Patient: Can someone please tell me what all these means. I just found it in my medical records after years of pain and suffering. Has disc herniation, annular tear, which is probably causing back pain, could try PT if meds are not helping Neurologic deficit , failed conservative therapy severe, intolerable pain refractory to analgesics left S1. L4-L5 small linear annular fibrosis tear and slight posterior right paracentral disk bulge. There is no evidence if nerve root impingement or significant canal stenosis. L5-S1 Large annular fibrosis tear with a shallow posterior disk protrusion, this appears to more promainate on the right side.
Doctor: All these mean that your severe back pain is due to a nerve root compression/irritation by a disc protrusion in two leve ls of your lumbar spine: L4-L5 and L5-S1.In younger patients, lumbar radiculopathy may be a result of a disc herniation (bulging/protrusion) or an acute injury causing impingement/irritation of an existing nerve.In the older patient, is often a result of spinal canal narrowing from bone (osteophyte) formation, decreased disc height and degenerative changes due to aging process.The treatment strategy usually includes: physical therapy program aimed to reduce pain and inflammation, and the use of anti-inflammatory medication (e.g.: “Motrin”, “Aleve”), try to keep a proper posture, avoiding repetitive lumbosacral stress (example weight lifting), adhering to a healthy lifestyle and proper nutrition, physical activity (20 minute walking 3 times a week), losing excess of weight, smoking cessation, seeking medical advice in a timely manner when indicated.During the pain crisis a physical therapy program should be followed and aimed to reduce pain and inflammation. Basically the conservative treatment of the Lumbar Radiculopathy is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-education , teaching you a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: sleeping with a pillow between the knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above, with the objective to keep you as far as possible from episodes of acute low back pain, and also to preserve your quality of life. If there is a poor response to these measures the surgical option may be considered.