What is multilevel disk disease?

Question

Hello doctor,

I have left-sided lower back pain. I had hemilaminectomy at L4-L5 and decompression done eight years ago. I have attached an MRI report of the lower spine and an ultrasound of the abdomen. I was diagnosed with cystic kidney and liver hemangioma a month back. Please give me your advice on this.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thanks for writing in, and I understand your concern. Based on your reports (attachments removed to protect the patient's identity), I will list the findings as they appear.

1. The spinal cord: Normal conus and conus terminates at the L1 level.

2. Disks: Multilevel dessication.

3. Bones: L3 mild height loss.

4. Soft tissues: T12-L1: No canal or foraminal stenosis.

5. L1-L2: No canal or foraminal stenosis.

6. L2-L3: Left paramedian disc extrusion results in obliteration of lateral recess and descending nerve compression. Diffuse disc bulge, ligaments flavum hypertrophy results in mild spinal canal stenosis.

7. L3-L4: Diffuse disk bulge, ligamentum flavum hypertrophy results in moderate spinal canal stenosis, bilateral lateral recess obliteration, and mild bilateral neural foraminal narrowing.

8. L4-L5: Grade 1 anterolisthesis results in mild bilateral neural foramina narrowing. Bilateral facet arthropathy and left ligamentum flavum hypertrophy result in left lateral recess obliteration and descending nerve compression. Left-sided hemilaminectomy or laminotomy.

9. L5-S1: Significant disk height loss, posterior annular tear, and bilateral facet arthropathy results in moderate neural foraminal narrowing, worse on the right.

10. Others: No abnormal contrast enhancement and bilateral renal cysts.

Impression: Multilevel degenerative disc disease of the lumbar spine.

Above is the formal report. Additionally, disk extrusion on the left side at the L2 and L3 is important, resulting in descending left L3 compression. At the L-3 and L-4 levels, degenerative changes result in moderate spinal canal stenosis, which causes multiple nerve compression. At L4-L5, the left lateral recess is obliterated, affecting the descending left L5. At the S1 level, the proper facet arthropathy compresses the right L5.

In my opinion, physical therapy is always on the table. Surgery only needs to be done if physical therapy does not help. Since there is multilevel disk disease, it is important to decide which level causes the most symptoms.

Regards.