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Old 02-23-2012, 02:29 PM   #1
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Question Lumbar MRI Results: Questions/Ideas?? LONG POST!

Hi,
I had an MRI on my lumbar spine on 1/10/2012. Here are the results:

There is satisfactory alignment. The vertebral body heights are preserved. This is disc desiccation at L4-L5 and L5-S1 with preservation of disc height. There is heterogeneous signal abnormality in the L5 vertebral body on the T1 and T2-weighted images. On T2, this demonstrates diffuse mildly increased T2 signal. On T1, there is heterogeneous low as well is increased T1 signal. There is suggestion of multiple linear structures within the vertebral body likely reflective of coarsened trabecula and an atypical hemangioma.

L1-L2: No central canal or neural foraminal narrowing. Moderate to severe bilateral facet arthropathy
L2-L3: Trace disc protrusion on the left. No central canal or neural foraminal narrowing. 3 to 4 mm bilateral perineural cysts are noted. Advanced facet arthropathy is noted with ligamentum flavum hypertrophy and bulky osteophytosis
L3-L4: There is broad-based disc protrusion, extending into the left foraminal region. There is severe bilateral facet arthropathy with bulky osteophytosis as well as bilateral facet effusions associated with ligamentum flavym hypertrophy. A combination of these findings results in moderate central canal narrowing. There is bilateral lateral recess stenosis, left greater than right, of mild severity. There is mild right neural foraminal narrowing. Small right-sided facet synovial cysts are noted, seen posterior to the joint and well away from the exiting nerve root.
L4-L5: Trace disc bulging. Advanced bilateral facet arthropathy. No significant central canal or neural foraminal narrowing. 4 mm left synovial cyst seen posterior to the joint and well from the exiting nerve.
L5-S1: No significant disc protrusion or central canal narrowing. Asymmetric advanced facet arthropahy, left greater than right. No significant neural foraminal narrowing.

IMPRESSION
1.Advanced multilevel fact arthropathy as described
2.Moderate central canal narrowing at L3-L4 with associated bilateral lateral recess stenosis of mild severity. Mild right neural foraminal narrowing at L3-L4
3.Other incidental findings as described. Favor atypical hemangioma at L5

I was diagnosed with DDD when I was 31 years old. I am now 48 years old. I’ve been dealing with Left (L) calf weakness, swelling, burning, hardness for three years. I’ve had two L ankle surgeries (one in 2009 and one in 2011), and a bilateral PFJR (patella femoral joint replacement) in Feb of 2010. I always thought my calf issues were due to either my L ankle or my bad L knee (but my L knee is now functioning with new parts). After healing from the last L ankle surgery (9 months post op), my L calf was still weird…AND…my L lower back has been increasing in pain. (I’ve notice the pain for over a year, but I was able to tolerate it. It sometimes took my breath away but it was still manageable). My lower back cracks (or feels like it’s shifting…must be all the osteophytes) all the time, I can’t rotate very well to the L, my hips are torqued, and I can tell that my L leg just isn’t right. Could this all stem from my spine??

My sports med doc thinks that the L calf pain could be related to my L3-L4 broad-based disc protrusion that extends into the left foraminal region (along with the bulky osteophytosis). I’d like to think that my calf issue comes from either isolated peroneal nerve dysfuntion from my L knee or un-resolved issues with my L ankle (since I have posterior tibial tendon weakness and an OCD lesion of the talus). The dermatone shows that L3-L5 radiate down to where some of my symptoms are but not all of them. I am scheduled for a bone scan to determine if the hemangioma at L5 is beign. I wonder if I should have a nerve conduction test done?

I don't have any blood clots, diabetes, sestemic issues. I'm mostly healthy..6'1" tall and 142 pounds. I am plagued with ostoarthritis all over my body. I want to remain as active as I can but I am concerned with this spinal stuff and the nerve type of pain that I get with it. I've already modified my lifestyle to accomodate my new knees and my "bum ankle" and it looks like I'll be making more modifications with my spine-recently told not to row. I bike, aqua jog, weight train, teach low-impact aerobics, hike.

