Bulged Disc

SCIATIC PAIN / LOWER LUMBAR, HIP AND BUTTOCK PAIN

I was in a RTC in January last year and since about 4 days after the accident have been experiencing some pain in my lower lumbar area, across buttock and down right leg.

Cut a long story short beteeen having had physio etc, I have just recently found out from an MRI scan the below results - My question is should this be sore like a sciatica pain or should I not feel it? Or should there be no pain and could this have been caused since the car accident?


Findings: There is straightening of the lumbar lordosis, alignment is otherwise maintained. Vertebral body heights are maintained.
Normal signal returned from the visualised cord and the cord terminates at L1. The imaged paravertebral soft tissues are
unremarkable.
The axial images were then reviewed.
L2-3: Normal appearances.
L3-4: There is a broad-based posterior disc bulge which causes mild indentation of the dura. There is minimal depression of the
central aspect of the superior endplate of L4 suggestive of early Schmorl's node formation. There is mild bilateral lateral recess
stenosis and mild narrowing of the neural exit foramen bilaterally without nerve root impingement.
L4-5: There is a broad-based posterior disc bulge which minimally indents the dura. This causes mild bilateral lateral recess
stenosis and minimal narrowing of the neural exit foramen bilaterally without nerve root impingement.
There is minimal depression of the superior endplate of L5 centrally. Again thought consistent with early Schmorl's node
formation.
L5-S1: Normal appearances.
There is no evidence of previous fracture. No aggressive signal abnormality within the vertebrae.


Many thanks for the advice,

HI Eion and thanks for the post. Having read your history and recent MRI findings they don't really seem to relate to one another. The slight discal bulging at L4/L5 is pretty normal with aging and whilst it could be associated with some trauma it would more likely lead to an increase in the lumbar lordosis rather than a decrease. The features themselves would more likely product localized low back discomfort rather than a sciatic type distribution that you are experiencing. That said you might have adjusted your posture due to low back discomfort and that has lead to some sciatic referral symptoms. The MRI also shows no nerve root compromise in the lumbosacral area which would be indicated in true sciatica.

My general comment on this would be that the restriction of the seatbelt around the pelvis could result in some sort of traction type 'injury' or disturbance to the balance of the pelvis. I would discuss this with your therapist in relation to how you were hit and where you were in the car. This might indicate some rotational traction trauma which could be assessed and treated directly at the lumbar spine and pelvis. If the therapist is not confident with assessment and treating pelvic asymmetry then perhaps they know a good osteopath or even chiropractor who could assist you in the treatment plan. A year later would for sure indicate a broadening of the treatment team.

I think from the symptoms you describe and the initial MRI results you should be confident of full recovery on this. Your MRI findings would be normal in as many people with low back discomfort as without it which means it is always hard to say what was there first, or what caused what in this instance. That said you will need to be an active participant in some relevant exercise planning specific to your needs as being a passive recipient of treatment lying on a physio plinth won't be enough.

Let us know what the pelvic symmetry investigations show and how your therapist plans to progress.

regards

PhysioBob