MRI results for lumbar spine....thoughts?
 

At L5-S1, disc narrow and dehydrated.
Modic type 2 endplate spinal change (in the two vertebrae).
Left paracentral disc protrusion displacing the transversing left S1 nerve root posteriorly.
Swelling of left S1 nerve root ganglion.

Basically I have a slipped disc of some type (herniated? Protruding? Prolapsed?) and type 2 modic changes. Modic changes are a change in the bone structure of the two vertebrae, replacing healthy bone marrow with infected fluid. There are 3 types, 1 is worst. Treatment is tricky, experimental and confused.

I have to wait now (of course :rolleyes:) to see a spinal specialist, but will see the physio next week. Obviously with the CRPS everything is complicated, so I'd really like any advice or thoughts from those with experience of spine problems themselves, or knowledge of correct treatment protocol I should expect. I've had my share of treatment that turned out to be wrong in the end, and I don't want to risk making this worse now...

The pain is variable. Overall I think it's improved from the early days that got me on the morphine hell-ride in the first place. I'm just taking paracetemol now, because I want to know if I aggravate it, not do more damage by doing any old thing in a drugged out haze. Mornings are worst, mentally and physically, afternoons probably better. Evenings uncomfortable. I struggle to settle down in any position, so I alternate between standing and walking, sitting and lying down. By night I'm knackered and strangely I'm sleeping ok.

Any ideas on stretches, exercises, positions etc would be very welcome. I'm walking as much as I can, which isn't much at any one time lol.

Thanks guys. Hope you're doing ok today.

Bram :grouphug:

Hi Bram! Sorry, but I cannot help in this area. I have three buldging discs in my lower back, but they are not really problemsome for me. I just wanted to say that I am glad you found out what is going on, as much as it sucks it is good to know what you are dealing with. I also hope you can get in with the spine specialist very soon and that he can help you.

Take care,
Nanc
:hug:

Hi Bram, I am sorry you have all these problems and pain. I don't think what I with my back is similar, but I will put my two cents in hoping it may help you. I had an MRI a few weeks ago and they found bulging discs in my lower back. I already have had ddd in my neck and I can barely walk sometimes because of my hips. I was diagnosed with ostepenia about a year go in my right hip after a bone density test and osteoarthritis in my hips and lower back from my MRI. My dr said there was not much they could do except tell me to see a pm dr which if they read all the papers they had me fill out prior they would already know that I see one. My pm NP says to see my rhuematologist so I am at a loss for words with that right now. But I"m straying off topic. Sorry. They also recommended PT which if they read my papers they would see I already have a HEP becaue my insurance cut me off from PT. AGain I"m straying. Maybe try pt but if you have infection I wouldsee someone who can take care of that right away. especially with rsd in the mix. I am praying for you Bram to feel better. You always make me laugh and you are such a good person. I"m probably not helping much but do care and am here if you need a friend. I know it's hard , but try to get some rest. With love. Renee.

Thanks Nanc and Renee :)

Don't worry so much about what you're replying with....just the fact that you've read it and care enough to write something supportive always means so much. And any information and thoughts are useful ;)

Take care both of you, I know you're having a rough time too. No comparisons here...

Bram x

Hey Bram,

I'm so sorry you are suffering from horrible back pain in addition to what CRPS throws at you!

Obviously I am not a doctor but from my experience with my own issues this is what I get out of your MRI. I wanted to ask if this was the all that was written in the 'impression' section at the end of your report?

It looks like you have degenerative disc disease. The disc narrowing and dehydration is a common finding with that as is other findings on your report.

The modic type 2 changes are most likely a result of the acute inflammatory response to the DDD.

The protrusion on the left is most likely leaking the center disc material (nucleus pulposus) out onto your left S1 nerve root causing the swelling/inflammation around that nerve - that would cause pain down your leg in the form of 'radiculopathy'.

As far as what to do - Pool walking would be the best and least painful for you, I would think. I would caution PT until after you see the spine doctor, they would likely write the best PT order for you. Keeping really hydrated is really important for the spine when we are short on fluids our bodies pull it from the least important areas first.. one of those areas is our discs that hold an enormous amount of water and aren't needed to support life. I'm not saying that is the cause of your disc dehydration just mentioning it because it was shared with me along the journey with back pain.

I really hope things calm down without the need for surgical intervention!!

Take care,
Tessa

Oh Bram! I wish I had some helpful suggestions. I'm glad you have some answers and are on track to get the right treatment, even though it is always frustrating to have to wait to see a specialist.

You are doing really well toughing it out with just paracetamol. I think you are absolutely right that you need to feel what is going on so you don't accidentally do any damage. You've got quite enough damage already! Poor thing!

Hang in there!

Kim

Try using an inversion table. I find it to be very relaxing and tension easing...

