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Old 12-17-2010, 05:28 AM   #1
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lower back pain radiating to legs, especially right leg

Hi All,

I need your help to u/stand my MRI reports.

I have lower back pain since few years but it got diagonsed in Dec2009 when I went for MRI (Lumbo Sacral Spine with Screening of Whole Spine). Now again I went for same MRI.

New MRI results:
1) Diffuse annular bulge with posterocentral annular fissure of L4/5 intervertebral disc indenting the thecal sac and abutting the bilateral exiting L4 nerve roots.
2) Diffuse bulge with right paracentral annular fissure of L5/S1 intervertebral disc indenting the thecal sac and compressing the exiting right L5 nerve root.

Old MRI results :
1) A transitional vertebra at the lumbosacral junction (S1) is lumbarized
2) Minimal retrolisthesis of L4 vertebra over L5 and L5 vertebra over S1
3) Mild diffuse bulge of L5/S1 disc
4) Diffuse bulge with focal posterocentral annular tear and protusion of S1-2 disc

[COLOR="red"]Comparing the two above reports, can anyone tell me whether the results are worse or better and explain the meaning for these both results ?[/COLOR]

I am having tremendous pain in my back and legs. Also has numbness.
I have got the nerve block injection too after my first MRI and have done physiotherapy too.

[COLOR="red"]Can anyone tell me the treatment for the above problem ?[/COLOR]

Thanks

 
Old 12-17-2010, 06:18 AM   #2
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Re: lower back pain radiating to legs, especially right leg

Welcome to the board.

More important that what each report states is what the physician looking at both MRIs side by side will discover in the images. The written report by the radiologist are "highlights" of the MRI, the things the radiologist felt were most important. But the doctor who is treating you, who looks at the images will notice things that are not mentioned in the report.

I am not a doctor or trained in medicine in any way, just a fellow back pain sufferer, but what I notice is that it looks like the bulging discs have gotten a bit worse. They are now pressing on the exiting spinal nerve roots at L4 and L5. Any compression of these nerves can cause you to have pain in your buttocks, and run down the back of the leg and even into the foot. If you want to do some research, look up "dermatome map" to see the area of the limb that these nerves innervate.

After conservative treatments are given a chance to work, a surgery procedure to decompress the nerves is sometimes recommended.

I hope you are seeing a spine specialist. She/He will be able to explain your MRI findings and propose a plan of treatment.

 
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Old 12-19-2010, 12:12 PM   #3
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Re: lower back pain radiating to legs, especially right leg

A lot of medical terms there that really need to be explained to you by a doctor. I think I know what's wrong but I'm going to zip it at the risk of being wrong. (and also not having any medical degrees)

Plain and simple: You need a neurosurgeon to speak with you. No patient is EVER expected to get the radiology report and interpret it themselves. There is always a follow-up appointment after an MRI. Not sure what's up in your case, sorry.

Last edited by MikeMass; 12-19-2010 at 12:15 PM.

 
Old 12-19-2010, 01:58 PM   #4
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Re: lower back pain radiating to legs, especially right leg

Definitely see a neurosurgeon. They will possibly not even read the report as they usually look at the film first and usually can tell you strait up the treatment they recommend. By the sound of the report though and if you have been in a lot of pain and have leg symptoms the doctor may well recommend surgery.
In my case he asked me if this is what I wanted and if I was ready for that. As I had spent a long time looking for the right surgeon for me and he confirmed what my research had turned up. I agreed that the surgery was a priority for me and I had tried all sorts of treatments first. So he recommended fusion at L5-S1 and a disc replacement at L5-4, but as it turned out he only needed to do L5-S1.
After the surgery he said that level was very bad and was causing all the nerve compression and he didn't touch L4-5. So I now hope that level will not need surgery in the future. So I plan to change my habits and be conscious that if I continue punishing my back I may damage it again. I intend on finding a different trade to work in and will not be doing physical labour in future, that includes moving furniture and the like as I have in the past. I just don't want to go through this again. Besides I will probably have some back pain for the rest of my life anyway.
Finding a good neurosurgeon who specialises in spine surgery is probably the most important thing so do your research and get a second or third opinion if need be. Let us know how you go.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 12-20-2010, 01:27 AM   #5
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Re: lower back pain radiating to legs, especially right leg

