EXAMINATION:
MRI LUMBAR SPINE Clinical History:
Low back pain Technique:
Sagittal T1, T2, axial T2 and Coronal STIR on a 3T platform. Comparison:
CT lumbar spine 6 November 2024.
Findings:
Lumbosacral vertebral alignment is normal. Marrow signal is normal for age.
The lowest open disc space will be taken to be L5/S1.
The conus terminates at L1 and is normal in signal and contour.
At T12/L1, the disc is preserved with no central or foraminal narrowing or impingement.
Normal appearance to the facet joints. At L1/L2,
the disc is preserved with no central or foraminal narrowing or impingement.
Normal appearance to the facet joints.
At L2/L3, the disc is preserved with no central or foraminal narrowing or impingement.
Normal appearance to the facet joints. At L3/L4, the disc is preserved with no central or foraminal narrowing or impingement.
Normal appearance to the facet joints. At L4/L5 there is a mild degree of non neural compressive annular bulging of the disc to the left.
No focal central posterior disc protrusion detected. No spinal canal or foraminal stenosis detected.
There is left L4/5 facet arthropathy compared to the right. At L5/S1 There is a broadbased posterior disc bulge slightly more marked on the left than the right there is an annular tear in the posterior left disc margin.
The disc material is abutting the left S1 nerve root?
Causing left S1 nerve root irritation. L5/S1 foramina are widely patent.
Facet joints appear satisfactory.
There is no paraspinal mass or inflammatory change.
Sacroiliac joints appear normal
CONCLUSION:
Left L4/5 facet arthropathy Shallow broadbased left posterior L5/S1 disc bulge close to the origin of the left S1 nerve root Dr Mark Keen Queensland X-Ray
MRI Summary – What’s Normal
- Spinal alignment: Straight and in the right position — no scoliosis or slippage.
- Bone health: Bone marrow looks healthy for your age.
- Spinal cord ending (conus): Normal shape and position at L1.
- Upper discs (T12/L1 through L3/L4): All look normal — no narrowing, pinching, or joint wear.
Main Findings
- L4/L5 – Facet Joint Arthropathy (Left Side)
- The facet joints are little hinges at the back of the spine that help with stability and movement.
- You’ve got wear-and-tear arthritis in the left joint here.
- This can cause local back pain and stiffness, especially with twisting or leaning back.
- Arthropathy can also irritate nearby small nerves, which sometimes leads to tingling or burning sensations in the skin over the lower back, hip, or thigh.
- L5/S1 – Broad-Based Posterior Disc Bulge with Annular Tear
- Broad-based bulge: The disc is pushed slightly out at the back, more on the left side.
- Annular tear: Small tear in the tough outer ring of the disc — this can release inflammatory chemicals that irritate nerves.
- Nerve contact: The disc is touching the left S1 nerve root. Even without full compression, this can cause irritation — pain, tingling, burning, pins and needles, or even itchy nerve sensations down the buttock, thigh, calf, or foot.
- Foramina (nerve exit holes) are still wide open — so it’s not “trapped” in a tight space, but contact alone can still cause nerve symptoms.
Why You Might Get Itching
- When the S1 nerve root or small sensory nerves in the lumbar region are irritated, the brain can misinterpret the signals as itch instead of pain.
- Nerve-related itch (neuropathic pruritus) often feels deep, like you can’t scratch it properly.
- The facet arthropathy and disc annular tear can both contribute to nerve irritation that produces this sensation.
How This Fits Into my Doctor Report
MRI lumbar spine shows left L4/5 facet arthropathy and a broad-based posterior disc bulge at L5/S1 with posterior left annular tear, contacting the left S1 nerve root. These findings are consistent with potential left-sided nerve root irritation, which may explain both pain and neuropathic itch sensations radiating from the lower back.
Comprehensive Clinical Summary & Management Plan
Patient: Brentdee
Date: 15/08/2025
Injury Duration: 12 months, 7 days
Imaging: MRI Lumbar Spine (Queensland X-Ray – Dr Mark Keen)
History & Mechanism of Injury
The patient sustained a lumbar spine injury approximately one year ago, resulting in persistent lower back pain, intermittent headaches, neuropathic itching, and mobility limitations. Pain has been constant, with episodes of increased intensity triggered by certain movements or prolonged standing/sitting. Symptoms have persisted despite conservative management, indicating ongoing structural and nerve-related irritation.
MRI Findings
- L4/L5 – Left Facet Arthropathy
- Degenerative/arthritic changes in the left facet joint, leading to inflammation and local nerve irritation.
- L5/S1 – Broad-Based Left Posterior Disc Bulge with Annular Tear
- Disc bulge is abutting the left S1 nerve root, causing irritation.
