Brief Answer:
Disc changes at L 2 - L 3 and L 4 - L 5 levels giving rise to pain

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.

I have read through your query in details.
Your husband seems to be having a torn rotator cuff at the shoulder and lower back problems.

The lumbar spine is made up of 5 small bones aligned on top of each other. There are spongy discs between these small bones which give it a cushioning effect and help in forward backward and turning movements. There are nerves which pass through foramen between the discs on each side of the spine. When the discs get degenerated causing disc bulges or herniation, there is pressure on the nerves causing pain and discomfort.

The MRI scan findings in lower back are explained below.
1. The vertebral bodies of the lumbar spine are normal in height and alignment, without fracture or subluxation. There is no bone marrow edema or significant bone marrow signal abnormality. The visualized spinal cord is unremarkable, with the conus terminating at the L1 level.

This says that the alignment and appearance of the bone marrow in the lower back spine and point of termination of lower end of spinal cord is normal.

2. At the T12-L1 level, there are no significant degenerative changes.

At this level (approximately at upper end of kidneys) there is no abnormality noted in the disc between bones T 12 and L 1.

3. At the L1-L2 level, there is a minimal annular bulge with mild facet arthropathy. There is no spinal canal stenosis. There is mild narrowing of the neural foramina.

At L 1 - L 2, there is a slight bulge of the disc seen in its posterior part with the surfaces showing changes due to aging. Little pressure on the disc on nerves is visible.

4. At the L2-L3 level, there is a small broad-based disk bulge with minimal facet arthropathy. There is flattening of the ventral thecal sac, without significant spinal canal stenosis. There is moderate narrowing of the neural foramina greater on the right.

At this level there is a small bulge with degenerative changes. There is pressure on the nerves at this level which is seen on the right side.

5. At the L4-L5 level, there is mild disk desiccation with minimal loss of disk height. There is a broad-based disk bulge with face arthropathy and ligamentum favum hypertrophy. There is a small central disk protrusion. There is moderate narrowing of the spinal canal, with mild to moderate narrowing of the bileteral neural foramina.

At L 4 - L 5 level, there is decreased water content in the disc and this is also due to aging and degeneration. At this level, there is disc bulge with small part of the disc protruding in to the spinal canal. This causes the spinal canal to become narrow and there is pressure on the nerves on both sides.

6. At the L5-S1 level, there is disk desiccation with a disk bulge. There is a right foraminal annular tear. Facet arthropathy is noted. There is no spinal canal stenosis. There is no significant neural narrowing.

At L 5 - S 1 level there is loss of water content in the disc and small tear. There is no pressure on the nerves.

There is nothing mentioned about the L 3 - L 4 disc in your query and I guess it is normal.

In conclusion, there is
(i) Mild pressure on nerve roots at L 1 - L 2 disc level.
(ii) Moderate pressure on the nerve root on the right side at L 2 - L 3 level.
(iii) Moderate pressure on nerve roots on both sides at L 4 - L 5 level.

The pain experienced is mainly due to the disc degenerations at L 1 - L 2, L 2 - L 3 and L 4 - L 5 levels with the findings at L 2 - L 3 and L 4 - L 5 levels being more severe in nature.

The spinal surgeon will discuss in detail and offer treatment based on the severity of pain and any other symptoms that your husband is having.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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