MRI of the lumbar spine: help to understand it

Patient

Q: I just had the result of my MRI scan, stating: The L4 5 disc is degenerate and shows a left central broad-based protrusion, the margins of which is in contact with the forming left L5 nerve root in the subarticular space. The effective spinal canal dimensions and neural foramina are adequate and there is no evidence of nerve root compression in the visualised spine. Since I got constant back pain, so often going down in my left leg, when I work I'm in agony and I'm very down with my mood, the consultant want me to have surgery. I already tried phisiotherapy and Nsaids, but nothing helps. Is it surgery going to be the best option?

Doctor

A:    Apparently the herniated disc is compressing the root nerve, causing inflammation (neuritis) that is producing the pain. In the younger patients, as you, lumbar radiculopathy may be a result of a disc herniation or an acute injury causing impingement of an exiting nerve. In the older patient, radiculopathy is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process. The conservative treatment strategy usually includes: a physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory medication (Aleve, Motrin), also a re-education of your habits and posture in order to improve your quality of life. You should be independent in a stretching and strengthening program and continue with these exercises under the periodic supervision of a physical therapist initially and then completely on your own. If after all these, you still continue having pain, I strongly recommend you an evaluation by a Spine specialist to explore if the surgical treatment is an option for you.

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