Question
I would like, in plain words, what this can mean or does mean, and the simplest action that would be taken. "at L3-L4,theer are degenerative changes characterized by disc desiccation & disc bulging. There is also facet joint hypertrophy. There is no herniation, spinal stenosis, or nerver root impingement. At L5-S1, mild degenerative changess of disc bulging & facet joint hypertrophy, but no herniation, spinal stenosis or nerver root impingement. Marrow signal is uniform. The visualized portion of spinal cord and cauda equina are normal.
Impression: 1.Right sided eccentric disc herniation at L4-L5 causing spinal stenosis.
2. Degenerative changes at L2-L3 & L3&L4, but no disc herniation, spinal stenosis or nerve root impingement at any other level.
What would be my best options bases on all of this finding.. I am a 68 yr old female. I do not have an appt with a neurosurgeor til Aug. 5th. My pain seems to all be in my right hip and down my leg at times.  Thank You so much.

Answer
Hi Letty,
Sorry This is late, I was away all weekend and set my vacation dates on this site, apperently it didn't work.
You have some degenerative changes that are consistent with your age. The only clinical problem you have is the herniated disc at L4/L5. This explains the pain the the right hip and down the right leg. (Sciatic Nerve) The rest of your spine isn't too bad. You should have great success in a week or two with flexion/distraction therapy, it has been around for decades. I would undergo conservative therapy before surgery.
Flexion-Distraction Therapy - What is it?


Flexion-Distraction, (F/D) is a gentle, chiropractic treatment procedure utilized for back and neck pain. Flexion-Distraction is a safe alternative to back surgery for those 95% of patients whose conditions do not demand surgical intervention. The doctor is in control of the treatment movements at all times.

Flexion-Distraction is utilized for many conditions such as:

Failed Back surgical Syndromes
Disc Herniation/Ruptured Disc / Bulging Disc / Herniated Disc
Sciatica / Leg pain
"Whiplash" injuries
Stenosis
Arm Pain
Neck Pain
Failed course of Steroid Injections
Chemical Radiculitis
Spondylolisthesis
Headache
Transitional segment
Many more conditions?
How does Flexion-Distraction Work?

For Disc related conditions:

Increases the intervertebral disc height to remove annular tension on the annular fibers and nerve by making more room and improving circulation.
Allows the nucleus pulposus, the center of the disc, to assume its central position within the annular fibers and relieves irritation of the spinal nerve.
Restores vertebral joints to their physiological relationships of motion.
Improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
For Non-Disc related conditions:

Patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac restrictions and misalignment, certain types of spinal stenosis), Flexion/Distraction provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain:

The posterior disc space increases in height.
F/D decreases disc protrusion and reduces stenosis.
Flexion stretches the ligamentum flavum to reduce stenosis.
Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6mm more than extension.
Flexion increases metabolite transport into the disc.
Flexion opens the apophyseal joints and reduces posterior disc stress
The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100mm Hg. On extension the nucleus or annulus is seen to protrude posterior into the vertebral canal.
Intervertebral foraminal openings enlarge giving patency to the nerve.

Reference: Cox JM, Feller JA, Cox-Cid JA: Topics in clinical Chiropractic 1996; 3(3):45-59

This site can aid in understanding the procedure and locate a physician............

http://www.coxtechnic.com/homepage.asp

This will help tremendously!

Dr. Timothy Durnin
drs.chiroweb.com