[QUOTE=allanbruce;4644423]Definitely see a neurosurgeon. They will possibly not even read the report as they usually look at the film first and usually can tell you strait up the treatment they recommend. By the sound of the report though and if you have been in a lot of pain and have leg symptoms the doctor may well recommend surgery.
In my case he asked me if this is what I wanted and if I was ready for that. As I had spent a long time looking for the right surgeon for me and he confirmed what my research had turned up. I agreed that the surgery was a priority for me and I had tried all sorts of treatments first. So he recommended fusion at L5-S1 and a disc replacement at L5-4, but as it turned out he only needed to do L5-S1.
After the surgery he said that level was very bad and was causing all the nerve compression and he didn't touch L4-5. So I now hope that level will not need surgery in the future. So I plan to change my habits and be conscious that if I continue punishing my back I may damage it again. I intend on finding a different trade to work in and will not be doing physical labour in future, that includes moving furniture and the like as I have in the past. I just don't want to go through this again. Besides I will probably have some back pain for the rest of my life anyway.
Finding a good neurosurgeon who specialises in spine surgery is probably the most important thing so do your research and get a second or third opinion if need be. Let us know how you go.
Allan[/QUOTE]


Hi,

Can you please provide me few more details.
Like when your surgery was done ?
Before surgery what all treatment you did ?
What the dos and donts after surgery ?
How worse or beneficial the surgery can be ?

you can add more things to it since that will help me...

I have been asked for the surgery but still thinking...

One more thing, can you tell me why you asked me to go to neurosurgeon and not the spine specilist or spine surgeon ?

Thanks

 
Old 12-20-2010, 05:06 AM   #6
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Re: lower back pain radiating to legs, especially right leg

My surgery was done on the 25th of November.

Before surgery I first tried physio then I did a course on pain management over several months with exercise. The doctor I did that with also started me on steroid injections. That was into the facet joints in my lower back. I also had a course of injections with a pain specialist over about 12 months every 4 to 6 weeks. He gave me 6 injections each time into the facet joints at L4-5, L5-S1 and at sacrum. But after the 12 months I could not take it any longer emotionally. It was like a roller coaster of having the injections done a few days of being sore from it then some relief from pain for a couple weeks then it wearing off and going back for another round. So I stopped them.

The muscular skeletal specialist I see now also tried nerve blocks and epidural injections but none really helped me for very long. The only relief was to lay in bed which I did a lot. I also tried walking and other exercises. But the sciatica caused me pain when walking. I had to use a walking stick. These problems started about 7 years into my chronic pain problems. I had these issues for about 18 months before surgery. I may have ended up in a wheel chair eventually if I didn't have the surgery.

Well does and don't, I suppose walking and rest with under 20 minutes of sitting is the main thing to know after surgery. There are plenty of treads on this subject and others you can read about here just do a search.

The same with surgery risks and benefits. For me it freed up the nerves that were being compressed and causing me butt and leg pain and weakness in my left leg and foot.

Well the neurosurgeon I went with is a spine surgeon and the training he would have done to gain that title would take a couple years more than an orthopaedic surgeon. But the main reason I went with a neurosurgeon was that the orthopaedic surgeons I saw didn't do the type of surgery mine did. And I was also told if you are not confident in your surgeon look for one who you are happy with and who feels right to you.

Like I said do a search here and read some threads on the anything you want to know..
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 12-20-2010, 11:47 PM   #7
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Re: lower back pain radiating to legs, especially right leg

I visited doctor y/day and I showed him my old MRI and latest MRI reports.
Doctor didnt see the reports, he saw the MRI films.

Interpretetion of old MRI :
1) I had a problem at C6-C7 which was just starting 1 year b4.
2) I had problem of buldges at L4-5 and DDD and disc had slipped from it place and had become non functional.

Interpretetion of new MRI :
1) Now problem at C6-C7 has increased by 25%. Means it is more severe.
2) Now addition to L4-5 disc there are few more injurys (buldges) at L5-S1 deisc and this disc had also stopped working and DDD remains same and L5-S1 has also become non functional.

Previously doctor has told me that I will require Level 1 surgery with disc replacement. But now he said that I will require Level 2 fusion surgery and not disc replacement.

He also said that the results are not good with disc replacement after 4 to 5 years. So he suggested me Level 2 fusion with controlled mobility plate placed inside my spine.

[COLOR="Red"]I want all of you's suggestions(those who had/has similar problem) wheather to go for surgery or rely on physio for atleast couple of months.Can my back be treated with physio or sooner or later I will require surgery ?[/COLOR]

My pain has worsened and doctor suggested me nerve block which I had one in feb2010.

Also I have Vit D deficiency and calcium deficiency.

