L5S1 disk degeneration , Modic change, lower back pain

by carla vannucci
(Italy)

Lower back pain and stiffness


Hi, I has Magnetic Resonance of lumbar spine in May 2009 and it
showed spongiosa inflammation, disk degeneration and inflammation
at L5 S1 (Modic change), also listhesis of L5 and moderate
bulging of L4 L5, spinal canal is normal range.
Another Magnetic Resonance in october 2010 showed no change.
My pain is not severe, STIFFNESS is annoying, but since october my condition worsened because I have greater difficulty walking, I have very short step.
Is a fusion surgery the only option?
Many thanks, carla from Italy (I AM FEMALE, 58 YO, I HAVE SCOLIOSIS TOO, OTHERWISE HEALTHY)

Hello C, thank you for your question.

Very important, you make no mention of pain in your leg. Thus to my mind surgery should not be considered at this stage.

By the sounds of things you have had an injury to the disc, and the swelling has seeped into the bone. That modic change is not particularly unusual.

If the sciatic nerve is irritated, or there is a fixation in the sacro-iliac joint then you will have difficulty taking long steps.

My advice is to start looking for an experienced chiropractor. You have the sort of condition that we treat on an every-day basis.

You'll be getting some lower back exercises from Chiropractic Tips and they are now available on video at C-H. Do them faithfully every morning before getting out of bed.

Your English is very good!

I hope this has contributed.

PS Take the scans and X-rays with you.

Dr B

PS If you can, export a few of the MRI graphics to me. Then I can load them to this page.

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Sep 18, 2016
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MRI report with Modic changes
by: Anonymous

Hi, these are my MRI results, could you let me know what kind of treatment I'd be looking at. Pain initially started 4 months ago.

Spondylarthropathy at l5/s1 with disc desiccation and a left paracentral disc protusion. There is a small annular tear at the right paracentral location. Modic type 11 superior end plate change of s1 noted. The disc protusion results in mild canal stenosis and displacement of the left s1 nerve root.

Hello Anon,
It all depends on how much leg pain you have, if any, and whether there is any significant weakness in the lower leg.

Standing on your left, with right foot off the floor, can you raise your left heel and stand with a reasonable amount of control? You can hold onto something for balance?

The biggest difficulty is probably that you've been sore for so long and you wouldn't be writing this letter if it were improving. That means oedema and inflammation and the Modic changes seen.

Given so many unknowns for me, I'd be looking at two chiropractic treatments a week for at least a month and then decreasing the amount of care, but increasing the amount of exercise you'd be doing.

In the interim period I'd be expecting you to greatly reduce your sitting, and if the leg pain is severe or there is weakness of heel raising then staying at home for a period.

Take it seriously; this is the stuff that ends up in surgery if you don't.

You can find our exercises at chiropractic help in the navigation bar on the left. Do them faithfully EVERY morning before getting out of bed. They take less than two minutes. Several times a day would be better still.

Dr B



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Aug 22, 2014
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DDD + MODIC TYPE 11 CHANGES
by: Charmaine Bothma

I have been suffering from lower back pain for the past 3 years. The pain is more intense at night and I find myself tossing and turning. The pain is more in my hips and down my right leg. The pain down my leg feels as if it is right inside the marrow!!!!!! During the day I find it difficult to sit or stand for long periods of time. Bending is out of the question.
I had Xrays taken of my hips, but they are in good condition (I am a 51 year old female) I also tend to wake up with pain at the lower right side of the back of my head.
Over the past 3 years, I went for numerous sessions with my chiropractor. I also went to a physiotherapist and Yoga instructor that does manipulations. Eventually went for a MRI scan Oct 2013 with the following comment : Degenerative disc disease at L5/S1 level with disc space narrowing and Modic Type 11 endplate changes. Small central disc protrusion with internal annular tear. No neuroforaminal and lateral recess encroachment.
The local surgeon suggested anti-inflammatory and physiotherapy. It did not make ANY difference.
I read on the Internet about the Antibiotic treatment of Dr Hannah, but my GP refuses to go down that road. He AGAIN gave me a crash course of Prednisones and anti-inflammatory tablets, which did not do ANYTHING.
Any other suggestions would be highly appreciated!!!!

Hello Charmaine,
Two little tests for you.
1. Slowly bend forwards. I know it's difficult. Is one leg much tighter or painful that the other as you bend.

2. Go to the Slump test for sciatiac (use the search site function at C-H) and let me know the result.

Dr B

Mar 27, 2013
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L4-L5-S1 severe chronic pain
by: Dianne

L4-L5-S1 severe chronic pain

Mri of lumbar sp 3/25/13 shows bilateral severe facet arthropathy with fluid seen in facet joints. Your recomendation please?

I need more information, Dianne. Firstly, do you have leg pain? Where in the leg?

Secondly, your general physical condition and age.

Thirdly, does bending backwards and sideways produce lower back and leg pain particularly the leg pain.

At this page you'll see a test for weakness in the legs. The result?

Go from L4-L5-S1 severe chronic pain to other Chiropractic Conditions often treated…

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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