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Old 09-21-2012, 11:17 AM   #1
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MRI results. Need help understanding!

Findings: Vertbral body types are essentially maintained. There is 4 mm of anterolistheie of L4 relative to L5. L4 pars appear to be intact. Anterior disc osteophyte compleses are most apparent at T11-T12, L1-L2 and L2-L3.

Artifact partially obscures the dorsal elements and spinal cnal at T-10 and T-11. There is mild disc bulging versusprotrusion at T10-T11 and T11-T12 which exhibits mild mass effect upon the thecal sac. If clinically indicated, dedicated imaging of the thoracic spine may be performed.

L1/2: No axial images are available. There is mild disc bulging with a mass effect upon the thecal sac. No significant aubarticular/foraminal stenosis is present.

L2/3: No disc herniation, spinal canal stenosis or significant subarticular/foraminal stenosis is present.

L3/4: There is facet arthopathy and disc bulging contributing to mild central canal stenosis. No significant subarticular/ foraminal stenosis is present.

L4/5 There is uncovering of disc material and bilateral facet arthopathy. Mild central stenosis is present. There is minimal subarticular/foraminal stenosis.

L5/S1: Rhe is a broad-based somewhat bilobed disc extrusion extending from the central zone through the left subarticular/foraminal zone. In the central zone, the disc extrusion extends posteriorly 6 mm and exhibits mild mass effect on the thecal sac. It contributes to moderate left-sided subarticular/foraminal stenosis. No significant right-sided subarticular/ foraminal stenosis is present. There is mild facet arthropathy. The is a mild degree of degenerative type subendplate bone marrow edema at this level.

Visualized portions of the spinal cord are normal in signal intensity. The conus medullaris terminates at L1.

Impession:

Multilevel disc and facet pathology as described above.

I would like to better understand what this information means before I see the Neurologist. Can anyone please help me to understand this report? I would really appreciate any one's help. Will an injection help with the pain? Thank you!

 
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Old 09-21-2012, 02:51 PM   #2
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Re: MRI results. Need help understanding!

Have you had a fusion previously? What are your pain symptoms?

 
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Old 09-21-2012, 07:35 PM   #3
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Re: MRI results. Need help understanding!

I've not a fusion of the lumbar region. I have had an anterior cervical fusion of C3-4 to C-5. I still have problems with my neck but really right now my problem is with my lower back. I'm hoping that these problemes can be helped with PT. I'm not into surgery and only had the neck fusion because of a sublexation with 2 trips to the ER with viral Meningitis. Horrible pain.

My lower back hurts all the time and am ready to do whatever it takes to make the pain stop except surgery.

Thank you for replying. I'm desperate! ;-)

 
Old 09-21-2012, 07:43 PM   #4
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Re: MRI results. Need help understanding!

Is your pain primarily in your lower back or is it running down your leg, too?

 
Old 09-21-2012, 08:14 PM   #5
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Re: MRI results. Need help understanding!

Well, I've had quite the medical journey to leg pain. In 2006 I had an Aortal Bi Femoral Bi Pass.. I've lived with leg pain for 14 years. Siatica is nothing compared to what I've been through. I had a 100% occluted Aorta in my belly. I've had all the necessary test to make sure my back/buttock/leg/hip pain is not related to my bi pass. Pipes are clear! My right hip was hurting like crazy so I went to a Hip Doc and all looked good. He suggested a MRI with a refural to my Neurologist that did my cervical/neck surgery. I'm waiting to hear back from the Neuro on the MRI results. I hurt like crazy from morning to night.

 
Old 09-21-2012, 08:30 PM   #6
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Re: MRI results. Need help understanding!

There are a couple issues that often are responsible for lower back pain. One is a disc herniation, and the second is stenosis. Often they go hand in hand. Both these issues cause pain when they result in a spinal nerve becoming irritated or compressed. When this happens, the nerve no longer functions normally. It sends off signals that the brain interprets as pain.

Stenosis means narrowing. In the lumbar spine, there are two primarily areas where stenosis can occur. One is in the central canal. The second area is in the foramina. This is an opening that is used by a spinal nerve to exit the spine as it goes out into the body.

I like to visualize stenosis as an old lead pipe that has become clogged up with minerals and "gunk." As the pipe becomes more and more clogged up, only a few drops of water can pass through.

In the case of the foramen, the opening can become "clogged" by a disc that is bulging into the space, by bone spurs, by inflammation of surrounding tissue, etc. In the case of bone spurs, they can continue to form and take up space, just like the minerals pile up on the interior of the pipe. The nerves end up getting "squished" as there is no longer enough room to accommodate them.

With the case of a bulging or herniated disc, the disc pushes beyond the disc space between the two vertebrae. Depending on where the disc bulges, it can press into the foraminal opening or into the central canal. Nerves are located in both places, so it can cause nerve pain wherever it occurs.

The MRI is indicating degenerative changes throughout the lumbar spine with the exception of the L2-L3 segment. This is resulting in arthritic changes in the facet joints and central canal stenosis.

There is a small disc bulge at L1-L2 that is pushing into the thecal sac.

At L3-L4 and L4-L5 there are some indications of arthritis in the facet joints.
A bulging disc contributes to central canal stenosis. (The facets are synovial joints that link the vertebrae together. They are subject to deterioration from wear and tear and arthritis, just like any other synovial joint like the ankle, hip, knee, etc.