Does anyone have any thoughts on this?

Thanks very much!
Julie

 
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Old 02-24-2012, 11:14 AM   #2
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Just out of curiosity, who ordered the MRI? Have they reviewed it with you? I have been told unless it is moderate to severe not to worry. You do have the word moderate L3-4 there on one level. I am more well versed in the cervical MRI rather than the lumber. Just starting to have problems there. I would go to an Orthopedic Spine Specialist and PT not a chicro. Just my thoughts. Good luck.

 
Old 02-24-2012, 11:56 AM   #3
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

You have a lot of issues with the facet joints. These are the synovial joints that connect the vertebrae. Just like any other synovial joint in the body, they are subject to the degenerative changes of arthritis.

I don't know who ordered the MRI or whether you are under the care of a spine specialist, but I would highly recommend a visit to one. The problem is that the facet joints contribute greatly to the stability of the spine. They are what prevents us from leaning so far forward or backward that the spine could snap, and they allow us to bend and twist. They are like a little stopper that keeps us from going "too far."

When the facets wear down, it can allow the spine to bend in ways it was not intended to. It results in spinal instability. At the least, this can cause a nerve to be compressed, resulting in the radiating pain the patient feels in the limbs. These changes in the facets are described as "advanced" and "severe."

I think it is important that you go to a spine specialist to see if there may be something else going on, like one of the degenerative arthritis conditions.

The L3-L4 disc problem would be more likely to cause pain in the front of your thigh. Pain in the calf is more likely coming from L5-S1.

Many times knee and foot problems stem from a lumbar spine issue, so I wouldn't be a bit surprised if that wasn't the case for you, too.

Be sure to get a flexion/extension X-ray to check for lumbar spine instability. From your description it certainly sounds like you may have some issues with stability.

Do not confuse a sports medicine doc with an orthopedic spine surgeon. Their fellowship training is entirely different, even though they both share similar orthopedic residency training.

Good luck, and please let us know how you are doing.

Last edited by teteri66; 02-24-2012 at 11:57 AM.

 
Old 02-24-2012, 01:29 PM   #4
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Hi Frenchfri1003,
Thanks for your reply. The spinal MRI was ordered by my sports med doc who did review it with me. I asked him for a referral to see our spine institute.
-Julie

 
Old 02-24-2012, 01:43 PM   #5
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Thanks for your reply Tetonteri66!

Your reply is very much appreciated and I'm a bit freaked out by your comment regarding my facet joint arthritis: "They are what prevents us from leaning so far forward or backward that the spine could snap, and they allow us to bend and twist. They are like a little stopper that keeps us from going too far." I'm now concerned with my spine snapping at any moment...it actually cracks and shifts all the time now, which has had me concerned for a while.

I just called my SM doc to get a referral to our spine institute to see a spine specialist. It takes a month. It seems that my body doesn't do well with articular cartilage...the patella replacements, which are articular cartilage, the talus, which is articular cartilage, and now my facet joints, which are articular cartilage. I've always had hypermobile joints and it's haunting me in mid-life.

I'll try not to obsess about this and think positive. It's scary to now be dealing with spinal issues.

Thanks again,
Julie

 
Old 02-24-2012, 03:37 PM   #6
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

I didn't phrase that very well....a PT described the function to me that way -- of course you wouldn't really snap the spine....but if there was nothing to keep the lumbar spine from bending too much, we would just fall forward.

Your spine will not snap, but until you have it checked out you might want to be a little bit careful with any strenuous activity, and I would avoid activities that involve bending and twisting.

I was wondering if you had joint issues in general when I saw the other surgeries you have had.

I have had two lumbar fusions. During this time I never had an inkling of facet problems...other than being told I had a "little bit of spinal arthritis." But I did have an undiagnosed issue that caused a great deal of nerve pain that kept me from standing or walking. When my surgeon went in for my second fusion, he was surprised to discover that my facets at L3 had completely worn away. There were little nubs left, and this had not shown up on any imaging I'd had done previously. My surgeon ended up reconstructing the facets at that level.