Thanks

 
Old 12-21-2010, 12:03 PM   #8
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Re: lower back pain radiating to legs, especially right leg

Well I would be doing something about the vitamins and calcium first as that would effect your recovery quite a bit. And get out in the sun a little to help the D vitamins. I don't have that problem here as it is so hot and mostly sunny in Queensland, Though we have had a lot of rain this season. I have been taking a mens multi vitamin and zinc also vitamin C. I have also been told magnesium is good for the joints etc. Also I stopped taking celebrex a few weeks before surgery as anti-inflammatory drugs stop the inflammation needed for recovery along with aspirin etc and Fish oil. So if you do go with surgery remember to quit them before hand.
As far as surgery goes I suppose that is either a personal choise or if you can't deal with the pain any longer it is an option I would probably have chosen much sooner but I couldn't get a surgeon to operate on me before I had the bad leg prroblems. If you do already I think I would be going with the surgery. That is only my opinion though. As you have multiple levels it makes it a bit more complicated.
I wish you well and hope you are able to build up your health first
Allan
__________________
25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 08-27-2012, 10:36 PM   #9
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Re: lower back pain radiating to legs, especially right leg

[QUOTE=rony israni;4643097]Hi All,

I need your help to u/stand my MRI reports.

I have lower back pain since few years but it got diagonsed in Dec2009 when I went for MRI (Lumbo Sacral Spine with Screening of Whole Spine). Now again I went for same MRI.

New MRI results:
1) Diffuse annular bulge with posterocentral annular fissure of L4/5 intervertebral disc indenting the thecal sac and abutting the bilateral exiting L4 nerve roots.
2) Diffuse bulge with right paracentral annular fissure of L5/S1 intervertebral disc indenting the thecal sac and compressing the exiting right L5 nerve root.

Old MRI results :
1) A transitional vertebra at the lumbosacral junction (S1) is lumbarized
2) Minimal retrolisthesis of L4 vertebra over L5 and L5 vertebra over S1
3) Mild diffuse bulge of L5/S1 disc
4) Diffuse bulge with focal posterocentral annular tear and protusion of S1-2 disc

[COLOR="red"]Comparing the two above reports, can anyone tell me whether the results are worse or better and explain the meaning for these both results ?[/COLOR]

I am having tremendous pain in my back and legs. Also has numbness.
I have got the nerve block injection too after my first MRI and have done physiotherapy too.

[COLOR="red"]Can anyone tell me the treatment for the above problem ?[/COLOR]

Thanks[/QUOTE]

Dear Rony,
Sounds like we have alot of the same conditions. I was told I had a 5mm retrolisthesis of L5 around 2 years ago but the doctors acted as if it wasn't a big deal. I continued to have worsening symptoms of back, leg, and perineal pain. I eventually started having hips, knee, and foot pain, all worse on the right. Now it is to the point where I cannot sit, stand, walk, for very long, and I have perineal spasms that come on when I lie flat against sacral area or sit too long. I also recently developed plantar faciaitis, and sharp burning pains in groin area, as well as a feeling of having a burning belt half way around my waist on the right side. I've been to 13 different practitioners, ranging from GI, Neurologist, Orthopedic, rheumatologist, and Pain management doctors. I went through 4 months of physical therapy, chiropractic treatments, 9 L3/L4/L5 steroidal injections and 9 caudal injections.. I've tried every kind of gadget out there, massage devices, etc. All to no avail. I had a sitting MRI which showed the transitional vertebrae at L5/S1, DDD, facet arthropathy and some buldging discs at L4 and L5 and an osteophyte at L4/L5(which is a bone spur).
I decided enough is enough. Each of the doctors I have seen have only had limited knowledge of what could be causing these symptoms or the significance of them. They have only been able to keep me on medications. I decided to do my own research and try to find a way to fix this problem. I am a nurse, and even I, have been at a loss in trying to understand what is happening to me. I started searching for answers, and here is some of what I have found:
One thing for you to know is that the transitional vertebrae is very significant. It is a congenital birth defect called "bertolotti's syndrome". It is supposed to be a rare occurrence, but I think it is just being overlooked. I have met many others who also have it. There is one place that I found that operates on it. It is the Cleveland clinic. I believe that all the rest of the problems are a direct result of that birth defect and the fact that I fell on my sacrum when I was a teen, causing an injury that rendered me immobile for over a month. I am now 44 and I guess it is really starting to peak in severity. The Cleveland Clinic is quite far away for me, because I live in Louisiana. I am planning to take the information I have gathered to a well known neurosurgeon here and see if he would be willing to learn the surgery and perform it on me.
That tear you have in S1 and S2 will probably start causing you some sacral radiculopathy. That's burning pains in or around the sacral spine. I was diagnosed with Levator Ani Syndrome, Piriformis Syndrome, and Pudendal Neuralgia.
If you are having any of those other symptoms I mentioned, there is also a better test for looking at nerves than an MRI. It is called a MRN. Magnetic Resonance Neurography. A doctor in California developed it, but he is opening new radiology centers across the nation where one can get it done at. I think in your case and mine, we will have to do our own research and educate the doctors or make them aware rather of what is available. I believe some surgeons would be willing to take on a new challenge and learn about a new treatment if it were presented to them in a good way. This is my hope and prayer at least, because I cannot afford to go all over the country to seek treatment. I haven't had the MRN yet, but am scheduled to see the neurosurgeon soon and I am going to ask if he will order it for me. I am hoping I can get on the road to the right treatment with the new neurosurgeon. Best of luck to you in your search for relief. Feel free to write me anytime. I hope I can help one person not to have to go through what I have been through.
Good luck to you.

