Lumbar Spondyloarthrosis

Diagnosis

Degenerative-dystrophic changes of the lumbar spine of grade 3 osteochondrosis, grade 3 deforming spondylosis, grade 2 lumbar spondyloarthrosis with synovitis, complicated by circumferential bulging, intervertebral disc protrusion at L3–4, and herniation at L4–5 and L5–S1.

Patient’s Complaints

Lower back pain began about 15 years ago, infrequent and tolerable. Previously, I had kidney problems, so I thought the pain was coming from the kidneys (I took painkillers when necessary). In October 2021, I had COVID-19, and during that period, the first severe exacerbation occurred. I couldn’t walk or stand. Since then, the pain has never fully subsided. That was when I learned about the spine issues. Over the past three years I periodically received injections — painkillers — and was given dietary recommendations.

Currently, the lower back pain radiates into the right thigh. I can only sleep on my right side. I cannot sit for long. Bending forward is almost impossible, as it immediately causes pain flare-ups. Walking or standing provides relief. I cannot describe the exact character of the pain, but it feels as if something is being torn away.

Response from Spinal Surgeon Dr. Bitter

MRI scans of the lumbar spine show a pronounced spondyloarthrosis, especially in the coronal projection, with prominent lateral osteophytes. The spinal canal itself is rather wide. There is no clinically significant or visible compression of the neural structures. This suggests that we are dealing with pseudoradicular pain — that is, pain not directly associated with nerve root compression.
There may also be coronal (lateral) micro-instability at the L3–L4–L5 levels with the formation of a left-sided tilt of the lumbar spine. In addition, the images show significant muscle atrophy with fatty replacement, especially at the L5–S1 level.

In this case, conservative treatment must be initiated first: intensive and regular therapeutic exercise, periodic massage, and physiotherapy. If improvement does not follow, we recommend periradicular, facet joint, and para-articular blocks using an anesthetic solution and injectable cortisone. Additionally, thermal coagulation of the facet joints and sacroiliac joints may be considered.
Only as a last resort would surgery be indicated — lumbar spinal fusion, whose aim is stabilization of the spine using pedicle screws and intervertebral cages at L3–L4–L5 and possibly additionally segment S1.

The sooner treatment begins, the better the outcome. Leave your request now: +49 170 62 47 020

Patient’s Questions

• I was told that one of my legs is shorter than the other and that this may negatively affect my back overall. Can you advise something?
• Please tell me what type of massage is allowed for this condition (in Belarus they told me it is contraindicated), or is it strictly individual?
• Do you have a video example of suitable therapeutic exercises? I am currently undergoing physical therapy.

Doctor's response

• A difference in leg length affects pelvic alignment and can overload specific spinal segments — this varies from person to person. If the difference is significant, an experienced orthopedist will easily select appropriate orthopedic insoles. In rare cases, special footwear is needed.
• There are no contraindications to massage in your case. Ideally, you should consult an experienced manual therapist who can assess the broader picture. Such a specialist will choose the appropriate massage technique. You can combine deep classical massage with trigger-point massage and stretching.
• I do not have my own channel. But the key is not a specific exercise — it is regularity and duration. Exercises should ideally be done every morning for 30 minutes, covering all sections of the spine and engaging major joints: hip and shoulder joints. Don’t forget about abdominal muscles. In the evening, you may add 30–60 minutes of additional training. To avoid fatigue and allow different muscles to recover, alternate the activities. For example: 2–3 times a week running or long-distance walking, and on other days — something different. Choose what you enjoy. Consider a rowing machine — it trains all muscle groups, despite the common misconception that it targets only the lower back. There are many training examples online. During acute flare-ups, local steroid therapy (e.g., Diprospan) can be used. For osteoporosis prevention, consult with an orthopedist or endocrinologist.

Patient’s Review

If you are searching for the correct diagnosis, treatment, or want a second opinion from Germany’s top doctors — feel free to contact GHP Pulse. I can say that Konstantin and his team can help solve any issue in the shortest possible time. Even the New Year holidays were not an obstacle, which pleasantly surprised me. Competence, speed, responsibility, and humanity. It is impossible not to notice that Konstantin’s work is not a commercial project, but a sincere desire to help people.

Thank you!

The treatment examples presented on our website are for informational purposes only and should not be used as medical advice. Medications must be taken only as prescribed by a physician.