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Dr.Sawhney
Dr.Sawhney, Doctor
Category: Medical
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Experience:  MBBS,MS
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I need someone to read my spin MRI . I have discussed with

Resolved Question:

I need someone to read my spin MRI . I have discussed with a doctor in person but he was unable to explain me clearly what are the issues there or if they can be fixed or how ? I started to have some pains but most important I really want to sort out this issue (if it can be fixed ) or at least to know what should I do and expect in the future. I upload the MRI report on this link http://dl.dropbox.com/u/37789360/MRI.zip .
  I also need to add that I spend a lot of time on the computer desk and just sometimes I also do physical exercise at the gym .
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. German replied 3 years ago.
Hi, welcome to justanswer, I am trying to open the report .

Will you be able to tell me what is written in the report (the main results) in order to help you ?
Expert:  Dr. German replied 3 years ago.
I am trying to open the link and I am not able to open it?

Could you write the results directly?
Customer: replied 3 years ago.
You need first to unarchive the file in order to be able to read it. The written report says there are small issues at C5-C6-C7, minimal intersomatic hernia at inferior L1
Other issues are noticed at L3-L4-L5 . What means intersomatic hernia ? Is that hernia disc ?
Customer: replied 3 years ago.
You should be able to download the report . Please copy/paste http://dl.dropbox.com/u/37789360/MRI.zip
After the file is downloaded you need to unarchive it as it is in .zip format . After is unarchived/extracted it there is a file CDStart.exe with a kind of Kodak icon so once you click on it you should get the report in front .
Expert:  Dr. German replied 3 years ago.
Hi, what your result means is that you have ligaments ( with cartilage tissue ) between your spine discs .

In your case, there is an herniation in the lumbar disc L1 . This middle back disc has slipped out of its normal location .

As consequence , the nerve roots that travel through that space could become compressed producing pain or there could be certain level of inflammation or irritation which can produce pain .This occurs when the vertebrae ,where the herniation is located , rub one against the other.

In most cases, doctors treat this condition with anti-inflammatory medication and pain medication.

The treatment also include physical therapy .

Most cases of back disc herniations improve with these measures , surgery is usually not performed . It is usually the last option .

Any additional questions, just ask me so I can help or clear any of your doubts.


If you like the answer,please click accept so I can get credit for my work. A bonus will always be sincerely appreciated.
Expert:  Dr. German replied 3 years ago.
The small issues usually means ,there is some level of minimal inflammation ( C5,C6 and C7) in your neck discs or some level of muscle inflammation . This is treated the same way , with antiinflammatory and pain medication.
Customer: replied 3 years ago.
so basically there is not treatment other than drugs to manage the paid ?
Customer: replied 3 years ago.
I meant to manage the *pain
Expert:  Dr. German replied 3 years ago.
In most cases, the treatment involves these medications and the reason for this ,like you know is that the spine is a very delicate anatomical area , so most doctors ,do not perform any direct surgical intervention , only if it extremely necessary. In most cases, the pain improves notably with pain and anti-inflammatory medication that your doctor will prescribe you ,specially when the changes are minimal, like your case. If you like the answer, please click accept so I can get credit for my work. A bonus will always be sincerely appreciated.
Expert:  Dr. German replied 3 years ago.
There is also alternative therapy like chiropractic therapy to manage the pain , however , you should check with your doctor first to see if he/she approves it.
Expert:  Dr. German replied 3 years ago.
There is also alternative therapy like chiropractic therapy to manage the pain , however , you should check with your doctor first to see if he/she approves it.

If you like the answer,please click accept so I can get credit for my work. A bonus will always be sincerely appreciated.
Customer: replied 3 years ago.
Dr. German, You explained me what I already told you was written in the report but didn't read the MRI as requested in the question . I also made a CT (x-ray) scan and that doctor told me something else ... he told me that I would have hernia on a different vertebrae (C) not (L) so that's why I'm looking for an expert , independent opinion .
Expert:  Dr. German replied 3 years ago.
Hi, I have an Apple and I am trying to unzip the document and I am not able to do it .

If they did this CT Scan and there is a cervical hernia. That does not exclude the hernia they found at lumbar level.

Both conditions can be coexistent .

However, like I am not able to open it , I will opt out ,so other medical expert can help you and see if he/she can read the report and give you additional information.
Expert:  Dr.Sawhney replied 3 years ago.
Hello

I am a spine surgeon and would be happy to help you.

I am downloading the MRI and would get back to you after I see the MRI.
Customer: replied 3 years ago.
Thank you Dr.Sawhney, I will be waiting for your response . Please don't rush as all the other doctors did that and now I ended up without a clear diagnostic which is very frustrating .
Expert:  Dr.Sawhney replied 3 years ago.
Hello

I have opened the MRI and would be studying it.

Meanwhile please explain in detail the symptoms you have.
Expert:  Dr.Sawhney replied 3 years ago.
Hello

I am waiting for your response regarding the symptoms you have.