Don't lie awake worrying about this, but I imagine these facet issues are contributing to your pain issues.

Do you see a rheumatologist?

 
Old 02-24-2012, 04:31 PM   #7
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Tetonteri66,
I was tested for rheumatoid arthritis 3 years ago and everything came back negative. I guess I am plagued with OA!

Thanks for replying again. I appreciate it a lot!! I did get my referral and I'll be seeing one of the best lumbar spine people in our area! Although, my SM doc doesn't think I'll be needing surgery anytime soon. I don't want surgery..but I want answers...and I do want a better functioning L leg (after all of the surgeries I've been through already...).

I'm curious.. how is your mobility and pain after having two lumbar fusions (where were the fusions)? How did your suregon reconstruct your facet joints? What was your undiagnosed issue that caused your nerve pain?

Does the tetonteri66 refer to your age...were you born in 1966 or are you 66 years old...or is that too foward to ask? (I'm asking b/c all of the suregons have told me that I'm too young for this much arthritis....you get what you get in life, I guess...). Do you love the Tetons??? I do....they are amazing!

Thanks!
Julie

 
Old 02-26-2012, 10:34 PM   #8
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Sounds like you have a lot of arthritis and maybe some stenosis. L 5-S1 bulge could cause leg and hip pain, numbness and a burning sensation in hip and foot. Also tingling. I had all these symptoms and ended up having a discectomy and fusion. If the discs appear dark instead of clear on the MRI it represents desiccation. That means the disc has dried out and hardened. A hardened disc could actually break in pieces and cut the thecal sac. Find a very reputable spine surgeon. Don't go to just a broad range ortho or sports medicine doc. I saw an excellent ortho for two yrs before he sent me to a spine specialist who told me exactly what was wrong with me after talking just a couple of minutes. After my MRI he ordered me basically non mobile. He was shocked that I could even still walk. Wasting time with the wrong kind of Doctor almost crippled me. And he said if I would have went to a chiropractor I could have ended up crippled. It takes a specialist to get into that low back.
Hope this helps a little. Good luck.

 
Old 02-28-2012, 11:29 AM   #9
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Hi Bradleyh100,
Your reply is freaking me out but thanks for responding. I am in process of getting my referral to see the spine specialist and I will ask about this (and a ton of other things). I would think that if the disc desiccation was that bad, my SM doctor would have mentioned it to me...but after reading your post and doing a little research on line I am now freaked out by it all (one reason NOT to post on-line...but overall it is helpful to do so). I haven't really looked at all of your posts...but how are you doing these days?

Let me walk (Julie)

 
Old 02-28-2012, 12:33 PM   #10
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Julie ~

Go make a cup of tea and relax. Your MRI doesn't indicate anywhere the level of damage that the other poster is describing. It is very RARE to have a lumbar issue cause paralysis.(mainly because the spinal cord stops at the T-12-L1 level). And while the report indicates some of the facet joint arthritis is fairly extensive, there is still room in the central canal. There is a mild amount of compression, but not severe.

What usually happens with degenerative disc disease is if the disc is just left alone, it may eventually dry out, but when that happens it collapses and then the two bones (vertebrae) rub together. If this is left alone, eventually the two bones will fuse together naturally and usually there is no more pain after this process is complete.

I think I had my first cervical MRI when I was around age 57 and was surprised to learn that two of my lower cervical vertebrae were in the process of fusing. I would never know this if I hadn't seen the films and report! I have NO pain.

At the cervical level where there is a lot less space and where the spinal cord runs through the thecal sac, when there is a big herniation and it is pressing on the spinal cord, situations can come up where the chances for paralysis developing are real. But in the lumbar area, when something is pressing on the thecal sac, and it is indenting the central canal, you end up with stenosis and the resulting nerve pain that radiates down into the leg. Sometimes in particularly severe cases the patient can develop issues with bowel or bladder or can develop sudden muscle weakness such as a drop foot...but except in the case of some really freaky accident, paralysis is not something to worry about occurring.

