Severe pain in top of left shoulder, and constant pain in left buttocks and posterior thigh and knee. Sometimes the pain goes down to the ankle. My pain is so bad, I get very little sleep, and it is difficult to function. I have been taking Arthrotec and Darvocets for the pain with little relief. I am seeing a neuro-surgeon Monday. I need help understanding my MRI Results.
MRI Lumbar Spine:
Disc desiccation at L1/2, L4/5, and L5/S1
Osseous degenerative changes present at the L4/5 and Posterior inferior L1 levels.
Vertebral hemangiomas noted at L2 and T12.
Conus is positioned at mid body L1.
Findings at individual disc levels are detailed below:
L3/4: Central left paracentral disc protrusion with small annular tear centrally. No central or neuroforaminal stenosis.
L4/5: Disc narrowing. Generalized disc protrusion without central or foraminal stenosis. Mild facet arthropathy.
L5/S1: Mild central disc protrusion without foraminal or canal stenosis.
No sacral abnormalities.
No evidence of aortic aneurysm.
Impression: Confined annular tear at the L3/4 level and multilevel disc protrusion from L3/5 through L5/S1, not producing canal or foraminal stenosis.
MRI SPINE CERVICAL:
Full Result: There is evidence of a moderate-sized herniated nucleus pulposus identified at C5/6 with some spondylosis resulting in significant compression of the thecal sac. There is no abnormal cord or marrow signal noted.
Impression: 1) Moderate sized herniated nucleus pulposus, central, broad-based seen at C5/6 with some spondylosis resulting in significant compression of the thecal sac.
2) Minimal spondylosis noted at C6/7 with little or no imprinting on the thecal sac.
I have gone through PT for over 12 weeks with no relief. They gave up on me and told me to see a surgeon.
Thanks for any help anyone can give!
Last edited by kentuckywoman; 05-23-2010 at 12:48 AM.
I can "translate" some terminology for you but cannot say what these changes mean - it's not that helpful, really, but I feel for you and hope this helps you to cope with your situation (by the way, ask your doctor or a surgeon to go through this report with you line by line and write down what they say).
You have this at two levels of the spine, without any stenosis of any kind (for explanation of stenosis - see above).
Sacral = pelvis. Your pelvis is fine, according to the report.
The disc pathologies visualised are causing no stenosis. This is good. (Never mind asking for protrusion size estimate, then. They probably can't measure off of the MRI since there is not enough to stenose anything).
This reading is good. But you have degeneration which requires constant care on your part so it doesn't worsen too quickly or catastrophically. That means PT, it means core strengthening exercises (NO SIT UPS. Not the kind of core strengthening we popularly think of in our culture - by "core" I mean, the deepest abdominal muscles, the paraspinal muscles, the pelvic muscles, etc. - seek a very good PT - and by PT I mean someone who has more than a 4 year college degree, and not a "sports therapist." You want someone who really grasps the spine and knows how to strengthen without hurting discs or soft tissue.
Avoid long periods of sitting.
That tear, if real, poses a risk for big problems down the road. Sitting is really bad for annular tears, so get up and stretch every once in a while.
For disc decompression, I was prescribed PT in a swimming pool, and would hang in the pool - with a "noodle float" under the arms - deep enough so I wouldn't touch the bottom of the pool - for at least 20 minutes at a time three times a week. It worked wonders. (That was while I still had a disc there). You can discuss these things with a PT. But to be effective, disc decompression treatment must be for at least 20 minutes (I don't know why, but I have read this and been told this by PTs, surgeons, etc). So. . . hope this helps!
Osseous degenerative changes present at the L4/5 and Posterior inferior L1 levels.
Osseous = bone. Posterior = Rear; inferior = below
Basically, this refers to the facet joint at the L4-L5 level and the rear lower facet at L1.
(The facet joints are at the rear of the spine - at each level of the spine two emerge from the top of any given level, and two from the bottom - these "meet up" - in sort of a "functional" handshake. My understanding is that the function of facet joints is to stabilize the spine. From reading spine studies, I learned that when discs degenerate (meaning, get small), so do the facets - only they may enlarge in the degenerative process - to compensate for the fact that the disc is not absorbing as much pressure anymore. In any event, your MRI report would seem to indicate that you have enlarged facets. There is a finding of no stenosis at L4-L5. This means there is no narrowing of the "free spaces" for nerves to pass through. There are two types of stenosis, as far as I know: central canal stenosis and transforaminal stenosis. Central canal stenosis means there is a degeneration of structures that shrinks the available space for the spinal cord. Transforaminal stenosis (there are other names for this) refers to narrowing of the space through which the spinal nerves pass, and is affected by the placement of the facets. Therefore, this report suggests that there is NO narrowing of the spaces the nerves need to pass through, but I would confirm this with a surgeon or some other expert, to confirm this finding (always good to be certain of things).
