Dear Dr. Roach: I am 44 years old and female. Nine months ago, I suddenly experienced severe low backache without any associated physical activities. I was bedridden for five days, though during that time I experienced severe spasmodic lower backache just in my back. My bowel and bladder function were normal. I had pain on lifting my right leg. With treatment, including a muscle relaxant, analgesic and physiotherapy, I was painless within five to six days. Seven months after my first pain attack, I again experienced similar pain while I was trying to take a step in staircase. I had no history of trauma or severe physical activity. It has already been 15 days, and I still feel discomfort and feeling of pressure in my back. But I was able to walk after three days with the same medication I took previously.
My MRI report says “focal central disc protrusion with posterior annular tear at L4 L5 level without any neural or spinal canal stenosis.”
I also have tuft of hair at my sacrum area. What is my diagnosis and treatment? Am I suffering from spina bifida? I feel as if I have slipped vertebrae in my back with each attempt to bend. Still now, I cannot bend my body.
R.K.
After going over your entire MRI report, let’s first review the problem with your disc. The intervertebral discs act as shock absorbers and spacers between the bones of the back. The spacing allows the nerve roots the room they need to come off of the spinal cord. These discs consist of a gelatinous centre, the nucleus pulposus, which is held in place by the tough annulus fibrosis. A herniated disc (sometimes still called a “slipped disc,” which is a misnomer) is when the centre part pushes out through a tear in the annulus fibrosis. Sometimes, the disc material presses on the spinal cord or on the nerve root, causing pain, numbness or weakness in the areas supplied by that nerve. You have a herniated disc, although the disc material was not pressing on the cord or nerves at the time of the MRI.
The report also found multiple areas of degeneration and bony abnormalities, and these are consistent with the diagnosis of osteoarthritis of the spine.
As for your question of spina bifida, that is a whole spectrum of conditions involving abnormal development of the “neural tube,” parts of which will become the spine, and which sometimes involves skin and other structures. Incomplete forms of spina bifida are called “closed spinal dysraphisms,” and some of these might not be diagnosed until late in life. A tuft of hair at the sacrum, the base of the spine, is a clue that this might be going on. However, there is no evidence on your MRI of a neural tube defect.
You have symptoms that are a combination of both herniated disc and spine arthritis.
Medicines and physical therapy are the right treatment. Surgery is occasionally necessary, but I see no need for it in your case.
Dear Dr. Roach: Why do I get lightheaded just before I have a bowel movement? This happens during the day or in the evening.
R.E.
This is due to stimulation of the vagus nerve, which provides the nerves to your gut but which also can slow down the heart. Yours is an exaggeration of a normal reflex. It can be extreme, with some people fainting when going to the bathroom. Making sure you have adequate fluid and avoiding straining are the first steps in treatment.
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