I just realized I never responded to your last post....my first fusion was a PLIF at L4-L5. I had spondylolisthesis at that level and severe spinal stenosis that caused horrendous leg pain and numb feet. Everyone thought a one level fusion would correct the problem....it did correct the spondy but I still had the radicular pain. Several doctors thought it was because I just had permanent nerve damage, but I refused to believe that because it would go away as soon as I got off my feet.

About 18 months later I was finally able to convince my second surgeon that my spine was unstable...and eventually I had more surgery...so I am now fused from L3 to S1. I don't know how he reconstructed the facets at L3. He was a trauma surgeon for a number of years before he did a fellowship in spine surgery and switched careers...and I think that allows him to do some creative things that some other surgeons do not do. It was not any type of new joint replacement or anything fancy like that!

I am doing great. After 4 days all my leg pain went away for the first time in about 8 years....I've been holding my breath ever since that it would return, but, I'm beginning to think they actually found what was causing my pain and were able to "fix" it. As for being fused, I don't notice much change in flexibility. I cannot bend too far to the sides or backward, but I don't need to, so who cares? I can bend forward and put my palms on the floor...not that I need to do that either, and I don't make a habit of it! My lower spine starts to feel "weak" if I do too much, but I can walk as far as I want, I can stand without pain and am very pleased with my results and grateful for the skill of my surgeon.

Last edited by teteri66; 02-28-2012 at 12:37 PM.

 
Old 02-29-2012, 06:48 PM   #11
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Tetonterri66,
Thanks again for your reply! You have a lot of spine knowledge and your posts are very helpful. It's somewhat comforting to learn that you are doing so well after all that you've been through with your spine. I know how much hard work on your part went into your recovery. Recovering from surgery is a full time job.

I am currently experiencing a lot of low back pain and really funky L leg stuff...it doesn't work right. It's not exactly a tingling, burning sensation...those types of sensations are there... but it's just more of a "leg doesn't work right type of sensation." I can tell that my pelvis is totally off. I'm curious...did you ever have that "not recruiting correctly" type of sensation in your legs/hips...or was all of your pain the burning, tingling, sharp sensation type of pain? (I'm still trying to determine if my left leg calf weirdness is coming from my knee....I'm still not 100% percent convinced that all of my leg stuff is totally coming from my spine).

The pains and sensations with this spinal stuff are so different than the knee arthritis that led to my replacements or the ankle injuries that led to my post traumatic ankle arthritis. It's challenging and concerning to me.

-Julie

 
Old 02-29-2012, 06:58 PM   #12
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Tetonterri66,
Thanks again for your reply! You have a lot of spine knowledge and your posts are very helpful. It's somewhat comforting to learn that you are doing so well after all that you've been through with your spine. I know how much hard work on your part went into your recovery. Recovering from surgery is a full time job.

I am currently experiencing a lot of low back pain and really funky L leg stuff...it doesn't work right. It's not exactly a tingling, burning sensation...those types of sensations are there... but it's just more of a "leg doesn't work right type of sensation." I can tell that my pelvis is totally off. I'm curious...did you ever have that "not recruiting correctly" type of sensation in your legs/hips...or was all of your pain the burning, tingling, sharp sensation type of pain? (I'm still trying to determine if my left leg calf weirdness is coming from my knee....I'm still not 100% percent convinced that all of my leg stuff is totally coming from my spine).

The pains and sensations with this spinal stuff are so different than the knee arthritis that led to my replacements or the ankle injuries that led to my post traumatic ankle arthritis. It's challenging and concerning to me.

-Julie

 
Old 02-29-2012, 08:34 PM   #13
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Thanks for the kind words. I didn't know a thing about the spine prior to 2004. I've learned since then through innate curiosity, necessity and self preservation!

In your particular case, I think it will be even more tricky than normal to figure out what may be contributing to your problems, what with the various surgeries you have already have had.

