I was hoping someone could help me understand my MRI. I have had lower back and leg pain for sometime. Finally my GP ordered an MRI. I got a call from the DR office that said I need to talk with a spine surgeon and was referred no other information was given. I have an appointment on March 13. I am curious what to expect and exactly what this means. Any help would be great. Thanks
At L5-S1,Broad-based disc bulge. No central stenosis. there are bilateral pars defects without spondylolisthesis. Broad-based disc bulge lateralizes to the right resulting in bilateral foraminal stenosis slightly greater on the right than the left. No central stenosis
Welcome to the board. People come here with a wide variety of knowledge pertaining to the spine. I'm going to assume that you are relatively new to the wonderful world of back problems, and will give you some basic information.
First, I congratulate your PCP for suggesting you see a spine specialist sooner rather than later. I contended with terrible pain for over a year because my PCP felt he knew what was going on, and it was a wasted twelve months when I could have been receiving proper treatment.
It is always a bit of a shock when the PCP reviews your MRI findings and tells you to see a spine surgeon because all we hear is the word "surgeon." But, I can assure you that a spine surgeon will give you an accurate diagnosis, based on the results of the MRI, but correlated with a physical exam and whatever you tell him/her about your medical history and pain symptoms.
The spine specialist with try all conservative treatments before even considering surgery, so do not worry! Going to a spine surgeon does not mean you need surgery. Your PCP is just telling you that your issues are more complex than his training has prepared him for.
Now to what you've reported on the findings. Since you do have an issue that will probably be ongoing, I would suggest you learn about your spine and basic lumbar anatomy so you will be able to understand what the spine specialist discusses with you when you make that appointment. We are lucky now in that there is a lot of wonderful information on the internet, and if we are careful to find sites that are medically based, we can learn a lot. Particularly though, when it comes to back pain, there are also lots of sites that promise "quick fixes" and you will need to learn to tell them apart.
First...finding a spine surgeon. Look for a fellowship-trained orthopedic spine or neuro surgeon who limit their practice to issues of the neck and back. You do not want a general ortho or sports medicine doc who does joint replacements or fixes broken bones, ankles, knees, etc. Likewise you do not want a neurosurgeon who really wants to be a brain surgeon. You can find this again on a doctor's or clinic's website...and take your time choosing someone that is well-qualified and well-trained.
If you look at a diagram of the spine, you will see that the bones of the spine, the vertebrae, are separated by a soft cushion, the intervertebral disc. The problem disc in your case is located near the bottom of the spinal column between the Lumbar 5 and Sacral 1 vertebra. The L4-L5 and L5-S1 segments get the brunt of the workout whenever the body bends or twists, so they often are the first to show signs of wear-and-tear, injury, etc.
Unfortunately, your findings do not indicate the size of your disc bulge. Usually the words used by a radiologist in the report are minimal, mild, moderate or severe. Since none are used to describe your situation, I am guessing that the protrusion is not large.
The "interesting" thing about spinal problems in general is that the amount of "damage" does not indicate amount of pain. A small disc bulge can result in a huge amount of nerve pain, and vice versa.
OK, so you have a disc with a broad-based protrusion. Think of a water balloon. Something has caused the edge of that balloon to bulge out and this bulge comprises 25-50% of the disc circumference. When a disc bulges, it displaces or squishes something else. In your case, it is not bulging into the central canal, but into the foraminal openings on both sides. The foramen are openings through which the spinal nerves exit from the spine out into the body. When anything causes the foramina to narrow or become blocked, it results in pain to the nerve that runs through it. Since these spinal nerves carry sensation to the limbs and other parts of the body, the nerve pain can be felt at any point along the path of that particular nerve.
There is a handy tool called a dermatome map that you can find online to see where the L5 and S1 nerves go. But very basically, pain can be felt in the lower back, and running down the side of the leg into the foot. Pars defect is mentioned at the same segment, but in your case is not causing any problems. A pars defect is like a mild stress fracture. It can result in a spondylolisthesis which is a situation where one vertebra slips over the top of the adjoining vertebra. It can result in an instability, which can result in a nerve getting pinched. You do NOT have this problem...so the pars defect is a "finding" but chances are, it is not causing you any pain or issues.
So basically, in layman's language, you have a bulging disc that is pressing into the foramina, which is causing the nerves at that level to be squished, which is resulting in the pain you feel in your lower back and legs.
Now the good news is that a bulging disc can heal on its own without surgical intervention. They will probably send you for a course of physical therapy where you will learn exercises that will help to stabilize your spine. It is also treated with oral medications, and possible one or more steroid injections that help the tissue heal and that reduce swelling that may be pressing on the nerve.
You can be helping yourself by avoiding any activity that involves bending, twisting, pushing, pulling and lifting or carrying anything heavier than a weight that will be established by your doctor, but is often around 10-20 pounds. Eat a nutritious diet and be sure to take in plenty of fluids, especially water. You can use ice for pain. Place a cold gel pack or ice pack over the lower lumbar spine for 15-20 minutes at a time, being careful to protect the skin from getting damaged.
WOW!!!!!!! Thank you so much for the information. Your information is going to be so helpful and it has really eased my and my wife’s mind. We both thought by being referred to a Spine Surgeon indicated the only solution was surgery. Now we know that there are multiple options before that would happen.
I now have some very specific information to familiarize myself with before the appointment.
It is normal to panic when you hear the words "spine surgeon." If for some reason, the person you go to immediately suggests surgery, that is a good reason to get another opinion!
Most insurance carriers do not even allow surgery without a good record that a trial of "conservative measures" has failed.
Remember that none of the members have formal medical training. I am giving you a general idea of your report...so you know the general direction in which you are heading and can do a little research before you go in to meet with the spine specialist...so you can understand somewhat what he/she will be talking about.
Just out of curiosity, did you ever play contact sports or participate in sports where your spine was in extension such as gymnastics, diving, skating, etc?
Thank you for the additional comments. Having someone point you in the right direction is so very helpful! Your information about the dermatome map really illustrates how the pain tracks and from which part of the spine it begins. The specialist I am going to see is a fellowship trained spine specialist at a highly regarded practice here. I am also trying to understand the spine better and what my options are for treatment. I do have to admit the shot thing does not sound to appealing though.
As far as contact sports I have not been involved in contact sports for close to 40 years. I have been an active water skier and taken some nasty falls (one fall resulted in me injuring my shoulder and needing surgery to repair it) though I have not done much skiing for about 5 years.
Thanks again for your time and consideration in answering my questions!
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