[JJ32]

I've had lower back pain for years. Done chiropractic care, physical therapy, I have a tens unit at home I used to use. I have a pretty high pain tolerance and I think I'm just sick of it. My 11year old daughter has to help me put my pants on in the mornings cause the pain is so bad upon waking I can't even lift my legs, nor bend at my waist. I decided enough was enough and made an appt with my family doctor and figured I'd start there. He ordered an MRI after I told him I've done other therapy for years. My family doc sent me this report this morning.

L5/S1 central disc protrusion/extrusion, decreased intervertebral space height and mild bilateral facet disease resulting in moderate bilateral foramina narrowing and mild to moderate central canal stenosis.

Diffuse increase T1 and T2 signal of the L5 vertebral body that can be associated to hemangioma versus focal fat.

Modic type ll degenerative changes at the superior end plate of S1.

He then writes: this seems like the cause of your pain, lets try physical therapy.

My pain is often debilitating, going down my legs. My left foot has started hurting in the outer middle part the past few days, I can't stand for long periods of time, my bladder seems to not want to work properly lately and I can't even tell you the last time I have laid on my stomach as it causes paralyzing pain. Des it seem this MRI report would account for all of my pain? And is it reasonable to give physical therapy another shot with the MRI results?

Thank you so much in advance of any help.

[Rabid Weasel]

Unfortunately most family doctors just are not knowledgeable about anything greater than the most general of medical conditions. That's not a disparaging remark about PCPs, just the fact of life. The human body is a complex machine that is often difficult for a specialist to navigate, not to mention to a doctor who mainly gives flu shots and fixes sprained ankles.

I would highly suggest to have him/her refer you to a neurosurgeon for a second opinion. I'm quite surprised that he didn't do that right off the bat if you were having problems with your bladder.

Obviously I am not a doctor, but a few of you symptoms coincide with what I had gone through. That is, a part of your spinal cord is being "pinched". That is nothing to take lightly.

[Leesa]

Hi ~ I'll explain all this below. Well, you have a herniation along with the fact that the vertebra are too close together (degenerative disc disease), and you have facet disease (possibly osteoarthritis) which results in moderate foraminal narrowing and mild to moderate spinal canal narrowing. Then you have the hemangioma at L5.. The increase signal, I'm not understanding.

Ok with degenerative disk disease the disks dry out and flatten, and sometimes bulge & herniate. This allows the vertebra to 'sink down' and in fact you become shorter. I used to be 5'4" and how I'm about 5'2'. The foramen are the holes that the nerves pass thru to get to the spinal cord. These holes are getting narrow due to decreased disc space and due to facet disease. The Hemangioma is a BENIGN tumor of blood vessels that typically occur as purplish/reddish elevated area of tissue.

PLEASE DO NOT see a Chiropractor anymore!!! i've been told by 3 total Neurosurgeons that spinal patients should NEVER go to Chiropractors unless they want to be paralyzed. And that's exactly what they said. I know there's probably professional jealousy or something, but they explained that Chiropractors dont have the extended training in the Central Nervous System that Neurosurgeons have. They said that too many people go to Chiropractors before they even know what's wrong with them, and they could easily end up paralyzed! it makes sense to me. And I must admit that once I was desperate, and I went to a Chiro -- and he promptly broke my STERNUM. Boy was that painful -- try to breathe with a broken sternum!!

Anyway -- You need to see a Neurosurgeon for an opinion. And after you've seen one, you should see 2 more. Then whatever the 3 of them said, do what the MAJORITY advises. And please let us know what happens, will you? I'd appreciate it. God bless and please take care. Hugs, Lee

[Dubious]

Originally Posted by Leesa

Hi ~ I'll explain all this below. Well, you have a herniation along with the fact that the vertebra are too close together (degenerative disc disease), and you have facet disease (possibly osteoarthritis) which results in moderate foraminal narrowing and mild to moderate spinal canal narrowing. Then you have the hemangioma at L5.. The increase signal, I'm not understanding.

Ok with degenerative disk disease the disks dry out and flatten, and sometimes bulge & herniate. This allows the vertebra to 'sink down' and in fact you become shorter. I used to be 5'4" and how I'm about 5'2'. The foramen are the holes that the nerves pass thru to get to the spinal cord. These holes are getting narrow due to decreased disc space and due to facet disease. The Hemangioma is a BENIGN tumor of blood vessels that typically occur as purplish/reddish elevated area of tissue.

PLEASE DO NOT see a Chiropractor anymore!!! i've been told by 3 total Neurosurgeons that spinal patients should NEVER go to Chiropractors unless they want to be paralyzed. And that's exactly what they said. I know there's probably professional jealousy or something, but they explained that Chiropractors dont have the extended training in the Central Nervous System that Neurosurgeons have. They said that too many people go to Chiropractors before they even know what's wrong with them, and they could easily end up paralyzed! it makes sense to me. And I must admit that once I was desperate, and I went to a Chiro -- and he promptly broke my STERNUM. Boy was that painful -- try to breathe with a broken sternum!!

Anyway -- You need to see a Neurosurgeon for an opinion. And after you've seen one, you should see 2 more. Then whatever the 3 of them said, do what the MAJORITY advises. And please let us know what happens, will you? I'd appreciate it. God bless and please take care. Hugs, Lee

Hi Leesa,

I am sorry you had such a bad experience. I should preface this by saying I was chiropractor, board-certified in orthopedics, before (ironically) a neurosurgeon and orthopedic surgeon ruined me with their surgeries. I have lost everything now; my business and my health. I am disabled because of them and would have been far better off and still working had I never listened to them and persued their surgical advice.

