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Old 04-27-2005, 09:19 AM   #1
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gmonsterfrog HB User
Help with reading MRI and....

Hello all, I was wondering if someone could explain some of these terms in simple terms for me. I have 2 reports and was wondering why the two would be so different? At least I think they are I'll explain as I go:

1st MRI report before surgery:
Findings: L1-2 disc normal. Neural foramen open.
L2-3 disc normal. Minimal facet hypertrophy.
L3-4 Disc has small focal prominence posteriorily just left of midline. Most consistent with very small herniation. Due to size, clinical significance would need to be questioned.
Mild-to-moderate facet hypertropy at this level. Neural foramen open.
L4-5 Mild focal prominence related to posterior aspect of disc central. Appearance is more suggestive of focal bulging as opposed to herniation.
Mild facet hypertrophy at this level. Some narrowing of the space available of the thecal sac and there may well be some mild central stenosis here. Neural foramina at this level open.
At L5-S1 there is marked focal abnormal prominence of the posterior aspect of the disc, to the left of the midline. The apprearance would be most consistent with a large herniation here. Given it's location, I would expect this to affect the descending S1 nerve root on the left here.
IMPRESSION:
1. Herniation L5-S1 on left.
2. Very small herniation L3-4 to left. The significance of this questioned.
3. Some focal bulging L4-5 and possible mild central stenosis here.



Second MRI after surgery,I've had more but I'm just using these as examples: 02-02-05
MRI Lumbar spine.
Techniques T1 and T2 weighted image sequences in axial and sagittal plane were submitted through the lumbar disks.
Findings: Sagittal image sequences shows normal signal characteristic of the vertebral bodies with no evidence of masses or compression or fractures. Conus medullaris terminates normally at L1-2 level. The vertebral disks at L4-5 and L5-S1 has lost it normal bright signal on T2-weighted image consistent with degenerative disk disease. There are degenerative diskitis changes in the end-plates around the L4-5 and L5-S1 disk.
Axial images at:
L2-3 shows normal disk signal. No stenosis. Neural foramina, lateral recess and facet joints are normal.
L3-4 shows circumferential disk bulge. No stenosis. Neural foramina, lateral recess and facet joints are normal.
L5-S1 there is left paracentral disk extrusion with narrowing of the lateral recess. No significant spinal stenosis. There is posterior laminectomy in the level. The right lateral recess and neural foramen are patent.
Impression:
1. Left paracentral disk extrusion at L5-S1 causing narrowing of the left lateral recess at that level. There is no spinal stenosis, however, There is posterior laminectomy at that level.
2. Circumferential disk bulge at L3-4 and L4-5 No significant spinal stenosis. : remail patent.

Ok now I realize that there are different ppl (radiologists if I'm correct), reading the impressions but the language from the 1st and 2nd MRI are very different to me. The first says mild stenosis and the second not. Can something like that just disappear? I did see narrowing, but not stenosis. Is narrowing meant to be the same thing? I understand what bulging, herniation and such are but the words like: Neural foramen, lateral recess and facet joints, Conus medullaris terminates normally at L1-2 level, Mild-to-moderate facet hypertropy, these are some of the examples if someone could help me with understanding terms. I would appreciate it greatly!!

I was telling my Ortho that I was having lots of pain and wanted an MRI and he just wouldn't do it for me. He told me he didn't feel it was necessary. After I was told that I felt like he was almost hiding something. To the eye, it looks as if nothing was done by MRI view. I am no Dr. so I could tell for sure, but I thought I would see a noticible different after having the surgery. I had "Bilateral L5-S1 decompression, and diskectomy on the left side L5-S1". I do feel if I am asking for something I should be able to get it. My ins. will pay so why not. I personally wanted to see what was done during surgery. So I kept asking every Dr. I saw and the one who finally did it almost a year after surgery was my PCP. I had my surgery in May of 04, and the MRI in Feb. Isn't that a shame. Thanks to everyone here. This is a great place to be.
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Old 04-27-2005, 09:31 AM   #2
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victorsch HB User
Re: Help with reading MRI and....

I'll try to help you.

It looks as if yes, there were two different people reading the MRIs. Unfortunately, some of what they view is open to interpretation. The first impression stated that there was a "possible" stenosis, but they basically are covering themselves, because if there is, then they look like they were right, and if there isn't, they never said that there was definite stenosis. Know what I mean?