A hemangioma is a vascular growth of some kind. I have no idea what a "vertebral" hemangioma is, other than it sounds like this is found in the bone on which the disc sits (the "pad"). I would ask the prescribing doctor about this one.
Dessication means "drying out" - A "healthy" disc is like a pad of jello on the inside with really strong fibers surrounding the jello. It's the spine's shock absorber, amongst other things. (It also participates in communication with surrounding muscles, as I read in a really interesting study - can't recall the name at the moment) anyway, A degenerated disc has lost its "form" - it tends to flatten out a bit like a pancake. The more degenerated, the flatter. Degeneration brings more degenerative changes and the disc can start to become brittle or dry. (In my case, it was found in dried tiny, ground-down pieces - pretty much non-existent). So, your discs are "dried out" or "drying out." This merely means "degeneration," but how extensive, I don't know. Again, it is a question to ask.This degeneration is present at L1-L2 (disc in the topmost spinal unit in the lumbar spine), L4-L5 and L5-S1 (the disc at the lowest spinal unit in the lumbar spine). Because L5-S1 is the part of the spine that bears the most weight, and L4-L5 is the most important for weight-bearing while in motion, I recommend asking the expert who ordered the MRI for advice. In the studies I read about disc pressure and motion, twisting and rotation movements seem to be "bad" for L4-L5 ESPECIALLY when weight is applied. So, I would avoid twisting. NO BENDING FROM THE WAIST DOWN - squat instead, and bend the knees, keeping the back nice and straight (any PT or chiropractor will tell you this)! Save L5-S1 and L4-L5!!! Also, try not to hold your hands over your head for too long - ie: painting ceilings. Not great for pressure on the lumbar spine - again, according to studies that I read.
Anyway. . .at L3-L4, there is a "left paracentral disc Protrusion" with central annular disc tear. I don't know how they saw this annular disc tear, unless it's on the outermost margin of the disc (from studies I read, and from personal experience talking to orthopedic spine surgeons, my understanding always was that in order to really "see" a disc tear within the disc, a discogram is needed. Therefore, this tear sounds like it is on the "outer rim" of the disc itself. This sounds like the kind of herniation where the disc has an outer tear, and the disc material may have oozed out, or it could mean that there is a tear, which has healed over - so it's not an ooze of disc material, so much as that the disc is being squashed beyond the margins of the pad. Also, I am unfamiliar with "protrusion" - ask whether the disc is forwardly protruding or posteriorly (backwards) protruding. (Discs almost never forwardly protrude, but it has happened in human history, so. . .) It is worth a conversation with the person ordering the MRI, or the neuroradiologist who read it, just to get clarification. Again, i would ask how they determined that there IS a disc tear (did it look white? was there extra intensity on the image?) and also, how BIG is the protrusion? Can they measure it in millimeters? (Mine was an extrusion - huge - which measured 10x10x15 mm. Believe me, you never want what I had!) Also,
Last edited by Administrator; 05-25-2010 at 12:12 AM.
Part of my post had gotten cut off! I started talking about disc dessication and that got dropped off, somehow.
My second paragraph started off with the finding of disc dessication. Basically, a "normal" disc is plumb and gelatinous on the inside. With lots of fibers keeping the "gel" safe and contained. Well, as we age, after years of pressure, etc. discs tend to "flatten down." this flattening is really, when you think about it, a "dessication", which means "drying out." (It's less "goo" and more "tough" and brittle.) It does not sound like your dessication is really bad, because if it were you would see some stenosing (there is a continuum of degeneration: it starts off without bone - or osseous - pathology but then osseous pathology occurs).
Osseous pathology: in your case, they found no stenosis. This is good. Osseous = bone.
(This cut off from my prior posting also, so I am rewriting it). The function and purpose of the disc is to shock absorb. When it gets flatter, it works less effectively. Also, it has to bear weight so the nerves that pass through the facets don't get squashed on top or bottom.
The facets are those bones that stick out on either side of the spine and "handshake" with one another." There was mention about posterior and inferior osseous changes on the MRI (I can't see the language from this view). That refers to enlargement of the facet joint. As discs degenerate, they tend to shrink, and to compensate for the diminished functionality of the discs, the facets (bone structures) expand. That sounds good, except for when they get "too big" they cause problems. It seems like you have some osseous enlargement on the left and bottom facet joint that is not causing any damage or potential damage to nerves in the neighborhood. But this only means that it is wise for you to attend to this finding by seeing a PT and getting a list of do's and dont's - and make sure that the advice is good. (I was told to do bike riding for my degenerative condition. I rode a bike like a fiend for many years; when the disc finally ruptured and splattered all over my s1 nerve, the neurosurgeon shook his head and said, "You should never have biked.") So whenever a positive recommendation is made for a treatment, follow up with a second opinion to be reasonably sure that the recommendation is safe.
