From the June 2008 The “G”Note
This is a case of a male, aged 53 years, who demonstrated some restoration of the L3 disc space. His initial primary complaint was left lateral hip region pain and inflexibility and constriction. He said that the area felt “tight and jammed.” Thee was lower lumbar and right laeral sacral border pain. Significant pain was noted 80% of the time and limited overall household function about 20%. The prior year, he had had intense lower back pain from heavy lifting that was diagnosed as a “herniated disc.”
In the initial film of 12/13/2006, the L3 disc space would be best described as a D6 disc – there is some anterior wedging but miniscule spacing at the posterior. In the second film of 2/28/2008, a well delineated space appears both anteriorly and posteriorly.
There was some thought that the changes to the disc space might be due to a change in perspective or lateral curve of the spine (AP film). It is noted that the “hour glass” effect of the L4/L5 endplates is reduced on the second film which may add to the appearance of the improved L3 disc space. However, that cannot account for all of the effect as the both APs show the same measured vertebral tipping and wedging. The upper lumbars do not demonstrate the “hour glass” effect.
Comments by Steven Tanaka, DC – “G”Note Editor: This is a tough call. Dr. Martin and I discussed the case and after repeated viewing of the images, felt that there was disc space change, in spite of potential perspective changes between the two films. The time sequence is about 14 months. One wonders what a few more years would produce.
The L2 and L3 relationship appears to be improved. That will also influence the L3/L4 disc.
If filling did occur, what would fill the space? It is likely reducing subluxations allows some disc cell synthesis to re-initate and increase the number of cells and water content and the all important neurological function, in particular, mechanoreceptors. It is highly unlikely that distinct anulus fibrosus and nucleus pulposus regions will be restored – with significant disc degeneration, the two regions become indistinguishable.
If you have any pre- and post-x-rays where there has been a distinct improvements in the disc space, we would like to see them.