Lower back pain. On injections and physical therapy. MRI showing Schmorl node type superior endplate defect, disc protrusion
Patient: I have had low back pain for a couple of years now. I have had injections , physical therapy and a tens unit at home. Nothing has worked. Sometimes the pain will go into my hips and legs. It has gotten to the point that I can stand at my sink for more than five minutes to wash dishes. I am only 39. My MRI reads: The alignment is normal. Vertebral body marrow signal is benign throughout. There is a small Schmorl node type superior endplate defect at L2 centrally and a similar slightly smaller lesion at L3. The lesion at L2 has signal which suggests it may be relatively recent. T12-L1: tiny left paracentral disc protrusion minimally indenting the thecal sac without significant canal or foraminal stenosis . L5-S1: small central disc protrusion just abutting the ventral thecal sac without significant associated canal or foraminal stenosis. Can someone please explain some of this and what other options are there? Doctor: Hai,  Thanks for writing in.  Schmorl's node are nothing but disc protrusions inside your vertebral bodies. They are benign and usually don't cause any problems. After reading your MRI it seems there doesn't seems to be any significant findings. Small / tiny disc protrusions might be present for all individuals. Since there is no canal or foraminal stenosis, the pain is not a neurogenic / discogenic pain. Your MRI also didnt comment anything abnormal in your sacro-iliac joints.  Sometimes spondylolysis at L5/S1 or any other levels can be missed by MRI. After a thorough clinical examination, you might need to undergo stress views of your spine +/- CT at the levels to rule-out any instability of segment or spondylolysis.  Till that time you can wear lumbo-sacral belt, back strengthening exercises, lying on hard bed etc.. Avoid leaning forward, sitting /standing in same posture for longer periods, lifting heavy weights.  Regards, Dr.Sathyadharan