Lumbar disc degeneration

In this video blog post, Dr. Castanet will show you some typical degenerative changes in the lumbar spine of this 61-year-old man. The MRI scan is actually improved from a previous one done several years ago. The previous MRI showed a moderately large, herniated disc, now resolved- yes, herniated discs can resolve.

Among the degenerated changes noted are Modic changes, i.e. edema of the vertebral end-plate, disc desiccation, i.e. loss of water content in the disc, partial disc collapse, ligament enlargement, i.e. hypertrophy, central canal stenosis, a very small disc herniation, an annular tear, and some paraspinal muscle atrophy (multifidus muscle), which is another common accompaniment of low back pain.

This man has occasional right-sided low back pain, often felt in the right sacral area. It is treated with occasional spinal decompression treatment, which reduces the compressive degenerative changes. In fact, if you could see his lumbar x-rays from in front (AP), you would see that he has some disc collapse on the right side of his L5 lumbar vertebra. This results in a right-convex scoliosis, on a degenerative basis. The disc collapse also puts more pressure on his right L5-S1 joint, which looks sclerotic, i.e. more white than the left-sided L5-S1 joint. And the extra pressure on the right L5-S1 joint probably accounts for the right-sided, sacral pain he sometimes feels. In another video review of this patient, I will show you the x-ray image and describe this status, process and how these mechanical changes account for his symptoms. It will also, then, seem intuitive to you why he has these symptoms, and why a mechanical approach to treating him would be a valid and effective method for resolving his pain.

In fact, take a look at the x-ray image, below, and you can see his L5 vertebral, right-sided collapse, and the consequent right-sided, degenerative scoliosis. Keep in mind that the x-ray is taken from the front, so the right side appears on the left, and vice versa.