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Old 10-15-2012, 01:10 PM   #1
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New MRI done, different findings - translation please?

Without going into the boring details of my leg and low back pain, I just want to see if anyone can translate this for me while I wait for my doctor to respond.

On a side note, this MRI was ordered as a result of a severe infection I had last month where the ER Dr thought the ESI I had might have caused it, but it was negative. The initial diagnosis had been meningitis... anyway...

So here are the findings for one level, I won't post the whole MRI report:

[B]Moderate-to-Severe bilateral facet joint hypertrophic degenerative changes at L4-5 with posteriorly directed facet joint synovial cysts.[/B]

Okay - the cyst thing is new to me. Am I reading this to say there is more than one? and, does the word "bilateral" also refer to cysts or just the degenerative changes? And... are these obvious now because this MRI was actually done with contrast?

For what it's worth, previous MRI's (no contrast) don't show anything that would have generated the pain I have felt over the months. I am currently still under the effects of the 2 ESI's I had recently. But I can tell that the left facet joint one is wearing off....

Thank you!!

 
Old 10-15-2012, 08:14 PM   #2
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Re: New MRI done, different findings - translation please?

"Moderate-to-Severe bilateral facet joint hypertrophic degenerative changes at L4-5 with posteriorly directed facet joint synovial cysts.

Okay - the cyst thing is new to me. Am I reading this to say there is more than one? and, does the word "bilateral" also refer to cysts or just the degenerative changes? And... are these obvious now because this MRI was actually done with contrast?"

Yes, it does appear that there is more than one cyst. Synovial cysts are fluid filled so yes, the contrast may have enhanced them making them more clear.
Did your last MRI also show moderate to severe bilat facet joint hypertrophy is that finding new as well?

 
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Old 10-17-2012, 10:44 AM   #3
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Re: New MRI done, different findings - translation please?

Thanks for responding... that's a good idea. I am going to go back and look at me previous MRI report. I hadn't even thought of that.

 
Old 10-17-2012, 11:56 AM   #4
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Re: New MRI done, different findings - translation please?

The radiologist wants to have a previous MRI available to read as the changes are often just as significant as any new findings. I gather you had the new MRI taken at a different facility?

As you probably know, in radiology language the adjectives serve as a "ranking" system and the words in order are minimal, mild, moderate, severe.

Moderate to severe facet joint hypertrophic degenerative changes indicate that there is quite a bit of degeneration going on at the L4-L5 segment of your spine.

Have you ever had a flexion/extension x-ray to check for spondylolisthesis? It may be that rather than wearing away, the facets have become very enlarged from new nodules of bone growth and this is causing the nerves to be "pinched" as they come through the foraminal openings. Also the cysts are taking up space that would otherwise be available for the nerves to function normally -- so you have kind of a double-whammy issue here.

I would imagine you have a sciatic type pain running down your leg from this that is causing pain and perhaps the inability to walk too far.

 
Old 10-19-2012, 08:47 AM   #5
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Re: New MRI done, different findings - translation please?

The thing about this new MRI which was done in the hospital vs. clinic where all my others had been is that this one was done with contrast. not sure if that made the difference.

I have been struggling with leg pain in both legs, but pain is very distinct and different in both. Also I could not sit in a car or at my desk for very long without it causing the pain down my legs. THis had been going on for 4-5 years.

I have had 4 MRI's and all have said that there was a slight bulge at L5/S1 and on the right. Nothing that would even cause pain in the left leg.

Needless to say, most Dr. appts were quite dismissive. It also wasn't constant. Sometimes I'd go months without pain and other times I would be in the worst pain and would want to rip my leg off.

I've had 2 ESIs over the summer and the right one worked like a charm. The left one has worn off.

Since then, I had 2 days of the intense throbbing, nerve pain that would start on the left and shoot down the leg. About every 30-40 seconds. A pulsating nerve pain.

It was then I was curious as to what my MRI said so I requested a copy. When I read it, I was surprised. I hadn't seen mention of cysts before.

I emailed my PCP and described what it said. She responded by stating that "it sounds like sciatica, if it continues, please come see me". WHAT?!? She didn't comment on the cysts, (or even the fact that the MRI also found an ovarian cyst).

I googled synovial cysts and it actually sounds like they really could be my pain generator, but once again, dismissed by my PCP.

I should ask for a referral, should I see the neurologist? or spine specialist?

...and I still haven't been able to access my previous MRI results, out of town..

it's very discouraging.

 
Old 10-19-2012, 09:10 AM   #6
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Re: New MRI done, different findings - translation please?

I know firsthand that one can waste a lot of time wait a diagnosis from a PCP/family doctor. They have enough training and knowledge to look at a mri and give you the basics, but may miss the subtlties that a spine specialist has been trained to determine.

I would definitely recommend you see a spine specialist. This can be a fellowship-trained orthopedic SPINE surgeon or a neurosurgeon whose practice is devoted to the neck and back. You do not want a general ortho or a sports ortho, and, you don't want a neurosurgeon who prefers to work on the brain!

A neurologist is not the best option for a diagnosis as they do not have the additional training in the workings of the skeleton, muscles and soft tissue that contribute so much to the compression of the spinal nerve. They are helpful for testing, but their training is in diseases of the nervous system, like ms or stroke, etc.

Contrast is given because it does illuminate certain things that are not that clear on MRI without contrast. But there is a low percentage of risk using the medicine that is in the contrast, so it is not given routinely.

The cysts may or may not be a significant finding...but it might explain why the pain shifts from leg to leg and allows you to be pain-free for a time, only to have it return.

If your insurance carrier allows it, I would suggest you do some research and look into finding a spine specialist on your own. Do not automatically go to the doctor the PCP refers you to. That doctor may be the best option available to you, but more likely there is another, less important connection. Many spine docs do not require a referral from another doctor. You just call up and make the appointment.

The MRI is just one piece of the diagnostic puzzle. The information provided in the MRI will be correlated with a basic neurologic exam, physical exam and a description of your symptoms and health history.

 
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