It looks like there is a slightly more severe problem at the L5-S1 segment where the disc has ruptured. Some of the disc material is coming out of the disc and is taking up space in the lateral recess and is also pushing into the thecal sac in the central region. The radiologist indicates this is causing moderate stenosis in the left region....(In radiology language, severity of an issue is described or rated as follows: minimal, mild, moderate and severe)

Conservative treatment is always tried first. An injection may help if the stenosis isn't too bad. Hope this helps to give you some idea of what is reported. The surgeon will correlate it with the findings from a physical exam, basic neurologic exam and a description of your symptoms.

 
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Old 09-21-2012, 08:42 PM   #7
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Re: MRI results. Need help understanding!

Thank you! I'm hoping that a shot will help...I've been through alot as I'm sure you have. This is my first post on this board and I'm so thankful that you have helped me to understand, in laymans terms, what is going on with my lower spine. I'll soon meet with the Neuro and get back with ya! Thanks again for all your time and effort in helping me to understand the MRI report.

 
Old 09-22-2012, 07:49 AM   #8
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Re: MRI results. Need help understanding!

I see that I forgot to address the spondylolisthesis which is mentioned in the first sentence of your report! If you look at an x-ray or MRI of the spine from the side, you'll notice that the vertebrae all line up. Spondylolisthesis is a condition of spinal instability. When there is a spondylolisthesis, one vertebra has slipped over the top of the adjacent one. This can be a miniscule amount or can look like a big indentation. If the slippage is great enough, nerves can end up getting trapped.

There are different causes for spondylolisthesis, but given the other arthritis in your spine, my guess is that yours is probably degenerative. It is a very small amount so probably isn't causing any pain...but worth keeping an eye on. If the slippage is toward the back of the body it is called a retrolisthesis. If it is toward the anterior or front side, it is called a anterolisthesis, which is the direction yours is slipping.

In addition to a disc herniation and stenosis, spondylolisthesis is a fairly common cause of lower back pain, and leg pain.

 
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Old 09-22-2012, 11:22 AM   #9
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Re: MRI results. Need help understanding!

Interesting. When my daughter was 5 years old she couldn't walk anymore. Through testing we found that she had spondylolisthesis. We followed this diagnostically for 3 years and then she was recommended to have surgery because of slippage. That was 22 years ago. She had 2 fusion surgeries 1 year apart from one another. She is now 27 and is having Thoratic problems along with low back pain. She will probably need to have more fusions...

 
Old 09-22-2012, 01:12 PM   #10
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Re: MRI results. Need help understanding!

Been through two or three rounds of injections and I'm still torn if they helped me. I still have discomfort, but at least I can do my dishes without taking a break to rest now usually. I did seem to recover faster when my L3-L5 discs went out a couple months ago. I would add the recovery room nurse told me the injections are not a cure, they only help with pain management.

My last MRI showed mild to severe issues so I can definitely sympathize with folks going through this it can be very painful and disabling at times.

If you have any numbness or tingly feeling in legs or even burning it's could be from spinal fluid leaking out and irritating your nerves, that's one thing I deal with anyways. Spinal fluid is supposed to be a pressurized system so leaks are not good. Think of it like your water lines in your home if it springs a leak makes a huge mess somewhere. When I was still able to work I often found leaks in basements that were actually pipes upstairs that had pinhole leaks. Your MRI looked like you had some leakage around your L5-S1 if I recall and that could be causing leg irritation. I don't think this is something they can go in and stitch up either whether the sacs are too fine or whatever. They tend to prescribe Gabapentin/Neurotin to offset that.

My non-medical opinion is the disc bulging is the most painful when your disc is actually pushing out of alignment. Discs are like shock absorbers on your car so when they push out one way or another nerves can be pinched and your body is out of alignment. For instance, when mine goes out I lean about 30 degrees to the left, can barely walk to the restroom, etc... My right hip hurts like the dickens from my body being so far out of alignment.

I would add that back issues are different for everyone. We are dealing with the central nervous system so pain transference is common. It can be very difficult to diagnose/cure. Like I asked about surgery during my last injection and the doctor said it wouldn't help me, yet I spent three months this year on bed rest recovering from my disc(s) going out. That same doctor told me, "I need to learn to live with it". That doesn't encourage me much...

I'm torn on surgery issues with fusions and whatnot as I've heard both good and results from folks.

Hope some of this clarified some things for you. I know it's not easy to live with the high degree of pains we suffer from or even the day-to-day milder ones that seem to nag us incessantly. Wish you the best.

 
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Old 09-22-2012, 08:45 PM   #11
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Re: MRI results. Need help understanding!

I wish you the best life that you can have. Thank you for your informative post. I'm thinking I'll hear back from the neuro early this coming week...been there and done that with my neck. I do hope I'm not leaking though ;-) Will get back with you as soon as I know what is going on with my back issues.

Again, thank you for listening and helping me to understand what this report is saying.

 
Old 09-24-2012, 06:48 AM   #12
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Re: MRI results. Need help understanding!

Had mri on 14 sept 2012 and just got results:-

There is a focal left paracentral disk extrusion present at L4/5 which displaces and compromises the left lateral recess and exiting nerve to a moderate to severe degree.

Mild degree of degenerative disk is present from l2 to l4 and l5/s1

spine cord ok

would need a surgical referral

i have had constant back/leg pain since early April have tried physio helped a little for a couple of days then back to square 1.

What does everyone think is this going to end up with me having a operation if so what one?

 
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