70 year old lady with spondylosis

In this video Dr. Castanet will show you the lumbar MRI scan of a lady with relatively severe lumbar spondylosis. Among the lesions you will see are Modic changes at several levels, disc hernations at several levels, including intravertebral herniations, minimal spondylolisthesis at L4-5, retrolisthesis at L1-2 and L2-3, endplate deformities, ligamentum flavum hypertrophy, central stenosis, bulging discs at several levels, and multifidus muscle atrophy.

I have not seen this lady clinically yet, so I don’t know her history, symptoms, limitations, distribution of pain and more. She is referred by her primary care physician to see if I can help.

This is a good time to explain something about spinal problems that layity often don’t know. Most people, and maybe some physicians may thing that spinal problems have a simple triage. They may think, first send someone to physical therapy and/or chiropractic, and if that doesn’t work, then send them to pain management for injections, and then if that doesn’t work, send them to a surgeon for surgery. And the first two parts of that are generally true. But the third part is often not true. Specifically, if a patient fails to improve with non-surgical treatments, and pain management injections, and then sees a surgeon, the surgeon must review the records, history, exam and diagnostic imaging, and then decide, “Does this person have a problem, that correclates with a visible problem on the diagnostic imaigng, that I can treat with surgery, and has a high probability of improving or resolving. And sometimes the answer is, “No”. When that is the case, the patient may end up in a postion without any potential relief of their problem.

70 year old lady with spondylosis
Sometimes I get patients that have failed other treatments, and I cannot resolve their problem either. Some of those times, however, I can provide treatment that “manages” their pain and disability to their satisfaction. In other words, I have patients that I treat every 3-4 weeks to help them keep their pain managageable, and their function acceptable. That is sometimes the case with spines like this one; a spine with severe spondylosis, and multi-level surgery may not be a good idea for a variety of reasons.

If I can help you with your neck or back pain, please call me at 404-558-4015