After reading your MRI report, I went back and noticed your "pain profile." There is nothing obvious on the MRI report to explain the radiating pain down the legs. That can mean it was misread (Mine was misread to the point where a first grader could have done better - as one anesthesiologist-pain expert told me later, "I only saw a larger disc herniation once in my entire career - almost 1/2 of your S1 nerve is being pinched off - and meanwhile my radiology report said, "No impingement on spinal nerves." There you go!). So: Make sure the MRI reader was a NEURO Radiologist.
Also, did you have contrast administered during the MRI? (Did anyone give you an injection during the MRI procedure?) I don't know how much more detail contrast provides, but I do know it's more detailed than without.
What was the resolution of your MRI? Were the images clean? Clear? Hi res? (I only ever insist on 3.0 tesla resolution. Why accept less? If there's no 3.0 machine near you, try to get as close to 3.0 as possible. Many machines are 1.5, which is only 1/2 as detailed as the new machines, so. . .)
Find out the resolution of the machine that took the images, and research the name of the person who issued the report. Just to be safe.
I would also get a CD of the images and send them to a known expert. You're in Kentucky, and there is a really famous guy down there that my ortho trained with. I can't recall his name to save my life. . . I have an ortho appointment on Tuesday, and if I can remember (I take so many pain meds it's difficult to remember anything anymore) I will get his name for you. I believe he is in Louisville. He may be retired, but you can certainly ask around, or see if you get a referral from him.
Studies have shown that radicular pain (pain down the leg) can issue from a painful disc in the spine. (This would mean an orthopedic surgeon would possibly want to do a discogram. I don't want to scare you, but I thought having a disc rupture was miles better than the pain on discogram - then again, I had a very severe problem, so. . .). What is a painful disc, you may be wondering. This painful disc phenomenon occurs when/after a disc has been torn up on the inside. A disc can look relatively "great" on MRI, but a discogram can show little tears inside the disc fibers. At some point (and I am not expert enough to give a great explanation), the tearing of a disc can cause nerves to grow like weeds into it. (Like weeds in the crack of a sidewalk). This can be very painful, especially on standing or sitting (this is how my orthopedic surgeon explained this to me).
Before doing any discogram, should this subject ever come up, it could be that an fMRI would be useful.
An MRI images your spine while you lie down. But what happens when you stand or sit? How do the structures of your spine bear weight when sitting? So a "functional MRI" shows what structures do when you are "functional." Meaning, when standing or sitting.
It could be simply that you have a tear that hasn't healed yet. It can take time (weeks/months) for a tear to heal. Until then, it can be "symptomatic."
If instead, there is a structure that impinges on a nerve in certain postures or when you bear weight, which is more easy to diagnose on fMRI than plain old MRI, then that would be something to discuss with an orthopedic surgeon. (If there is nerve involvement, I would consult both ortho & neuro surgeons).
I hope this gives you some starting points.
FINALLY, DID ANYONE EVER X RAY YOUR HIP?! No joke, but you could have a hip problem, too, so get hip X Rays!!!!!
Thank you so much for taking the time to explain all these terms so that I have a much better understanding. I now know a lot more about what questions I should ask the neuro-surgeon when I see him tomorrow. I have had hip x-rays with only minor arthritis showing.
Last edited by kentuckywoman; 05-23-2010 at 07:56 AM.
Thanks to 3surgeries, I went to the neurosurgeon armed with a whole list of questions. The Dr. was very patient and answered all my questions. He went through the MRI films and pointed out each problem area. The C5/6 disc is ruptured, and has the nerves seriously pinched. Even I could see how pinched they are. So for the C5/6 I will need bone grafts with fusion. The lower 2 lumbar discs are totally shot. He said they are completely flat and dried up. Again he showed me this on the MRI, and it was very easy to see the difference in these discs and the healthy discs. I had seen this same surgeon 10 years ago and he still had the MRIs from that time. He showed me the changes from then and now. So this is going to require bone grafts with fusion also.
I have to have the cervical surgery first. The neuro said as badly as the nerves in my neck are pinched, that it is too risky to put me to sleep lying on my tummy until that is repaired. I am scheduled to have the first surgery on June 18.
Day 12 for me from L-4-5 interbody fusion. After surgery, it sounds like you are heading that way, do EXACTLY as doc and PT tell you. Try to be up and walking the same day. Try to climb the steps the PT will require before going home. Drink lots of fluids after surgery as the amount of production of urine is a factor of going home sooner. When home, have a toilet riser and a walker. Expect brusing below incesion and not having a stool for several days after surgery. Take stool softners with supplement of fiber like metamucial and eat a high fiber diet like raisin bran, apple sauce, prunes etc...