Oh Bram, how complicated & frustrating for you!!
I know nothing about spine issues sorry! Right now you need a team of very knowledgeable specialists. The only thing I can think of is my P.M. Dr. has me
on Vit. D3 drops and magnesium citrate for bone support. Because I'm developing osteopenia (bone shrinking and contracting in my CRPS hand).
I know you need WAY bigger help than that &
I really want to see you get it! :hug:

Great advice Russell! I had forgot to mention the benefits of decompression therapy - might be something to ask your spine doctor about.

Thanks everyone...:)

I want to see the physios next week anyway and ask what they can do for me, I'll ask about decompression tables etc. I'm not doing any exercises or stretches unless I've double and triple checked that they can't do me more damage....I've been bitten before by well-intentioned physios...

I'm taking a multivitamin at the moment to up my levels of things like vitamin D, magnesium etc, and I'm drinking a lot of fluids - I'm well aware of the hydration issue with discs lol, all this time I'm waiting I've been reading up on discs and health! I'm keeping as healthy a diet as I can, and apart from the odd crappy day like today :rolleyes: I'm overall increasing my activity levels of walking. I'm doing a few careful core exercises like bridges and side leg lifts, clams, pelvic floor exercises, glute squeezes, etc. Looking to increase the amounts gradually...

The paracetemol thing is going ok so far, surprisingly enough. I prefer to know what's going on with my back, and it certainly let's me know if I get it wrong!

Tessa, I've had DDD for at least five years in both my lumbar and cervical spine.

The rest of the report says:

Lower spinal cord appears normal, conus at L1. Upper 4 lumbar motion segments normal. Facet joints look normal, central canal capacious, no sign of central stenosis. No vertebral collapse or marrow infiltrate. Normal retroperitoneal structures. Conclusion: single level degenerative spondylosis at L5-S1 with a left paracentral disc protrusion displacing the swollen left S1 nerve root.

Bram.

Sounds like you are doing a lot just be careful to listen to your body and pull back or eliminate things that aggravate your pain.

lol.. I figured you had DDD for sometime as the changes don't occur overnight ;) What I meant by acute inflammation causing the modic type 2 changes -was that whatever happened that caused this huge increase in pain also created an inflammatory response a normal reaction when our body is injured or sick. You already know this but the left paracentral disc protrusion means that the disc is herniated (and leaking the painful nucleous fluid) protruding to the left side and impeding the normal position of the nerve.

My best guess is that they will try a round of medicated steroid injections along with PT before any other types of treatment.

Is there a pool that you could walk in anywhere near you? That would be so much better than trying to walk on land for now.

Wishing you well
Tessa

Thanks Tessa. I don't have a pool I can walk in nearby with any comfort - its a cold pool and created all sorts of CRPS issues last time I tried it, no chance with the bad back as well... So yet again it's my immune response at work with the modic changes.....do you know if they can heal and repair, or if it's a permanent change? It's hard to tell from the sites I've seen.

Bram.

Bummer about the pool! Perhaps the physio will have an aquatic therapy pool that you could use - crossing fingers.

As far as I understand about the modic changes with DDD is that those changes can occur and actually go back and forth between type 1 and 2 depending on the stage of the inflammatory response. From my understanding and based on what you shared it seems that it is a 'focal' change meaning it is only seen at the level where the disc is protruding. If it was a 'diffuse' finding then those changes would signify something else as the cause and further evaluation. I would guess that the modic change isn't what your doctor will be concerned about as the nerve displacement and clear aggravation is the reason for your pain.

Just in case you are thinking your immune system is behaving poorly in this - it isn't. It is doing exactly what it should be doing by sending the inflammation and triggering pain to warn you that something is wrong. Just like an alarm system.

What day do you see your spine doctor?

I sent you a message quite some time back - I have similar issues. I think my MRI showed worse damage than yours.

Pain meds do not help me, so I do not take them.

I got pneumonia after getting the flu in January and they put me on a burst of steroids, which helped.

I have been doing the very beginning of Tai Chi and Qi Gong and so far, it's going ok…. but, with the RSD, I am going really slowly. After a month, I am still working on the "warm up" exercises.

I still have my legs going numb, tingly, burning painful when I stand for more than a few minutes. I can't sit very well.

I try to walk some for exercise, but it is difficult.

They want me to go to a chiropractor, physical therapy, acupuncture etc…. but I just cannot afford it on SSDI. The two DVDs for Tai Chi and Qi Gong were $20 so I could afford that.

I need to much $$$ spent on eye surgery and dental work right now - can't go to the other things, so am doing the best I can.

I was not able to use a TENS for my RSD, but found it works for the lower back/scoliosis etc. So I got some more of the pads for it and have been using it. Seems to help break up the pain signals.

Hi daylily :) I can't find a message from you sorry - the system must have eaten it...but thank you anyway, I appreciate it all the same!

