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What should I do to manage ageing of the lower back?

Q: I am 46 years old. I have pain and burning sensation in the left leg. MRI evaluation was carried out utilizing a GE 1.0 Tesla magnet. Sagittal T1-weighted, potion density, inversion recovery, and T2-weighted series were acquired. T1-weighted and T2-weighted transaxial series were obtained. Vertebral body height, alignment and marrow signal intensities are normal. The discs are of normal height and are normally hydrated. The pedicle length is average to generous. The only abnormalities seen are mildly bilateral hypertrophic facet arthropathy at L4-5 and L5-S1 and a very slight subtle posterolateral annular bulge at L4-5 into the neural foramen. This does not significantly stenose the foramen and there is no eccroachment upon any of the neural structures at any level. The conus medullaris terminates at T12-L1. Not enough of this is included in the field of view to be adequately evaluated. No intradural or paraspinous soft tissue mass is seen. Impression: Very mild bilateral hypertropic facet artropathy at L4-5 and L5-S1 with a very slight subtle left posterolateral annular bulging of the L4-5 disc, without neural encroachment or foraminal stenosis. What does this mean. My hips hurt on my right side, my arms always go numb even when I am not leaning on them. I have tingling sensation in my toes, sharp pain shooting down mostly in my left leg. I have a burning sensation at the bottom of my left leg between my ankle an calf several times. Previous x-ray reports say that I have 2 degenerating disc in my neck at C4-5. Please advise.

A:The findings on Magnetic Resonance Imaging are reassuring. They show early signs of ageing in the lower back but these changes have not compressed any nerve. This means that you do not need any operation. It is possible that your symptoms can be relieved by simple measures such as observing some precautions and exercises to strengthen the lower back. The precautions are: a) No sharp bending of the spine forward or backward. Mild movements as when we wash the face or brush teeth are permissible. b) No carrying loads. Example: no carrying a bucket full of water or a suitcase weighing 20 kg. c) No squatting on the floor or using an Indian toilet. If possible switch to a commode (European toilet) or obtain a stool or chair with a hole cut out in the seat to fit an aluminum pot. After passage of urine or faeces into the pot, it can be cleansed, dried and replaced in the stool or chair. Your doctor or physiotherapist will teach you the exercises needed to strengthen the muscles in the lower back. I suggest you consult a senior neurosurgeon or orthopaedic surgeon for a complete evaluation of the cause of your symptoms. You state that you are also suspected to have a deteriorating disc in the neck. This needs to be checked and appropriate treatment prescribed.


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