Question: Hi,
My mother has been complaining of lower back pain that also affects her legs since the last 1.5 years.
Age 63 years (height 5’3” , weight – 70 kg ) , mild hypertension (controlled with medicine), no other ailments.
She is able to walk, but much slower than before. She is able to do all her normal daily activities but experiences discomfort while doing so. She is not able to climb stairs at all without support of the railing. Off late she also complains of feeling of weakness and tightness in the legs (no tingling).
MRI main findings (Report attached):
FINDINGS
Spinal curvature: normal
Spinal alignment: There is grade 1 anterolisthesis of L4 over L5
Vertebral signal intensity: Hemangioma noted at L4
Vertebral body height: Normal
Endoplate signal intensity: Schmorl's nodes noted at L2-L4
Disc:
L1-L2: Diffuse disc bulge causing mild impression on thecal sac
L2-L3: Diffuse disc bulge causing mild impression on thecal sac
L3-L4: Diffuse disc bulge causing mild impression on thecal sac and bilateral inferior foraminal compromise
L4-L5: Diffuse disc bulge causing mild impression on thecal sac, abutting bilateral exiting L4 nerve roots and causing compression of bilateral travresing L5 nerve roots, compression further augmented by the bilateral facetal hypertrophy
L5-S1: Normal
Lateral recesses: Effaced at L4-5
Facet Joints: Bilateral facetal hypertrophy noted from L2/3 to L4/5 with significant spinal canal and foraminal compression at L4/5
Ligamentum Flavum: Thickened at L4-5
Bony spinal canal dimensions: Decreased at L4/5
Pre and paravertebral spaces: Normal
Visualized spinal cord: Normal
Conus Medullaris termination: There is 2.8X1.3X1.4 cm sized CSF signal cystic structure noted within the conus medulalris expanding the conus suggestive of ventriculus terminalis
Visulaized sacroiliac joints: Normal
IMPRESSION
62 year old female with bilateral neurogenic caludication,
MR SPINE LUMBAR demonstrates:
Grade1 anterolisthesis of L4 over L5
Diffuse disc bulge and bilateral facetal hypertrophy at L4-5 causing moderate impression on the thecal sac, abutting bilateral exiting L4 nerve roots and causing compression of bilateral traversing L5 nerve roots. Diffuse disc bulges from L1-3 to L3-4 causing mild impression on thecal sac.
Ventriculus terminalis in the conus medullaris.

Queries:
1. What will be best line of treatment for her?

2. If any physiotherapy is going to help, what would be it?

3. Any alternate/ non invasive methods that can help?

Thanks

Thank you for specific answers.

Sir, Can you please explain the details of the scan? why is it increasing difficult to walk these days? can you please detail how serious the findings of MRI are? How long will it before it start hampering the life?