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Old 02-15-2012, 06:34 PM   #1
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Can I have some help with this MRI result please?

Hi all, as you can tell from the title I am looking for a little help decrypting my recent lumbar MRI.

Some background first, I am a 26 year old male and have been healthy all my life. I ended up hurting my back while doing some jump squats getting in shape to join the military. I injured it in September. The day I injured it, it was just a pain in my lower back. The next day it had spread down the right side of my body through my butt, down the outside/back of my thigh, through the outside of my calf, and to the top of my foot. I waited for it to go away on its own for about a month, of course it didn't so I sought out a chiropractor. After about a month of seeing the chiropractor it seemed like my pain was getting worse. I ended up going to my PCP who sent me off to physical therapy. The PT seemed to help at first, but toward the end of my treatments, the pains were coming back. The pains are always present in one area or another. My PCP ordered a MRI and the results follow:


RESULTS: There is straightening of the normal lumbar lordosis. The
vertebral body height and alignment appears well maintained. Mild loss of
disc height and desiccation of the disc identified at the L415 and L5/S1
level. The conus appears unremarkable.

L1/2: The disc, facets and exiting neural foramina appear unencroached.

L2/3: The disc appears unremarkable. There is mild facet hypertrophy;
the exiting neural foramina appear unencroached.

L3/4: The disc appears unremarkable. There is mild facet and posterior
ligamentous hypertrophy with no significant narrowing of the exiting
neural foramina or canal.

L4/5: There is moderate central bulging of the disc, this reaches the
thecal sac and mildly effaces it. There is mild facet and posterior
ligamentous hypertrophy with resultant mild to moderate canal stenosis.
There is mild to moderate narrowing of both exiting neural foramina also.

L5/S1: There is moderate central and right paracentral bulging of the
disc. This reaches the thecal sac but does not efface it. There is mild
effacement of the right S1 nerve root. There is moderate narrowing of
the right exiting neural foramina and mild narrowing of the left exiting
neural foramina.

IMPRESSION:
Moderate spondylosis L4/5 and mild to moderate spondylosis L5/S1. Please
see above for details.

Can I get a better picture of what's going on? Is this something I should consider surgery for? I'm not sure what my next step is. I feel I've given it a fair amount of time, I've seen a chiropractor and a physical therapist. I'm just worried this is something that has a good chance of preventing me from reaching my goals. Any help or advice would be greatly appreciated.

 
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Old 02-15-2012, 07:47 PM   #2
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Re: Can I have some help with this MRI result please?

Okay, so first, no doctors here. The first thing mentioned is a straightening of the lumbar lordosis. This means that the natural curve in your back is currently not as curved as expected. This could be due to muscle spasms from your back trying to protect a current injury.

At two levels, L2-L3, and L3-L4, you have mild facet and/or ligamentous hypertrophy. This represents that you have some enlargement of the joints and the ligament, but the enlargement is not interfering with any of your nerves, so this should not be problematic.

At L4-L5, you have a bulging disk, plus the enlarged joint and the enlarged ligament. This is pushing on the central spinal canal and the foramen, which is where the nerves exit the spine to travel to the areas of the body they are responsible for.

At L5-S1, you have a bulging disk, which is also pressing on the nerve and the foramen.

If you look up a dermatome map, you can see the areas of the body to which these nerves correspond, and the areas should match up with where you are having pain. The spondylosis refers to spinal instability in these two areas, L4-L5 and L5-S1.

For the problems causing pressure on the spinal canal and the foramen, you have a couple of options. The typical regimen of progressive care is physical therapy, oral steroids, epidural steroid injection(s), surgery. Sometimes augmented by chiropractic care.

If any of your physical therapy exercises cause your pain, particularly the non-back pain, to be aggravated, don't do them. The pain is a sign that the motion is aggravating a nerve. If your PT critiicizes you, get a new PT. Also, if you have any bowel, bladder, loss of leg use problems, go straight to the ER. (This is rare, but worth repeating.)

As far as the instability, you can look at either continuing your PT core strengthening forever or look toward surgery -- probably a fusion. When I had my flexion/extension X-rays, the surgeon could not detect any instability, but when I had my fusion, he found a lot of scar tissue, which he thought indicated long-term instability. However, because I was a former competitive swimmer (still swim, but not competitively) and I was keeping up with my physical therapy, the instability was somewhat ameliorated by the strong core.

Make sure you have a good doctor, preferably a spine-only, fellowship trained orthopedic surgeon or a spine-only neurologist, to advise you along the way. You may also want to look at engaging the services of a physiatrist, if you want to avoid surgery at all costs.

 
Old 02-15-2012, 09:02 PM   #3
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Re: Can I have some help with this MRI result please?

Welcome to the board. As the other poster mentioned, none of us are doctors, so consider that when reading on this, or other boards.

SweetPeainSF has given you probably more information than your doctor will pertaining to your MRI. I would just like to add a couple points. Most importantly, I see no mention of instability in the MRI report. "Spondylosis" is a general word used to describe what, in layman's terms, we would consider degenerative changes.

I believe the poster has spondylosis confused with a similar word, spondylolisthesis, which is a situation that can signify instability. It describes a situation where one vertebra slides over the top of the adjacent vertebra. This is NOT mentioned in your MRI report.

The Impression section of the report is like a summary of the important parts of the radiology report. The radiologist reports that you have some degenerative changes going on at both the L4-L5 and L5-S1 segments of the spine.

The other key words to pay attention to are "mild" and "moderate." In radiology lingo, problems are rated using adjectives starting with the most benign and ending with the most serious: minimal, mild, moderate, and severe. Minimal and mild generally mean the patient doesn't need to worry too much...it is something worth noticing and the doctor can keep an eye on it in years to come. Moderate is starting to cross the border into having the potential to be worrisome and when something is severe, it generally means that surgery is probably in the patient's future.

It looks to me like what is showing up on the MRI is of a degenerative nature. Unfortunately the spine begins the aging process in our twenties, and you are showing some signs that may prove to be troublesome if they continue to progress. As long as the nerve compression is not too bad, you should be able to deal with the issues conservatively -- with medications, physical therapy, perhaps some injections and other types of hands-on therapies.

I think it is in your best interest to take your MRI and go see a fellowship-trained orthopedic spine specialist or a neurosurgeon who limit their practice to issues of the neck and back. You can waste a lot of time going to PCPs, family doctors, etc. And a physical therapist cannot really address your issues until they are properly diagnosed. A spine specialist will provide you with an accurate diagnosis and plan of treatment, and should be able to tell you if your future goals are a possibility with your spinal issues.

Good luck and let us know how you are doing.

Last edited by teteri66; 02-15-2012 at 09:05 PM.

 
Old 02-15-2012, 11:24 PM   #4
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Re: Can I have some help with this MRI result please?

Oops -- I got confused with spondylolysis, which I have and causes instability, rather than spondylosis. Good news, if you don't have instability! That one "ly" in there makes all the difference.

 
Old 02-16-2012, 05:30 AM   #5
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Re: Can I have some help with this MRI result please?

Actually, you need more syllables -- spondylolisthesis....

Just to clarify for anyone who might be reading this thread, [B]spondylolysis[/B] is the fracture that occurs in the vertebra that can lead to [B]spondylolisthesis [/B]which is the anterior or posterior displacement, the "slippage" where one vertebra slides over the top of the adjacent vertebra.

 
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