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Old 08-28-2012, 10:18 AM   #1
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Unhappy Something does not seem right... MRI report

Hi all,
I have had back pain for years, and it has gotten really bad the last 2 years. I see the neurosurgeon later this week to see what they think. I had my first MRI done (finally) and the report does not sound bad, compared to the pain I feel. The word mild is used several times, although the pain is anything but mild. My job involves sitting 8 hours a day, and the pain worsens as the week goes on. I suspect all this sitting is aggravating the problems, however it can't be changed.

It just seems that pain level should at least be comparable to the MRI report. My report seems to have mild sounding problems.

Degenerative endplate changes are present at the L4-5 Level.
There is disc desiccation from L2-3 through L5-S1 levels with disc space narrowing at L4-5. Mild broad-based disc bulge is present at the L2-3 level which does not result in any appreciable canal stenosis or neural foraminal narrowing at this level. Mild broad based disc bulge with degenerative changes involving facet joints is present at the L3-4 level this results in mild central canal stenosis without appreciable neural foraminal narrowing. Combination of broad-based disc bulging degenerative changes involving facet joints and osteophytic spurring at L4-5 contributes to mild central canal stenosis and mild bilateral neural foraminal narrowing at this level. Minimal broad based disc bulge at L5-S1 does not result in any appreciable canal stenosis and together with degenerative changes involving facet joints contributes to mild bilateral neural foraminal narrowing slightly greater on the right than the left at this level. The conus medullaris is at a normal position and appears unremarkable. The paravertebral soft tissues appear normal.
IMPRESSION:
Osteophytic spur with degenerative changes involving the facet joints and mild disc bulge from L2-3 through L5-S1 results in mild central canal stenosis at L3-4 and L4-5 and varying degrees of nural foraminal narrowing greatest at L4-5.

My brother who is a RN looked at the images of the MRI and stated he sees "nerve clumping", although nothing is mentioned in the MRI about this. I will ask the doctor later this week what all this means.
I do have DDD, osteoarthritis with spurs, 4 bulging discs, and spinal stenosis. I have tried PT, chiropractor, TENS Unit, pain drugs and am nervous of the steroid injections, but think they are what will be suggested next. I had a EMG test, and all was normal.

I just expected "mild" to mean mild problems, and that does not appear to be the case. Is this fairly common? Thoughts?

Back pain has to be one of the worst things, because every movement seems to involve the back in some way.

 
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Old 08-28-2012, 11:40 AM   #2
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Re: Something does not seem right...MRI report

In radiology language the words used to rank the severity of a problem are: minimal, mild, moderate and severe. A MRI in no way is an indication of how much pain a person may be in. As a matter of fact, the MRI is just one piece of the diagnostic puzzle. The neurosurgeon will correlate it to what he finds upon physical exam, basic neurological exam and after listening to your symptoms and description of your problems.

Sometimes something that looks inconsequential on MRI can actually cause a great deal of pain...and conversely, something that looks very serious can be something the person is not even aware of.

Overall, you probably don't have anything that a spine surgeon would consider a big deal, but then, he isn't the one dealing with the pain! The things described in the report are of a degenerative nature. Disc dessication is a drying out of the natural moisture content of the disc. Since the disc is primarily comprised of water, when it dries out, it shrinks in size, which brings the vertebral bones closer together. This is what is meant by "disc space narrowing."

The report does not specifically mention that any nerves are being compressed. However, you have stenosis at several levels...some in the central canal and some in the foramina. Usually when there is stenosis, there is some nerve compression as these are the two passages that the nerves run through. When the central canal or any of the foramen located at each vertebral level are narrowed due to bulging discs, osteophytes, inflamed tissue, etc. it takes up space that is needed so that the nerve can go through the space without being squished. (think of an old iron pipe that has become corroded from years and years of mineral build-up...after a while, water can barely drip through if the "gunk" becomes bad enough).

There are some degenerative changes with the facet joints as well...and this could be contributing to your pain. The facets are synovial joints that allow us to be able to bend and twist. They are subject to arthritic changes just like the other synovial joints in the body, like the knee, hip, fingers and toes, etc. The cartilage breaks down and wears away; there can be swelling or inflammation. This can create some instability and nerves can end up getting pinched.

So, while you mostly have issues that are evaluated to be "mild," you have something going on at every segment of your lumbar spine. Most of it indicates degenerative disc disease which can be painful.

Hope the doctor will come up with a plan of treatment for you. Please come back and let us know what you learn at the appointment.

 
Old 08-29-2012, 09:27 AM   #3
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Re: Something does not seem right...MRI report

Thank you so very much for taking the time to explain so many things in that MRI report. You explained it in a way that I could understand and I appreciate that. Although the report says mild all over, perhaps the combination of all the things going on are making the pain so bad. My appointment was supposed to be Thursday 8/30, however I got a call yesterday that the doctor needed to reschedule. Now, I can't get in to see the doc until the end of September. That does not make me happy, to say the least. It is however, what it is.

I will continue on, as this back pain has been an issue for years and I know there isn't any magic fix to the problems. I am ever thankful for you explaining what is causing the pains. I am 47, but feel closer to 80. Although I never intended to slide into the grave in a fully preserved body, I didn't intend to wear it out so soon either.

Anyhow, I greatly appreciate your reply and time involved to assist and help me understand.

 
Old 08-29-2012, 01:02 PM   #4
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Re: Something does not seem right... MRI report

My first MRI didn't look bad either and my internist, who had ordered it and was treating me, told me that my back issues that showed on the MRI were typical for my age! But I was having terrible sciatic pain and couldn't walk for more than a few minutes before I had to sit down. After going back to the doctor and wasting about a year, I went to a spine specialist who took one look at the MRI and told me I would require a fusion if I wanted to address the pain. Needless to say, I was shocked!!

That spine surgeon also told me "when I was ready" that was the only surgery that would help my condition. Of course I spent the next 18 months going through various treatments, visiting various specialists in 3 states, etc. because fusion just sounded too extreme more my problems.

But, eventually I was ready...and I had the surgery....My point is that you cannot always tell just from the MRI what is going on. I'm sorry you have to wait another month to see a specialist. It is hard to get in for the first appointment. You might want to make an appointment with an orthopedic spine surgeon also, so you will have two opinions.

 
Old 08-29-2012, 03:46 PM   #5
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Re: Something does not seem right... MRI report

You might do well getting injections in your si joints.(cortisone). I have been going through the same thing. I kept going back until they gave me a new MRI and now sending me to a sergeon. I did ok with my first set of injections in 09. But now they do nothing. I hop u can get some relief. I don't know if your getting any pain meds. Or want to. I can't get out of bed without mine. Maybe he will give u something for pain until u can get in. I know how that is and I'm so sorry u have to go thru that. Don't hold back on telling the doc how u are really feeling. He needs to hear it to get u fixed.

 
Old 08-30-2012, 12:29 PM   #6
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Re: Something does not seem right... MRI report

The MRI alone does not tell the whole story, that's for certain. Diagnostic injections can help determine where the problem is actually coming from. They do serve a purpose. The various diagnostic injections I have had along with a CT scan showed my newest doc the real problem, which had been brushed off by all the other docs I have seen. If you can find one, a fellowship train specialist would probably be your best bet. My newest doc is, and I had seen the recommendation on this forum to find a fellowship trained spine specialist. It was the best decision I have ever made!

 
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