There are quite a few YouTube vids of the Qi Gong and that kind of thing, mindfulness meditation exercises, etc. I haven't paid for anything so far, lol, bit of a cheapskate, me :rolleyes:

I'm not doing that much yet, I'm only doing a few reps of anything if I feel up to it, which isn't often. No way I'm risking anything at the moment. Just want to get a definitive view of a specialist so I know what to do for the best and what my chances are of getting ay without surgery.... Hate the waiting around.

I'm sorry you've got such horrible spinal issues, back crap really sucks, you don't realise how much it affects things until it goes wrong.... Hope you're having an ok day today. What happened to your back? Hope it's something that can resolve with time or be treated.

Take care, and thanks for posting :grouphug:

Bram.

Bram,

If it gives you any comfort - a dear friend of mine who is 84 years old just went through the surgery that they usually do for this issue, this past Friday. She is doing very well post-op even at her age! She suffers from RSD/CRPS in her arms after going through radiation/chemo for breast cancer over 20 years ago, so there is hope that this could help you even with CRPS/RSD.

I also had similar issues in my cervical spine C3/4 & C6/7 and had a successful operation in 8/2012. I had immediate relief after they opened the nerve holes on both levels and haven't had any further problems since then. My only regret actually was enduring daily pain and headaches for so long before finally agreeing to surgery. I did have good relief from the injections, but they only gave temporary relief as the nerve openings were being closed off by bone spurs from the effects of DDD. The injections did however help the doctor determine if surgery would help so I'm glad I went forward with them even though they caused me great anxiety before hand. The one thing I would caution is to consider getting several opinions before agreeing to any surgical intervention.

:hug:

NOTE: Hey guys, so I didn’t read all the prior responses before posting mine (sorry, running tight on time), so if I’m overlapping I apologize.

Oh wow Bram… Sounds like you’ve got degenerative disc disease :( (me too) and have herniated the disc real good, yikes. That can hurt so bad and take a good bit of time to heal up, only to later have it herniate again. DDD sucks! Our MRI’s sound somewhat similar.

BEFORE I had surgery and we’re talking 24 years before, I would often go see a chiropractor and sometimes that would bring me relief. I will not see one since surgery. I feel like I am too fragile now.

Stretching my knees to my chest, ultimately stretching my back to open the vertebrae sometimes helped. Alternating heat and cold (I know & you know about crps & cold) so now I just soak in heat now.

Often it required doses of pain medications, muscle relaxers, and nsaids. If you can, get a lidoderm 5% (lidocaine generic) patch or Voltaren gel 1% and put on your back, this would be of great help! Now that I know something about these injections, I would definitely recommend you try them for this! PT will help you too.

Rest your back. Be patient, it can take a while (weeks) for this to work itself out. Listen to your back. It will tell you when you’re done doing whatever you’re doing. Then get off it. Like completely off of it. Don’t sit. This only puts a whole lot of pressure on your lower spine. Can you lay on your right or left side? I know lying on my back is not an option for me. I’m likely to never be able to get up. Once your back feels better (could be weeks from now), build your core. Get as much strength in that area of your body as possible. Something I myself wish I had more of.

Ultimately my disc gave way (23 years later) and ruptured. In hindsight what I learned was that there were some options (artificial disc, etc) that after my surgery were not options. Years and scar tissue and now more discs involved, and those are not available to me. Once the disc ruptured, compressing my spine some crazy 75%, it became an emergency and surgery was required/mandatory. Does that mean I would have had surgery before it ruptured, I’m not sure about that, but the reality is that my options changed after it ruptured and I had the discectomy.

Bram, I am really thinking that it may take weeks, but that your back will probably start to feel better soon if you baby it. Take a bit of time and look at treatment options. I think any kind of spinal surgery is risky and the results frankly usually are just not that great, but you have to decide what might be best for you. I really believe this will settle down, rear its head, and rinse, repeat, cycle. <big deep sigh> I’m so sorry hon. It’s just one more thing! :hug:


Something I found I thought you might find interesting.
Modic Changes:
The prevalence of Modic changes among patients with degenerative disk disease (DDD) of the lumbar spine varies between 19% and 59%, with type 1 and 2 changes being the most common and type 3 and mixed-type changes being relatively rare. There is disagreement as to whether Modic type 1 or 2 changes are most prevalent in this patient population. Although several series, including the original study of Modic et al, have shown that type 2 changes are the most frequent and may account for up to 90% of Modic changes, other studies have suggested that type 1 changes may be more common and may constitute up to 68% of Modic changes in these patients. Such differences in the quoted prevalence of Modic changes and the relative frequency of each Modic type are most likely the result of sampling errors and variations among the studied populations. Modic changes are most common at L4-L5 and L5-S1 and are associated with increasing age. These changes usually occur adjacent to degenerated or herniated intervertebral disks.