 
Old 08-28-2012, 01:23 PM   #10
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Re: lower back pain radiating to legs, especially right leg

[QUOTE=Krystalyn;5046704]Dear Rony,
Sounds like we have alot of the same conditions. I was told I had a 5mm retrolisthesis of L5 around 2 years ago but the doctors acted as if it wasn't a big deal. I continued to have worsening symptoms of back, leg, and perineal pain. I eventually started having hips, knee, and foot pain, all worse on the right. Now it is to the point where I cannot sit, stand, walk, for very long, and I have perineal spasms that come on when I lie flat against sacral area or sit too long. I also recently developed plantar faciaitis, and sharp burning pains in groin area, as well as a feeling of having a burning belt half way around my waist on the right side. I've been to 13 different practitioners, ranging from GI, Neurologist, Orthopedic, rheumatologist, and Pain management doctors. I went through 4 months of physical therapy, chiropractic treatments, 9 L3/L4/L5 steroidal injections and 9 caudal injections.. I've tried every kind of gadget out there, massage devices, etc. All to no avail. I had a sitting MRI which showed the transitional vertebrae at L5/S1, DDD, facet arthropathy and some buldging discs at L4 and L5 and an osteophyte at L4/L5(which is a bone spur).
I decided enough is enough. Each of the doctors I have seen have only had limited knowledge of what could be causing these symptoms or the significance of them. They have only been able to keep me on medications. I decided to do my own research and try to find a way to fix this problem. I am a nurse, and even I, have been at a loss in trying to understand what is happening to me. I started searching for answers, and here is some of what I have found:
One thing for you to know is that the transitional vertebrae is very significant. It is a congenital birth defect called "bertolotti's syndrome". It is supposed to be a rare occurrence, but I think it is just being overlooked. I have met many others who also have it. There is one place that I found that operates on it. It is the Cleveland clinic. I believe that all the rest of the problems are a direct result of that birth defect and the fact that I fell on my sacrum when I was a teen, causing an injury that rendered me immobile for over a month. I am now 44 and I guess it is really starting to peak in severity. The Cleveland Clinic is quite far away for me, because I live in Louisiana. I am planning to take the information I have gathered to a well known neurosurgeon here and see if he would be willing to learn the surgery and perform it on me.
That tear you have in S1 and S2 will probably start causing you some sacral radiculopathy. That's burning pains in or around the sacral spine. I was diagnosed with Levator Ani Syndrome, Piriformis Syndrome, and Pudendal Neuralgia.
If you are having any of those other symptoms I mentioned, there is also a better test for looking at nerves than an MRI. It is called a MRN. Magnetic Resonance Neurography. A doctor in California developed it, but he is opening new radiology centers across the nation where one can get it done at. I think in your case and mine, we will have to do our own research and educate the doctors or make them aware rather of what is available. I believe some surgeons would be willing to take on a new challenge and learn about a new treatment if it were presented to them in a good way. This is my hope and prayer at least, because I cannot afford to go all over the country to seek treatment. I haven't had the MRN yet, but am scheduled to see the neurosurgeon soon and I am going to ask if he will order it for me. I am hoping I can get on the road to the right treatment with the new neurosurgeon. Best of luck to you in your search for relief. Feel free to write me anytime. I hope I can help one person not to have to go through what I have been through.
Good luck to you.[/QUOTE]

Wow, we are very close together in geography and symptoms it seems. I'm in Crowley, LA. I went to Dr. Deareajo in Lafayette, who is a neurosurgeon, and had a foraminatomy performed on my L-4/L-5 area back in June. I'm still having some recovery issues and am scheduled to have a SI joint injection on Sept. 6th. I hope that works, since I seem to be having more issues now than before my surgery as far as pain around my hip area (particularly right hip) and right hip flexor area.

 
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