reduce my body weight, increase my core strength, and adopt a lifestyle that would maximally protect my spine for the decades to come. The more you do now, the better you will be when you get older.

    Wise.

  7. #7
    Unortunately it's my brother whose over weight, not me, if I loose more than 5kg I will Start to get all the "u look too skinny" comments - weird it's considered rude and hurtful to say your too fat, but ppl seem to think it's fine to say your too skinny. Anyway, so my brothers weight isn't really a gift to me.....
    But I get your point, I need to make sure my weight STAYS down, which can be hard in my family... I love swimming, so that's a good exercise for me I guess.
    It very hard to find the time to really work out tho, I run my own business (a childrens indoor play centre), which keeps me busy 6-7 days a week... But at least it also keeps me on my feet running around, sure that's mch better than a desk job, although there is a little bit of lifting, bending, carrying and reaching.
    I'll just have to try to build into my routine something for my back everyday day, any suggetions on a convenient way to build back strengthening exercises into a busy lifestyle?

  8. #8
    Helen

    In my lame way I was just about to make a few amateurish comments, and then realized that Dr. Young and Arndog had taken the trouble to write some really wisdom filled comments. I think you should read and reread them, so you don't miss the content that is in them. Then read them again until you have it all more or less memorized.

    Your life can be rendered miserable if you do not follow their advice. One cannot tell how fast a body will age or deteriorate, but no matter the rate, it will seem to have come on pretty fast when it happens. We cannot tell how long our teeth will hold out, but we can brush and floss and watch the sweets and starches.

    No matter what your occupation, your health comes first and deserves the first priority. Loading on your lower back is worse when sitting. I recommend you never sit in a wood or metal chair. When the chair was designed, the average male weighed 65 pounds. The heavier bodies today pay a price for the hard chairs they sit in. I have seen measurements on cadavers with strain gauges and it is really quite impressive how much more loading the disc takes when sitting. I have yet to see a person from the islands where people squat with feet inward who develops a lower back problem. If they move to modern civilization they get back pains just like everyone else. Use a recliner and pay the money to get a very good cushion for the times you have to sit in a chair. You may even go as far as a Rojo (every expensive) or you may purchase some VERY GOOD quality foam and make a cover yourself by sewing. Even so, avoid sitting, squatting is actually better for your back with feet in if you can manage it (most cannot unless raised to assume the position). Get a bed with the cushion effect which feels good for your back, and hope your genetics can see you through. Also be extremely cautious about high impact activity. Invest in very well padded shoes, particularly for exercise. Sorbothane heels for dress shoes and a full foot pad for casual shoes is the best I have seen. Your doctor may know something better.

    Wise's advice probably cannot be improved upon, so mainly read and reread it. It would cost you hundreds to get that in a doctor's office.

    Re: pregnancy. While swimming is a good exercise with low impact, during pregnancy it has been shown to cause extra weight gain. This is called the phocine effect. In pregnancy, the body does its best to maintain homeostatic conditions. Humans apparently have a little like the seal, when we immerse our bodies in colder water, we lay down fat under the skin to avoid "cold shock". On the other hand, hot tubs are harmful to the baby. Water above a 104 is particularly dangerous. So swim, but take precautions to avoid cold shock. Even a wet suit can be helpful.
    Last edited by dejerine; 02-27-2012 at 03:26 AM.

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