Back pain with radiating pain into the right leg - MRI images
October 5, 2014 | 20,00 EUR | answered by Dr. med. Ralf Berg
Hello,
I am asking a question for my father, who is 59 years old.
He has always had mild back pain that occasionally worsened and could be relieved by manipulation at the orthopedist. A classic case of "I have back pain".
However, for the past three weeks, he has been experiencing new pains in the lower back area that are different from his usual back pain and also radiate down his right leg. These pains came on suddenly and have neither worsened nor improved in the three weeks. Since then, my father has also had difficulty coordinating his right leg properly.
His orthopedist sent him to a radiologist, where MRI images were taken on 01.10. However, the follow-up appointment with the orthopedist is not until 13.10., and we would be very grateful for a preliminary opinion. Do you see anything serious here?
Thank you in advance and have a nice Sunday.
Hello,
I am happy to provide you with information and assistance, but one thing upfront: this is a preliminary assessment based on individual images. I also do not have expertise in MRI/diagnostics.
It is unfortunate that you received these images without at least a preliminary evaluation from the radiologist (who cannot provide more immediately, as all slice levels need to be carefully reviewed and diagnosed). However, this is unfortunately the norm and does not make it more patient-friendly.
What I see is as follows: in images I and II, there is a significant scoliosis in the lumbar spine area with severe degenerative changes including spondylophytes. In other words, changes that have likely been causing your father's back pain. I cannot evaluate image II as the slice level is not clear to me.
Images IV and V are interesting: there is a displacement of the disc to the right which could be responsible for the radiating pain. Whether this warrants surgery will be decided by the neurosurgeon only if the clinical picture worsens.
What does this mean for you: if there are any signs of paralysis or numbness in the right leg, seek immediate help with the images and your father at the emergency room, no matter what time it is. If not, your father should continue with all conservative measures that the orthopedist has hopefully already initiated (medication, proper posture, physical therapy, etc).
If nothing worsens, it can be evaluated on the 13th of October whether these measures are sufficient, if there is improvement in the clinical examination, or if further measures are necessary (such as stretching treatment, facet infiltration, or chiropractic treatment).
If no measures are currently being taken, these images certainly justify moving up an appointment.
Summary: No danger without paralysis/loss of sensation. Continue with ongoing therapy and present for evaluation on the 13th of October. If no treatment has been initiated, schedule an earlier appointment with the images.
Preliminary diagnosis: Partial disc herniation with severe degenerative changes and scoliosis of the lumbar spine.
I hope you can now see clearly and still enjoy your Sunday under the circumstances.
Warm regards,
Dr. R. Berg
