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My lower back pain diagnosis

dodgegirl89ddodgegirl89 Posts: 17
edited 06/11/2012 - 7:36 AM in Lower Back Pain
I have just been diagnosed with the following. I am hoping to get some answers or direction on what i should do next.

Xray Findings:
5 views of the lumbar spine show spondylolysis at L5. there is no spondylolisthesis. the disk heights are well maintained.

MRI Findings:
On the sagittal images, the conus ends at the appropriate level. There is no evidence for vertebral body fractures. There is no evidence for significant disk desiccation.

On the Axial images at the L1-2, L2-3, and L3-4, there is no evidence for central canal stenosis, neuroforaminal stenosis, or herniated disk.

On the axial images at L4-5, there is a small central protruding disk with a minimal annular tear suspected within it. there is no evidence for significant central canal stenosis, neuroforaminal stenosis, or herniated disk.

On the axial images at L5-S1, there is no evidence for central canl stenosis, neuroforaminal stenosis, or herniated disk. there os suggestion for a pars defect at the L5-S1 level, which would probably be best evaluated with plain film. DJD at pars defect extend into the central canal and does effect the dorsolateral aspect of the thecal sac. Edema seen at pars defect. No significant spondylolisthesis is identified.

Impression: The most significant finding is at the L5S1 level as described above. There may be a pars defect, but no evidence for herniated disks. Ct or plain film correlation to evaluate the possible pars defect would be helpful if clinically warranted.

CT Findings:
Notes bilateral pars interarticularis defects at the L5 level which have not changed. No acute fractures of the vertebral nodes are demonstrated. there is minimal narrowing of the L3-L4 and L4-L5 intervertebral disk space. there is mild physiologic narrowing of L5-S1 intervertebral disk space. there is no intervertebral disk protrusion at any of the scan levels. the neural foramina are not abnormally narrowed. there is slight hypertrophic degenerative arthritis of the facet joints at the L4-L5 and L5-S1 levels. there is a Schmorl's node inferiorly at the L1 level. The visualized paravertebral soft tissues appear normal.

Conclusion: Stable appearance of the lumbar spine CT scan since 9/29/07 again showing bilateral pars interarticularis defects at the L5 level and mild hypertrophic degenerative arthritis of the facet joints a L4-L5 and L5-S1. No intervertebral disk protrusion is demonstrated on this study but as noted on the previous study if there is clinical suspicion of nerve root impingement, an MRI study is more sensitive.

Any suggestions would be great. Im not even sure what some of this stuff means. Im in between doctors and am waiting to get a pain management specialist approved by the State (This is an on-the-job injury)
Thank you in advance!!!!


  • I'm not an expert but it seems like most of the findings are pretty benign, except for the possible pars defect. I believe a doctor's main question would be, how much pain are you in? Is this something that can be treated conservatively, i.e. through physical therapy, acupuncture etc.?
    Lawyers etc. often push people with on-the-job injuries to surgery because there's more money in it. Please make sure you've exhausted all conservative remedies before you consider surgery. That's just my own non-expert thinking here, so don't take it as medical advice.
    Best of luck,
  • Thanks! Im hoping my pain management specialist will give me some insite on what can be done
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  • It is kind of interesting in that each report indicates that more information might be gleaned by having another imaging test...and when all put together, there really isn't any significant conclusion.

    The most significant finding would be the pars defect, but as noted, the X-ray indicates there is no evidence of spondylolisthesis. This is when one disc slides over the top of the disc beneath it....It frequently results in spinal instability and the only real correction for it is a fusion surgery.

    However, your X-ray indicates there is spondylolysis. Note these two words are very similar but there is an important technical difference. Read the definition here: http://www.spine-health.com/glossary/s/spondylolysis and here:

    Were you a diver or gymnast in your teens?

    The spondylolysis often causes lower back pain. Often it will be treated conservatively, without the need for surgery. Your reports indicate that there are no bulging discs...no stenosis is noted in either the central spinal canal or in the foramina, which are the "openings" that the spinal nerves use to pass from the spine out into the body.

    There is tons of good information on the Spine Health website. There is a glossary where you can look up any of the terms in your test reports that you are unfamiliar with. It will benefit you to learn as much as you can about your particular problems so you can talk with the doctor and be an active participant in your treatment.
  • Thanks so much! Im in so much pain right now. im hoping to get some answers from my doctor and by looking more on this site. I ride and train horses as a hobby and profession. I have had to abandon that since my injury in April though.
  • I have pain from my annular tear as well as arthropy(arthritis) at lower lumber spine also and received facet joint injections and meds for that that helped a little with the pain. There's lots of info here as well as on www.chirogeek.com. Best wishes for your upcoming Dr. appointment. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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  • Thanks Charry. Im hoping i can get some kind of answers. wether it be here or my doctor or a combination of the two
  • are extremely painful. I have tears at several levels and had one surgically removed (lack of an easier explanation). Arthritis of the facet joints is also very painful for some folks. A Pain Mnagement Specialist sounds like a good idea since they can and will do more testing to find out exactly where your pain is coming from. Good luck to you and please keep us posted.
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