Lumbar Spinal Stenosis Case Study

MRI of the lumbar spine obtained on 05/19/15 revealed at L2-3, endplate osteophyte formation and disc bulge contribute to a mild degree of spinal canal stenosis and a mild degree of bilateral neural foraminal compromise. At L3-4, a disc bulge eccentric leftward and endplate osteophytes formation are responsible for a mild degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a moderate degree of left neural foraminal encroachment. At L4-5, there is a diffuse disc bulge and endplate osteophyte formation which effaces the ventral aspects of the thecal sac and are responsible for a moderate-to-severe degree of spinal canal stenosis, a mild degree of right neural foraminal encroachment, and a severe degree of left neural foraminal encroachment. At L5-S1, a shallow disc bulge and endplate osteophyte formation contribute to a mild degree of left neural foraminal encroachment, without compromise of the spinal

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11/13/14 MRI of the lumbar spine showed 4mm left paracentral and foraminal disc protrusion at L4-5, which mildly impinges upon the thecal sac and the proximal left L5 nerve root. The disc protrusion also moderately narrows the left foramen and lateral recess. There was also a 2mm posterior central disc protrusion at L5-S1. A 2mm disc bulge at L2-3 was seen. There was a mild degenerative facet and ligament flava hypertrophy at L4-5 and

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The impact of smoking in lumbar interval disc degeneration and sciatica was also reported several times. Battié et al. (1991) studied the impact of smoking in lumbar interval disc degeneration of identical twins using magnetic resonance imaging. Results showed that the risk of lumbar interval disc degeneration was 18% greater for smokers compared to non-smokers.

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The patient rejected the invasive nature of treatment protocols and opted for continuation of nonoperative treatment under conservative chiropractic management. The patient primarily complains of lumbosacral spinal pain at the right sacroiliac joint radiating into

Newton, the IW has reached MMI. Total Whole Person Impairment (WPI) rating is 17%. Future medical care for the lumbar spine includes nonsteroidal anti-inflammatory medications (NSAIDS), muscles relaxants, physician follow-up visits for acute exacerbations, and additional physiotherapy sessions for any acute exacerbations that do not improve after 6-8 weeks of medications and additional lumbar epidural injections. Any further diagnostic studies are not anticipated, unless there is a significant acute exacerbation or aggravation that does not improve after 6-8 weeks of conservative treatment. Lumbar surgery is not recommended or anticipated.

On examination of the lumbar spine, there is tenderness and guarding of the paraspinal musculature. Range of motion is decreased secondary to pain.

The pathogenic mechanisms leading to the development of LBPP remain poorly understood. However, ongoing research is advancing the understanding on the pathophysiology and many explanations have been advocated. Studies suggest that low back pain is commonly caused by disorders of the vertebrae and intervertebral joints, back muscles and ligaments, and spinal mechanics (Porth, 2011). The lower back (lumbar) is made up of five vertebrae (L1-L5) containing fibro cartilaginous discs to prevent the vertebrae from colliding, and protecting the spinal cord. The spine is stabilised by the multifidous muscles and ligaments of the back and abdomen. Additionally, facet joints support and enable spinal movement (Hughes et al., 2012) (Salzberg, 2012). An intervertebral disc consists of a gelatinous core covered by a fibrous ring (Hughes et al., 2012). Normally, the blood vessels and nerves flows outside of the disc, however if the discs loses its ability to manage physical forces, it

MRI of the lumbar spine obtained on 07/15/08 showed post-surgical changes at L4-5 and L5-S1, multilevel degenerative changes, most prominent at L4-5 and L5-S1, and foraminal narrowing at L4-5 and L5-S1.

DOI: 11/13/2014. Patient is a 32-year old male technician who sustained injury at the time he was breaking loose a pulser component, he felt a sharp pain to his right side, low back buttocks and right leg. The patient was subsequently diagnosed with lumbar degenerative disc disease, radiculopathy and, lumbar spinal stenosis. Per MRI of lumbar spine without contrast dated 12/23/14 revealed at L4-5 there is disc space height loss, disc bulging and facet degenerative change; at L5-S1 there is posterior disc bulging resulting in mild narrowing of the central canal, and; at T11 to T12 there is posterior disc bulging resulting in mild narrowing of the central canal. As per focused history and physical dated 3/17/15, patient is presented to the office

This is a 63-year-old male with a 6/13/1992 date of injury, when he fell off the roof of a building.

Traditionally, spinal problems are believed to always have specific patho-anatomic diagnoses just like other pathological conditions such as cancer, diabetes, heart disease, etc. Since the articles about cervical (Boden 1990)and lumbar spine (Boden 1990 and Jensen 1994) and demonstrating multiple imaging pathologies were found in pain-free individuals, and about 65% increase of spine care cost from 1997 to 2005 has produced worse health outcomes despite imaging technological advances (Martin et al 2008). This has led to a paradigm shift that between 70-90% of neck and back problems is actually non-specific in nature (Deyo et al 2008?). The non-specific nature of neck/back pain does not mean that they all have the same clinical features. For example, the patient’s experience of pain can have different neurophysiologic pain mechanisms at work that result in substantially different clinical and financial

A 28 year old female presented to our institution with a three-month history of right sciatic pain in the S1 distribution. She was initially treated conservatively with analgesia and physiotherapy, however her pain continued despite these interventions. She had no weakness or bowel or bladder symptoms. On examination she had a positive Lasegue?s test at 30 degrees on the right. No motor of sensory deficits were found. A lumbar Magnetic Resonance Image (MRI) scan done showed a paracentral disc bulge at L5/S1 impacting the traversing right S1 nerve root, and exit foraminal stenosis (Fig 1). She was taken to the