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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5330
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Can i get an opinion on results please have had most lower

Customer Question

Can i get an opinion on results please
Hi have had most lower back pain for 4 months now. Been to chiro. Physios. Had deep needle. Pain killers. Nothing has really helped. I was working a physical job repairing wooden pallets on a table that id stand at for 8 hours a day twisting and turning. Leaning over. Pulling. And at same time soccer training twice a week and playing on weekend. I had to quit my job as was in to much pain. Im only a 29yr male. Have seen 2 different drs and seem to be useless in knowing what to do or whats wrong. They said nothing really to wrong. Shouldnt be in much pain and go to physio. I have booked into 2 specialists in a couple of weeks for expert opinion. Ill just type what my mri shows
Report: There is minor undulation of vertebral body endplates which may reflect previous scheuermanns disease but there is no associated marrow stress response of the vertebral body endplates. There is mild marrow stress response at the inferior aspect of the right sacroiliac joint. There are bilateral pars defects of the L5 with a grade 1 anterolisthesis without marrow stress response to suggest active stress response. No facet joint marrow stress response.
The uncovering of the disc due to the spondylolisthesis with the disc contacting but not flattening the exiting right L5 nerve root within the foramen. No subarticular recess or central canal stenosis
Opinion :
1. Bilateral pars defect L5 with a grade 1 spondylolytic spondylolisthesis. This results in contact of the uncovered disc on the exiting right L5 nerve root without compression. There is no morrow stress response within the sacroiliac joints to suggest active bone stress.
2. Minor right sacroiliac joint marrow stress response inferiorly
I dont have any leg pains or that. Just lower back. Sometimes a few other places but i think maybe that could be fixed with massage
Do those results mean i have a mild slipped disc thats contacting a nerve but not compressing it to much? And a pars defect? Surely the contact on my nerve is what is causing me pain?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

Hi Martin. If there was contact of disc material on the right L5 nerve root causing pain, you would expect that pain to radiate into the right leg. In the absence of leg pain, you would have to consider other possible sources, such as the SI joint (if the pain is primarily in the sacral region), sequelae of scheuermanns disease, intermittent spondylolisthesis (excess movement) with ligamentous strain or injury, or chronic muscle strain. Many sources of low back pain in otherwise healthy young men such as yourself improve over time with conservative treatment. Surgery is typically not needed, or does not substantially improve longterm outcome.

Customer: replied 1 year ago.
If i had si joint pain would anti inflammatory meds fix that. Because i have also started taking them 5 days ago. The dr gave them to me just the rule it out. Havnt felt any better from them tho. Ive read i can get injection into the joint? I get sore back from sitting or standing to long. But it hurts in general all the time
Expert:  Dr. Bob replied 1 year ago.

Anti-inflammatories are hit-or-miss when it comes to low back pain. An SI joint injection can be both diagnositic and therapeutic. If it works you have your answer and your solution. If it does not work, you would have to look elsewhere for the cause. If it works only partially then you likely have a compound condition involving more than one source. In most instances of chronic or recurrent low back pain, a combination of approaches is required including physical therapy, medication, injections, acupuncture, meditation, etc.

Customer: replied 1 year ago.
Here is 2 of my xrays. I dont have the mri hard copys arm. Does that show you anything
Expert:  Dr. Bob replied 1 year ago.

It's difficult to make out details in these films. I see the findings mentioned above and what looks like an exaggerated lumbar lordosis (curve), which can predispose one to early degenerative changes of the spine (i.e. arthritis) particularly in the joints (facets) and margins of the vertebral bodies. This could be the cause of chronic progressive pain. Have you had a CT of the abdomen and pelvis to rule out an internal source of pain (i.e. other than the axial skeleton)? This would be a good idea if your doctors are not certain that the pain is musculoskeletal. Otherwise, you should consider seeing a pain management specialist at an academic medical institution (one with a medical school). These specialists are often anesthesiologists who have specialized training in eliminating or mitigating sources of pain.