In their original study, Modic et al analyzed histopathologic sections from 3 patients with type 1 changes and 3 patients with type 2 changes. The authors found that type 1 changes were associated with disruption and fissuring of endplates and formation of a fibrovascular granulation tissue. In contrast, type 2 changes were associated with fatty degeneration of the red marrow and its replacement by yellow marrow. They concluded that type 1 changes correspond to the inflammatory stage of DDD and indicate an ongoing active degenerative process, whereas type 2 changes represent the fatty stage of DDD and are related to a more stable and chronic process. These authors later postulated that type 3 changes represent the sclerotic stage of DDD.

Thank you Vrae! :)

Loads of information there, thanks such a lot... I'm actually sitting up at the moment simply because I get sooooooooo bored lying on my side. I only lie down once my back starts complaining loudly, and then rest and repeat. It's getting old very fast.

I do think it's improving. Slowly. So slowly. Some days are worse than others, but overall there's an improvement. It's been hard to get my head around the realization that now this has happened, I have to be very careful for ever now or it'll a) not heal, b) happen again or c) rupture completely and really give me grief. All excellent reasons to be wary....

I'm doing some core exercises, but hoping to see the physios before I really put the work in, as I want to be sure I'm doing them right. Don't want to risk making it worse...

Thanks again Vrae.

Bram :grouphug:

Hi Bram! I am so sorry to hear you are having these spine issues. I was diagnosed with degenerative disc disease in my thirties and have survived four spine surgeries. The third one is when CRPS came to live with me.
I agree with most everything that has been said by the others so I will try not to repeat. My best piece of advice is to go very cautiously with treatments especially if any doctor proposes surgery. Spine surgery should be the last resort when nerve damage is imminent.
I highly recommend conservative physical therapy, pacing your activity and resting BEFORE the back screams, warm water pool is ideal, NSAIDS if you can tolerate them, keep up with your meditation exercises, short walks. My guess is that you are in a acute phase and it can get better. Then, the challenge will be not to get into another acute phase - physio can help you with core and spinal muscle strenthening to stabilize the spine.
Feel free to private message me and I can share with you more of my personal spine story.
Wishing you wellness ~ Lottie

Hey Bram, I'm not so sure that you should really be doing too many exercises on your core right now. I'm thinking you should let it heal. And you're right about letting the PT guide you to know how to do them correctly.

Don't be too down. It may heal, and you may build up more strength in your core, and get real strong there and not have much trouble again. Try not to borrow trouble hon, it may turn out okay. :hug:

Hey Lottie :) thank you for your input, that's really helpful. I definitely don't want surgery of any kind, so I'll be avoiding it like the proverbial plague...the main reason I've been so frustrated by the delay in seeing the physios is that until I've talked with them, I can't be sure whether the care with my posture (and the ways I'm sitting and standing) is making things better or worse.

Vrae, as I've mentioned before, I'm really not doing many exercises. I'm just doing a few clams, buttock squeezes and abdominal clenches, and my usual pelvic floor. Literally just a few a day. and that's just because I lost so much tone and strength everywhere while I was so ill, and I didn't want to carry on losing that strength completely any longer. Hip, bum and abdominals hold everything together...

I'm ok today, a bit sorer than yesterday, but not bad. Ups and downs I guess. I'm trying to work out when to call things to a halt before they start to hurt, a whole new type of pacing to work out! I still think overall it's improving. And my biggest issue is still finding a position in bed to relax in with my feet up when the crips shouts too loud...if I lie completely flat I can't do anything to pass the time, and then I just end up getting down and frustrated with my own thoughts. My best so far is several pillows arranged behind me on a slant, and a small one in my lumbar curve. I end up lying at about 150 degrees. I move after half an hour anyway.

Thanks everyone for this discussion, it's so helpful every little bit of info and advice you can give me. Hope you guys are doing ok today.

Bram :grouphug:

Just one more quick thought. you mentioned that you were using pillows.. I find it helpful to put one in between my legs if I am laying on my side.

Go you that you're able to do any exercising! Atta girl that your keeping moving as much as you can! I just didn't want to come off sounding like ... now drop and give me 20 :D lol.. My memory sucks too... sorry about that, but I do remember now. :o

Lol Vrae, you do make me chuckle :p

I've been trying to do the pillow between my knees thing when I'm on my side, but I do sometimes forget, and when I'm asleep it doesn't stay there long!!!!

Spoke to physios today and got some pointers and advice. They're happy with what I'm doing and are sending me some info and physio sheets out.... I must be patient. Lol.

Bram x

good job, Bram!

Hi Bram, I hope you start feeling better soon my friend. Try to get as much rest as you can, though I know it's hard with young children around. I remember those days well. You are always in my thoughts and I hope you begin to recover quickly. With much love, Renee.