As far as terminology, here we go:

Neural foramen: The holes through which the nerves pass
Conus medullaris: The end of the spinal cord, which looks like a "cone" (and it does end in the lumbar spine normally), and it is "terminating" or ending at the L1-L2 levels
Lateral recess: The opening on the sides of your vertebrae where the nerves come out to go to the rest of your body
Facet joints: The "joints" that are formed when the two vertebrae come together (for example, C6 and C7 have what are called "facets" which you can look at like pieces of bread. C6's inferior facet makes a sandwich with C7's superior facets.)
Facet hypertrophy: When the facet joints become degenerated and lay down more bone, they become larger, or "hypertrophied." The problem with this is that it narrows the "lateral recess" so there is less room for the nerve, which can cause symptoms.

Hope this helps! I just love medical terminology! Don't you?

-V

Last edited by victorsch; 04-27-2005 at 09:32 AM.

 
Old 04-27-2005, 09:33 AM   #3
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et318 HB User
Re: Help with reading MRI and....

Silverdmd,

Facet hypertrophy = facets are small joint articulations on the posterior part of the lumbar spine. Hypertrophy is basically arthritis. These joints are what allow the spine to move while maintaining stability. Irritated facet joints can cause low back pain. By the way, some radiologists do a poor job of reporting facet hypertrophy because they do not think it is clinically significant. Some do not know / believe that facet joints can be pain generators.

Neural foramen - Nerve opening is the best way to put it. This is the canal that your spinal nerves use to exit from the posterior part of your spine. On posterolateral or lateral disc bulges the spinal nerves can be impinged in the neural foramen. These openings can also be narrowed due to poor alignment of the vertebra.


Conus Medullaris - This is just the terminology that describes the cone shaped ending of the spinal cord. In most adults the spinal cord terminates between the 1st and 2nd lumbar vertebra. You then have a series of nerves called the cauda equina that proceed from there and the spinal nerves that form from that exit through the neural foramen.

By the way, it seems that your disc herniation is back from your previous surgery. Your L3-4 disc bulge also seems to have progressed to a circumferential bulge from just being primarily on the left. You may want to consider second opinions on surgery, conservative treatment with a knowledgeable PM doctor who specializes in interventional pain treatments or ADR.

Good Luck

 
Old 04-27-2005, 09:39 AM   #4
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victorsch HB User
Re: Help with reading MRI and....

et318,

Well put! Thanks for the backup!

-V

 
Old 04-27-2005, 07:07 PM   #5
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gmonsterfrog HB User
Re: Help with reading MRI and....

I wanted to say thanks to both victorsch & et318 for your time with being my personal translators. I'm funny HUH!! I have a few questions about a few things you wrote in your responce if you don't mind.
[QUOTE]You may want to consider second opinions on surgery, conservative treatment with a knowledgeable PM doctor who specializes in interventional pain treatments or ADR.[/QUOTE]
Second opinions on surgery meaning another lami, or fusion or something, correct? My Ortho has mentioned fusion to me twice since and it's a scary thing. I think sort of like this, this lami didn't work so what are my real chances of having a successful operation. And after reading a lot of the material here, seeing things either don't work or more surgery needed and such. I just wish there was a fool proof way to go about this. If I was guananteed an outcome, positive of course, I wouldn't hesitate. I think if I get to the point of not being able to walk again then I'd be forced to do something. Is this a stupid way of thinking? I'm not sure
Another thing-interventional pain treatments? what's this? I have had 2 epidurals without much success, and am scheduled for a third on 5-3-05. I don't see the point in these if they don't work. I think this will be my last if I don't see an improvement. Good or not good idea?
I was going to ask what ADR was but it popped into my heas all of a sudden, Artificial Disk Replacement,correct? See this site is teaching me lots!! Can I ask why you say ADR? Does my MRI sound bad? Now I'm freaking out. I'm gonna take a valium now. Kidding, but that sounds serious. Today I had an app. with my PCP and he now switched me from vicoden es to the duragesic patch 75 mg. That is just crazy, now I know why the other day I tried to help my husband and child do some of the gardening which I once loved to do but now can't, anyway I took the shovel and tried to get a plant up to transplant it in another place in the yard, I couldn't even do it. It just hurt so bad. Then the next few days I was getting this stabbing pain in my left side that was almost putting me on the floor. I guess I'm going to baby myself even more now. Since my surgery you wouldn't believe how easy I have taken it. I never overdo anything, and if it's something my son or husband can do I leave it for them. I just don't know.

[QUOTE]Hope this helps! I just love medical terminology! Don't you? [/QUOTE]

It looks like I should take up medical terminology now. Maybe then I could know something of what these reports say. After surgery I picked up my reports and I brought it to an appointment and I was asking him all sorts of questions, what's this and that. I think he thought I was crazy, but why not just use English? HeHe.
Thanks again to the both of you, you really did help me out with this, and all the information you provided. I do appreciate all your help and every piece of info that your providing. Mary
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