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Old 02-08-2012, 01:15 PM   #1
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Please help decipher this MRI result

A little background about me: I'm 25 years old, otherwise healthy female. I had a girl 16 months ago and ever since her birth I have been having mild to moderate pain starting in my right hip radiating down my leg to my toes. I have just tolerated the pain for over a year now. About 3 months ago, I noticed it getting more and more severe. I couldn't work for more than 2 hours without the pain causing me to grit my teeth. (I walk a lot at work)

I went to my PCP two weeks ago after walking at the mall and my leg went very numb (like the feeling that I had an epidural) and was in excruciating pain.
He recommended an MRI ASAP given the neurological change.

I had an MRI last wednesday and this is what the report says:

The verebral marrow signal intensity appears unremarkable. The conus medularis ends at the level of T12-L1. There is spondylosis of the lower lumbar spine.

L1/L2, L2/L3, L3/L4, L4/L5 no disc protrusion, central canal or foraminal stenosis.

L5/S1 moderate right paracentral extending laterally disc herniation posterior displaces the traversing right S1 nerve root producing right sub reticular recess. Moderate right foraminal, mild to moderate central canal stenosis.

Impression:
L5/S1 moderate right paracentral extending laterally disc herniation posterior displaces the traversing right S1 nerve root producing right sub reticular recess. Moderate right foraminal, mild to moderate central canal stenosis.

My doctor recommended PT and to see a pain mgmt specialist for an epidural. I had my first session of PT today and hopefully the exercises will help alleviate some of the pain. I'm going to go 2-3 times a week. When the PT evaluated me, she seemed pretty concerned because a lot of the ROM things she did to my right leg I failed at (I couldn't push against her hand with my foot rotated inwards, push up or down on her hand either) It feels kind of funny though surrounded by people that are 3 times my age. Haha...

I have an appt scheduled with a pain mgmt specialist next week for an evaluation and possible epidural.
I've been taking naproxen 500mg BID for about 3 months now with very very little pain relief. My MD prescribed vicodin but I really don't want to take them as they make me super groggy and I can't function on them (even cut in half).

He said in a few weeks if I have increased neurological symptoms or the pain doesn't respond to these approaches he wants me to go see a neurosurgeon.

Has anyone else had findings similar to these? What did you do? What were your outcomes? I'm nervous that PT/meds/epidural won't work since it has been so long that I have had this pain and I have increasing numbness/weakness.

Thanks for any input.

 
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Old 02-08-2012, 07:34 PM   #2
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Re: Please help decipher this MRI result

Well I can tell you what a few things mean in the report: the radiologist states that there is lateral and posterior herniation of l5 possibly resulting in stenosis, meaning that there is narrowing of the disc space between your last lumbar vertebrae and first sacral vertebral disc. The space that is narrowing is where your spinal cord and nerves reside.This is what could be causing the pain and numbness you are experiencing, physical therapy is always the first option for herniation's, along with possibly chiropractic care or if unresolved possible surgery. Epidurals usually only provide a temporary solution to back pain, I had no luck. Seeing a neurosurgeon sounds like the best thing to do, he or she may discuss surgical options but that should be your last result. Try asking for a different type of medication. You could ask if you would benefit from massage therapy, chiropractic car or possibly acupuncture? This isnt something I would wait for, try the physical therapy for 2-4 weeks and if nothing changes schedule an appt asap.
Good luck to you.

 
Old 02-08-2012, 09:21 PM   #3
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Re: Please help decipher this MRI result

Welcome to the board.

I have a couple questions first. Did you have pain, like sciatic pain while you were pregnant? If not, did your current pain come on suddenly or gradually?

I gather your current doctor is something other than a spine specialist -- maybe a PCP or internist? If that is the case, if I were in your shoes, I would go ahead and make an appointment with a fellowship-trained orthopedic surgeon or a neurosurgeon for a consultation. It will probably take awhile to get that first apppointment, and since you have already had signs of nerve compression for many months, and you are now losing muscular strength and are numb, it makes sense to get into see a spine specialist sooner, rather than going through 3 weeks of wait-and-see, then making the appointment, and then having to wait another number of weeks to get that first appointment.

You could certainly try the PT and the appointment with the PM doc in the meantime, while you are waiting...

Briefly, the radiology report indicates that most of your lumbar area is normal, until you get down to the lowest lumbar segment. At this level, the disc between the Lumbar 5 and Sacral 1 vertebrae has herniated...and it is causing a narrowing into the far lateral recess.

Within the spinal canal in the lumbar region, the nerves run across the disc and just under the facet joints (subarticular region). When a disc herniates at this level, it can reduce the space in this subarticular or lateral recess space, and when this happens, the nerve becomes compressed. It is this lack of blood flow to the nerve that results in the symptoms of pain. When it is more severely compressed, it can result in loss of reflexes, muscle weakness and/or numbness.

You can find lots of general information with diagrams online that will help you understand what happens when a disc herniates. In your case though, the area where it is compressing the nerve makes it slightly different from the "average" disc herniation....You can also read up on lumbar stenosis.


The first step that doctors make is to order a course of PT and
often, the epidural steroid injections in an effort to get the disc to heal on its own. If this is not successful, then a minimally invasive discectomy may be in order...but of course, only a spine surgeon will be able to make the call on that.

One thing to be aware of is that IF you should develop any bladder or bowel issues such as incontinence, either go to the emergency room or call your doctor ASAP. There is always a possibility of developing something called "cauda equina syndrome" when a patient is having issues, particularly with either the L4-L5 or L5-S1 segment. This is one of the few times when a lumbar issue becomes a potential medical emergency...so just be aware that if you suddenly develop a problem with bladder or bowel, do not ignore the symptoms!!

By the way, disc herniations are most common in younger women (20s and 30s) than any other age group.

Last edited by teteri66; 02-08-2012 at 09:23 PM.

 
Old 02-09-2012, 04:20 PM   #4
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Re: Please help decipher this MRI result

Thank you for your input.

I never had pain before or during my pregnancy. I was careful lifting/bending while I was pregnant too. The pain started I would say about a week after I got home from the hospital. it started as a mild throbbing sensation that was almost always there. Just in the past few months it has intensified. When I'm at work, though, sometimes it is excruciating. I also can't go out shopping or doing errands for very long without the pain being intense. My doctor (he is a general practitioner) also told me that if I had bowel/bladder issues to go to the ER because that can be an emergency. I am doing the exercises that my PT taught me so hopefully that'll help strengthen and alleviate some of the pain. I just don't want to get to the point that I will need surgery because my fiance is in school and I'm the only one working :/ I do have short and long term disability (so financially we will be okay) but I don't know what we would do for help with our little rugrat when he is in school...

 
Old 02-09-2012, 06:13 PM   #5
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Re: Please help decipher this MRI result

The stenosis is what makes it difficult to stand or walk. But there are different reasons for stenosis. In your case, it is caused by the disc problem...so it may be possible for this to heal on its own, in which case the excess "material" kind of gets reabsorbed and those clogged up openings will free up enough so that the nerves can once again pass through unencumbered.

My husband ruptured the same disc almost 20 years ago. Back then they didn't rush a patient into surgery. He had a course of PT and within 6 months he had resumed a fairly normal schedule and lifestyle. But, he still faithfully does his back exercises every morning as soon as he gets out of bed, and he is careful to use what I've come to think of as good "back hygiene."

Because of where your disc has herniated, it may be a bit harder to heal up...but hopefully, with some patience on your part, carefully doing the back exercises and core exercises, etc., being VERY careful when picking up that baby, and avoiding that as much as possible, you will heal and be back to normal soon.

 
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