Disc problem causes lower-back pain

Q: I have lower-back pain and would like your opinion about what I should do. I had an epidural injection in April 2006 but still have pain. I also saw a chiropractor but couldn't afford to keep going. I have enclosed the results of an MRI of my lower back I had done in September 2006. I am a 57-year-old female.

A: According to the report you sent me, the MRI impression reported "multi-level degenerative disc changes." Taking a closer look at the findings, I note that most of your lower back appears normal. Two of the discs show mild narrowing and mild to moderate desiccation (drying). One disc also shows a "small subligamentous central disc protrusion with slight effacement of the thecal sac." This lovely little gem of "medicalese" simply means that one of your discs has been squashed, causing the soft inner part to bulge, which has thinned an area of the membrane that covers the spinal cord and contains the spinal fluid.

All in all, your MRI is not bad. I am, however, concerned about the disc protrusion that has caused thinning of the thecal sac. Without treatment, this could worsen and lead to a hole in the membrane, causing the spinal cord to be exposed and allowing it to be damaged easily.

You have been in pain for more than two years. You need to make an appointment with the physician who ordered the MRI. He or she should then order a follow-up MRI to see whether there is new damage and to asses the extent of the damage. At this point, you should also ask what treatment options he or she recommends.

Don't let lack of money prevent you from seeking medical treatment. If you let this go, you risk permanent damage and disability. If your physician is unwilling to make payment arrangements and/or lower his or her fees, find someone who will. You may also wish to try to get temporary medical assistance through your local department of social services.