Question: What to do with osteoarthritis diagnosis?

A physiatrist diagnosed me as having lumbar radiculopathy, based on his examination, and recommended an MRI which showed:

  1. At L4-L5, mild degenerative changes of disc and marked proliferate degenerative changes of facet joints, associated with minimal degenerative spondylolisthesis of L4onL5.
  2. L5-S1: mild degenerative changes of disc and a small, broad-based midline posterior disc protrusion, mildly encroaching upon the canal and an annular tear.
  3. Also found asymmetric hyertrophic degenerative changes of left facet joint and a small extra-spinal synovial cyst along posterior margin of the left facet joint.

Remainder of intervertebral discs appears maintained and remainder of canal and neural foramina appear free of encroachment and no significant areas of stenosis. The physiatrist concluded that the bulging disc would cause symptoms in my left leg (I have none) and he thought that my main problem is osteoarthritis of the spine.

What in this MRI indicates osteoarthritis? How severe is it? I'm 53, in excellent health, pre-menopausal, exercise regularly and have a BMI of 21. How many of these MRI findings are normal for someone of my age and physical condition?

Note that I have a strong family history of severe osteoarthritis, particularly in postmenopausal women and therefore am quite concerned about being told that I have osteoarthritis that is bad enough to be causing these symptoms in spite of my good health and lifestyle.

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Doctor's Response: Try conservative care for an osteoarthritis diagnosis

Without seeing the MRI scans it is difficult for me to accurately advise you, but it seems as though you were given an accurate diagnosis and counseling in regards to osteoarthritis.

If you have a strong family history of osteoarthritis (OA) it is not surprising that you have some early changes on your scan. You are doing the right things in that the more in shape you are, the healthier your back will be. Concentrate on stretching, especially the hamstring muscles, as this will keep some of the stress off the low back. Otherwise, try to stay as active as possible within your tolerance for the discomfort.

Some people feel chondroitin sulfate or glucosamine sulfate nutritional supplements can help those with OA. Fortunately, significant osteoarthritis and breakdown of a facet joint mainly happens at the L4-L5 level, and does not always significantly affect the other levels.

If it gets bad enough, you would probably be a good candidate for a one level decompression, instrumentation and fusion.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.