The spine is so affected by posture, structural alignment and how we move and use our bodies. You won't learn much about this from Western medical doctors who look at the body piecemeal. Spine docs don't want to acknowledge that soft tissue and muscle can and do contribute to how are spines work or don't work. I was very lucky in that I worked with a guy that I called my "rearranger" because I didn't have an easy label for him or what he did. He was one of those people with a variety of training and backgrounds; physical therapist, accupuncturist, Master's in Chinese Medicine, etc. He worked with the ultra athletes -- those people who run 100 mile races through the desert or Pike's Peak, etc. and he kept them injury-free and in balance so they didn't ruin their bodies through all the exercise.

It was due to his once-per-week treatments that I was able to keep going until everyone finally figured out what was wrong with me. My guy had it figured out but since he didn't have MD after his name, my doctors didn't put much credence in what I would tell them he had said.

He would treat me to get me realigned. My pelvis was usually tilted forward and various other things would get out of place. I would have times when my leg didn't want to support me, etc. Not sure if it was what you are describing, but it would get funky. But, it's all good now. Luckily, too, because my guy moved away and I don't know how I would replace him.

It is an interesting topic. The little song we sang in pre-school about the "knee bone's connected to the thigh bone...the thigh bone's connected to the hip bone" (or however it went) couldn't be more true. Pronated feet can cause spinal misalignment, etc. Carrying the head too far forward over the spine causes its own set of problems. There are some cultures where back problems do not exist. Women carry heavy burdens on their heads and have no cervical issues, etc. but it all boils down to how they carry themselves as soon as they learn to walk and they basically do not have chairs.

I'm wandering here...sorry. More later.

 
Old 03-04-2012, 05:14 AM   #14
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

Thanks for your reply again Tetonteri66,

Do you think that a nerve conduction study could help determine if the nerve compression/entrapment is stemming from the knee or the spine? I'm having symptoms all over the board and I'm not sure if they are consistent with L5/S1, L3/L4 facet and disc issues. Here are my symptoms:
INTENSE peroneal pain from the knee down to the outer foot (on the Left leg/foot only). It throbbs, when I stand it is SHARP-almost drops me down, when I walk the muscle cramps. However, I can usually walk it off after 5 minutes and the muscle cramp goes away. After getting done with activity, when sitting, the peronal pain is horrible down the calf. I get an intermittent surge of stiffled zinging sensations that are "time on"...like every 5 seconds the surge happens..then it goes away for 5 seconds...then it comes back for 5 seconds...this continues while I'm sitting down. It will finally subside after 40 minutes.

Burning pain in left thigh when biking, especially on the medial thigh.

Inability to walk correctly on my left side. My entire left hip, leg, knee, foot don't work right. When I really try to engage my muscles on my left side, I get a terrible burning sensation.

My spine cracks and it seems to be getting more pronounced...sometimes it feels like it's shifting.

So, back to my original question...are some of my nerve symptoms consistent with lumbar spinal facet arthritis and some broad based disc protrusion at L5/S1?

Thanks!

 
Old 03-04-2012, 10:52 AM   #15
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Re: Lumbar MRI Results: Questions/Ideas?? LONG POST!

[B]So, back to my original question...are some of my nerve symptoms consistent with lumbar spinal facet arthritis and some broad based disc protrusion at L5/S1?
[/B]

I cannot really say how many issues are related to your knee problems and what is spine when it comes to what's going on in your foot. But looking at your description of symptoms, when a spinal nerve is compressed, you usually can't "walk off" the pain...which leads me to think that this symptom may be occurring in the nerve below the knee.

If you read your MRI Impression comments again, you will notice that the problems at L3-L4 are perceived to be more pronounced. This would explain the pain in your thigh, for example. You are having symptoms of stenosis at this level. You also have a synovial cyst that very well may be pressing on the nerve and causing the pain in your calf and foot, particularly the inner side of ankle, foot and into big toe. You will notice that most of the "issues" are on the left side of the central canal....

Now the outside of the foot would be covered by the L5-S1 dermatome, so your foot problems could come from either of these spinal levels.

I think an EMG/nerve conduction study might be helpful in sorting things out.

 
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