- Annular tear allows leakage of inflammatory mediators, worsening nerve sensitivity.
- No severe spinal canal narrowing, but mechanical and chemical irritation persist.
Clinical Correlation
- Constant Lower Back Pain: From facet joint arthropathy and disc inflammation.
- Radiating Symptoms (Itching & Pain): Nerve root irritation produces abnormal sensory signals, leading to burning/itching down the leg or buttock.
- Headaches at Times: Likely secondary to chronic pain sensitization, muscle tension, and altered posture.
- Mobility Issues: Protective muscle guarding, pain avoidance behaviors, and reduced spinal flexibility.
- Chronicity: 12+ months without complete resolution suggests ongoing tissue inflammation and central sensitization — where the nervous system amplifies pain signals.
Why This is an Ongoing Problem
- Disc Healing Time: Annular tears heal slowly due to poor blood supply — often >12–18 months.
- Repeated Micro-Irritation: Everyday movements can re-trigger inflammation, especially twisting/side bending.
- Nerve Irritation: Nerve tissue can stay hypersensitive long after initial injury.
- Facet Arthropathy: Ongoing degenerative changes are not reversible but can be managed.
Prognosis
- Full tissue healing is possible, but nerve sensitivity may persist if not managed correctly.
- Recovery requires avoiding aggravating movements and focusing on nerve and joint calming therapies.
Recommended Management Plan
Manual Therapy
- Ongoing osteopathic or physiotherapy care to maintain mobility, reduce muscle guarding, and promote spinal alignment.
Exercise & Activity
- Gym Work:
- Limit weights to max 10 kg during recovery.
- Only train front-facing, neutral spine positions (no twisting or side loading).
- Avoid high-impact or heavy axial loading (e.g., squats with heavy barbell).
- Focus on core stability, gentle resistance bands, stationary cycling, and pool-based exercise.
- Prohibited Movements:
- Side bends with load.
- Rotational movements under load.
- Deep lumbar extension (overarching the lower back).
Lifestyle & Recovery
- Regular gentle walking to keep discs hydrated.
- Heat therapy for stiffness; cold packs for acute flare-ups.
- Adequate rest between gym sessions — avoid training on flare-up days.
- Anti-inflammatory diet to reduce systemic inflammation.
Additional Treatments to Consider
- Targeted nerve desensitization exercises via physiotherapy.
- Low-level laser therapy (for tissue repair).
- Clinical Pilates for controlled core re-education.
- Pain education program to address central sensitization.
Prevention of Further Injury
- Always brace core before lifting or bending.
- Use legs and hips to lift — not the back.
- Avoid sudden twisting while carrying weight.
- Gradually reintroduce activities after any flare-up.
Summary Statement:
The patient’s lumbar spine injury involves structural changes at L4/L5 and L5/S1,
producing ongoing nerve irritation and mechanical lower back pain.
Due to the chronicity and nature of the injury,
recovery is slow and requires careful load management,
avoidance of aggravating movements,
and ongoing manual therapy support.
Prognosis for functional improvement is good with adherence to a tailored rehabilitation program.
“Central sensitization”
(which is often misheard or misspelled as
“central sensational”)
it’s a medical term used to describe when the central nervous system — brain and spinal cord — becomes hypersensitive to pain signals.
Here’s the breakdown:
- Normal situation: Your nerves send pain signals from an injury site to the spinal cord and brain, and the brain interprets them.
- With central sensitization: The spinal cord and brain become overly reactive.
- Pain signals get amplified.
- Even non-painful touches or movements can feel painful (allodynia).
- Normal pain can feel much stronger than it should (hyperalgesia).
In the back, this can happen if:
- You’ve had a long-standing back injury (like disc problems, muscle damage, or surgery recovery).
- The nervous system has been “trained” over time to keep sending amplified pain signals even after the original injury heals.
- It can make chronic back pain persist even when scans show nothing severe left to fix physically.
Symptoms that suggest central sensitization in back pain:
- Widespread tenderness beyond the original injury site.
- Pain that seems “out of proportion” to activity.
- Flare-ups triggered by stress, poor sleep, or unrelated minor bumps.
- Other symptoms like fatigue, headaches, or sensitivity to light/sound (because the nervous system’s “volume” is turned up in general).
Treatment often focuses on calming the nervous system down, not just fixing muscles or joints:
- Graded exercise and gentle movement.
- Pain education (understanding the nervous system helps reduce threat signals).
- Stress and sleep management.
- In some cases, specific medications that target nerve sensitivity.
These Diagrams are designed by brent dee and are not to be replaced as medical advice,
These diagrams are to help current treating doctors pinpoint the problem quicker to a quicker result