In an ironic way though, for the 25 years that I practiced as a specialist, in part because of the non-invasive qualities of chiropractic, I received endless referrals from orthopedists, GP's, neurologists and yes...neurosurgeons! Shocking, I know. In fact, one of the neurosurgeons whom I adored, his father had been a chiropractor and he defended me every time one of his colleagues had a disparaging remark. So I guess I have to thank you every time I see your post bent on destroying chiropractic at the urging of your neurosurgeon, because without the medical doctors referring to and trusting me over the decades (including the neurosurgeons), I never would have made it!

[JJ32]

Thank you all so much and thank you Leesa for breaking it down in simple terms for me.
I'm still waiting to hear from my doctor after I left a message yesterday and am hoping to get a few opinions.

As far as Chiropractic care goes, that was the only thing that has ever given me relief for many years, however that is no longer the case as I'm assuming my condition has gotten worse. I also got mixed reviews from Doctors about going, some supported it, some turned their noses to it. To each their own I suppose. Now that I have nerves involved I've chosen to take another path.
I'd like to resolve or improve my condition as naturally as possible, I have 3 small children and taking meds or being out for surgery is not ideal.
J

[mg neck prob]

Hi Dubious,


Wow so intresting you were a chiropractor for 25 yrs and talk about irony that you became neck patient got bad results from fusion. I hear exactly what your saying but its so true that alot of these spinal surgeons put out warnings about chiropractors . To be honest my surgeon did too ---I asked why---- his simple response is most chiro like to do adjustements crack the neck and spine which can cause more damage to a prob spine--he said the spine is not meant to be cracked or adjusted. I have friends and family that love there chiro and swear about the treatments they recvd great benefits. To your point were not medical experts ---and I think guilty of just expressing what surgeons have told us. To your point this is not a fair assesment at all. ...going forward it will make me more mind full not to express this as well based on my surgeons oppinion.

[Leesa]

Hey Dubious -- I'm sorry -- I didn't know you were a Chiropractor at one time. I just knew that you knew alot about spines. Now I'm embarrassed! LOL But all I had to go by was what 3 Neurosurgeons told me, plus the fact that I got my sternum broken. Now I'll grant you that I got ahold of a rotten Chiro that broke my sternum, and all he offered me was a free visit as compensation. LOL What a guy. I should have pursued it, but I didn't.

Anyway -- will you grant me this? That too many people go to Chiropractors BEFORE they know what is wrong with them? Don't you think they should find out first thru MRI what is wrong before being manipulated, etc.?? Cause many Chiros WILL manipulate without benefit of MRI films. Your thoughts?

[Dubious]

Originally Posted by Leesa

Hey Dubious -- I'm sorry -- I didn't know you were a Chiropractor at one time. I just knew that you knew alot about spines. Now I'm embarrassed! LOL But all I had to go by was what 3 Neurosurgeons told me, plus the fact that I got my sternum broken. Now I'll grant you that I got ahold of a rotten Chiro that broke my sternum, and all he offered me was a free visit as compensation. LOL What a guy. I should have pursued it, but I didn't.

Anyway -- will you grant me this? That too many people go to Chiropractors BEFORE they know what is wrong with them? Don't you think they should find out first thru MRI what is wrong before being manipulated, etc.?? Cause many Chiros WILL manipulate without benefit of MRI films. Your thoughts?

No worries. My thoughts?

Since you asked, no not everyone needs an MRI. What I will say is that while I would have loved to have had an MRI on everyone (and everyone always wanted one) it would not be beneficial as most cases of back pain do not involve emergent problems, disc injuries or neurologic compromise, so there would be an extra $1500 expense (which ordered at the wrong time would not be reimbursed) that doesn't change the course of care at the end of the day. And then there are false positives of course which cost the patient needless money and scares the hell out of them to boot.

As I have maintained before, a skilled physician, whether it be an orthopedist, neurologist, neurosurgeon, chiropractic orthopedist or neurologist, a well thought out history needs to be taken, a thoughtfull examination performed, probably x-rays (bone integrity issues are important for chiropractors and there is a list of reasons for when to acquire such) and if there are no red flags, then a short course of care implemented. This is not an all-inclusive list, by the way. There are excptions to everything and I was always supportive of co-management with medical speciaist whom I worked with.

Reasons for early MRI and/or medical referral would involve suspected infection, tumor, bone weakening disease, metabolic disease, significant neurological compromise (which should have some suspicion from a good history and exam) for which any or all of these may represent a reason not to manipulate a given patient and scoot them along to some one else. Another reason would be a patient who has embarked on a short course of care (2-4 weeks) and either not improved or worsened. There are always exceptions to the above but this is instructive for most cases.

Finally, studies have been done on the education, training and clinical decision making of chiropactors, and in reviewing the few that I have read, as far as diagnostic accumen is concerned a general chiropractor is about as good as or slightly better than a GP when it comes to understanding musculoskeletal conditions. And a chiropractic specialist (board certified orthopedist, neurologist, radiologist) are almost as proficient as and in some cases equal to thier medical specialist counterparts.

[Leesa]

Thanks Dubious. I stand corrected.