Thanks
Customer: replied 3 years ago.
The most visible/sure "pain" that I have is when I look straight down ... I always feel that something is holding me somewhere in the T vertebraes area ...like something is pricking me but in a deaf way.
The other type of pain comes from time to time .. I think more often when I work on the desk ... I cannot locate it exactly but I think is somewhere in the lombar area or on the first T vertebraes(e.g T12, T11 area ). This pain is much worse as I really cannot ignore it .

Apart of this I do joging sometimes and often also go to gym but try to avoid to solicit my back. When I do this I feel better but I don't know if is a good thing (e.g if is a temporarry pain relieve due the feber or is a good thing for long term as well ).
Customer: replied 3 years ago.
Regarding the pain when I look straight down I have to mention that the pain is directed in the RIGHT side.
Expert:  Dr.Sawhney replied 3 years ago.
I have gone through all the images.

You have
  • Mild disc degeneration at C5,6 and C6,7 with a small osteophyte posteriorly at C5,6.The small osteophyte at C5-6 is located in the middle area of vertebral body.
  • Mild disc degeneration at L4,5 with mild facet joint arthropathy at the same level
  • A very small disc herniation from L1,2 disc which is herniating into the L1 vertebral body
The mild disc degeneration in cervical spine as well as lumbar spine may be responsible for the pain or discomfort you have in neck and lower back.In it the intervertebral discs lose their normal function of shock absorbers and start losing their water content. This causes more pressure to be exerted on the facet joints making the whole triple joint complex (consisting of disc and two facet joints) painful.These are changes which are normal for your age. If we take MRI of hundred people your age at least 50 are expected to have similar changes.The facet joint arthropathy may also be responsible for the lower back pain you have.But similar changes may be painless in some while may be painful in others.
The small herniation into the vertebral body is of no consequence and is not responsible for any symptoms you have.
The best way to counter these changes and to avoid pain is to have good posture and to start exercises specifically for lower back and neck.Also try to avoid sitting for long periods at one time.You should not sit for 20-25 minutes at a time.
A physiotherapist or a physiatrist( a doctor trained in physical therapy) would be able to teach you exercises for lower back and neck.

Please ask if you have any queries.
Customer: replied 3 years ago.
Dr.Sawhney, thank you very much for your comprehensive response . I have two main questions :
1. Can the arthropathy or osteophyte be cured with medications or a specific diet (including the physical therapy of course )? or do I have to live with this and just try to stop its evolution ?. I'm 23 and to be frank I didn't meet many of my age with such issues.
2. What should I expect form the L1,2 disc herniation on the next years ? I mean how it will evolve and what issues may appear ?
Expert:  Dr.Sawhney replied 3 years ago.
Sorry for the delay in reply.Had been busy in my surgery.

These are degenerative changes and unlike a disease which can be cured ( for example a bacterial infection can be cured with use of antibiotics ) degenerative changes cannot be cured.
Just like graying of hair ,degenerative changes in spine are inevitable and will progress with age.We can however ameliorate the symptoms caused by these changes with use of good posture and regular exercises.There is not much specific by way of diet which could help but having a diet rich in anti oxidants may help delay degenerative changes.
Nobody knows why some people tend to get pain with even mild degenerative changes while others do not get such pain even with higher degree of degenerative changes.

The disc herniation into the body of L1 is inconsequential as it is very small and is not responsible for pain. It is possible that this will progress over time but this herniation remains quiescent ( not causing any symptoms) in majority of patients as this does not impinge upon any nerve roots and is not inherently painful.In a small minority this can be painful if it progresses.It is considered as a possible cause of pain only when other possible causes are not present.
Customer: replied 3 years ago.
Thank you very much for your response. I have just 2 more questions :

1. I have been advised by the previous doctor to take some "articular cartilage restoration" piles and also drink a lot of water. Does it make sense to keep getting these piles if the degenerative changes cannot be restored ?
2. Should I make some further investigations to find out what caused me those issues or even to find if there is not something worse (e.g some kind of articular cancer) ?

Expert:  Dr.Sawhney replied 3 years ago.
The commonly used pills for articular restoration have glucosamine as constituent.It has been shown with recently published research that use of glucosamine does not have any benefit for low back pain.I feel that same would hold true for cervical spine.

See link below

http://www.ncbi.nlm.nih.gov/pubmed/20606148

MRI is an extremely sensitive investigation and is sufficient to pick up any cancer or any other pathology.If MRI has not shown any cancer it means that you do not have one.Moreover cancer is extremely unlikely at your age.I do not feel that you need any more investigations for this.
Dr.Sawhney, Doctor
Category: Medical
Satisfied Customers: 6294
Experience: MBBS,MS
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Customer: replied 3 years ago.
Thank you !
Off topic : It's really sad that some people live only half a life or even less .
Expert:  Dr.Sawhney replied 3 years ago.
Thanks and best of luck.
Just to reassure you.The symptoms due to degenerative changes are usually self limiting and get better over time.
Hope you are symptom free soon.

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