L5S1 disk degeneration , Modic change, lower back pain

by carla vannucci
(Italy)

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 Barrie Lewis

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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Apr 17, 2017
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Low back pain
by: Steven

Hi I am a 54 year old male have had low back pain now for 14 months. Had MRI 12 months ago modic 11 at L5 s1ight bulging discs first 3 levels with mild facet hypertrophic changes at the first 3 levels.

Disc tears at L5 s1 and l4/3 with soreness in my lower back most days and stiffness. Nerve or muscle pain right side. No pain in legs but cold feeling in buttocks and hips. Have read modic changes can burn out eventually. I am a plumber love my job and want to continue. Can you help please. I don't hurt when bending back or from side to side. Also got mild stenosis at l5s1.



Dr. Barrie Lewis Dr. Barrie Lewis


Hello Steven,
What's needed in the first instance is a commitment to lower back exercises every morning before getting out of bed; they take no more than a couple minutes. Find them in the navigation bar at Chiropractic Help.

Secondly be careful when going into extension, especially as when you might be lifting a heavy geyser into the ceiling.

Those modic changes reveal swelling into the bone, and yes deep ache and given a chance will subside. But with your work will it be given a chance?

I think you must accept that the days of really heavy work are over; stick to the side of plumbing that requires your brain, rather than brawn; it's a wonderful job.

Do those exercises; EVERY morning. At night too would help; the more the merrier.

Dr Barrie Lewis

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.



Dr. Barrie Lewis Dr. Barrie Lewis


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 Barrie Lewis



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!!!!



Dr. Barrie Lewis Dr. Barrie Lewis


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 Barrie Lewis

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?



Dr. Barrie Lewis Dr. Barrie Lewis


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?

Dr Barrie Lewis

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