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Old 01-20-2013, 05:21 PM   #1
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Help me interpret my MRI?

Hello, this is my first post. I am not really sure if I posted this in the right place. I need help reading my MRI so I am more prepared to talk with my doctor at my appointment this week, so any feedback would be appreciated Sorry in advance for the long post.

I am a 26 yr. old female. I started having pain in my left hip a year and a half ago. Both hips bother me now, but the left hip is the aggressor here, it wakes me up at night, and I have to sleep on my back or right side because of it. Shortly after the hip pain appeared, I developed sciatica, again beginning on the left side, starting under my butt cheek then running down the back of my thigh. But again, it occasionally happens on the right side as well. I started having lower back pain after all these other things showed up. There is a pressure and ache that is hard to describe, and standing for 15 minutes, or just lying in bed can aggravate it.

MRI reads:
EXAM
LUMBAR SPINE MRI WITHOUT IV CONTRAST
IMPRESSION:
1. Minimal disk bulging at L4-5 and L5-S1
2. Small focal areas of T2 hyperintensity near the left facet joint at L2-3 and L4-5 - See discussion.

DISCUSSION:
The study demonstrates normal alignment of the lumbar spine with no evidence of acute fracture or subluxation. Very mild changes of degenerative disc disease are suggested at L4-5 with minimal loss of disk signal and L5-S1 with mild loss of disk height. The conus medullaris is normally positioned. A small rounded focus of T2 hyperintensity measuring 4x4 mm is noted along the posterior left lamina at the L2-L3 level near the facet joint. A 6x3mm T2 hyperintense focus is noted adjacent to the left facet joint at the L4-5 level. These could be related to small synovial versus areas of prior therapeutic injection. Clinical correlation is suggested. The bone marrow signal is within normal limits.

At L1-2, L2-3, and L3-4, the intervertebral disks are maintained without significant disk bulging or herniation. No significant spinal stenosis or neural foraminal narrowing is apparent.

At L4-5, minimal disk bulging is suggested, predominantly laterally. Disk material appears to extend minimally into the inferior neural foramen, left greater than right without apparent nerve root impingement. Early degenerative facet joint changes are questioned. No significant spinal stenosis is noted.

At L5-S1, very minimal disk bulging is suggested. No significant spinal stenosis or neural foraminal narrowing is apparent.

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Old 01-20-2013, 08:06 PM   #2
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Re: Help me interpret my MRI?

Welcome to the board.

What type of problems are you having with your hip, which if I understand you correctly, seems to have preceeded the other issues? Is the pain situational or caused by certain activities?

The MRI report really doesn't do much to aid in helping to find a reason for pain in your hip/hips. Bear in mind that the radiologist feels obligated to write some narrative of the images. If there are serious issues, those will be mentioned, and the more minor issues will be overlooked. In your case there are a couple disc bulges mentioned. Radiologists use specific language to describe the severity of a problem. It is like a ranking system beginning with minimal...then mild, moderate and severe.

Your disc bulges are mentioned because they are a variation from a completely "normal" MRI, but they are nothing that would be regarded as causing pain. Discs are comprised of something like over 90% "water". As we age, the discs flatten out and lose moisture. There is a normal amount of wear and tear that we all experience...and this aging process begins in our twenties. Of course, some people are more impacted than others.

People do not develop pain unless a spinal nerve is being somehow affected. Usually this is from either irritation or compression. There are two main areas where nerves are compressed: in the central canal and in the neural foramen. These are little openings located at each vertebral segment where the nerve exists the spine out into the other areas of the body and limbs. When these areas narrow and cause the nerves to become "pinched" it is referred to as stenosis.

[B]At L4-5, minimal disk bulging is suggested, predominantly laterally. Disk material appears to extend minimally into the inferior neural foramen, left greater than right without apparent nerve root impingement. Early degenerative facet joint changes are questioned. No significant spinal stenosis is noted.[/B]

At this segment, there is a small bulge that is pushing out laterally. There is some disc material that is pushing out of the disc space into the foramen. While it is noticed, it not causing an issue with the nerve. The writer indicates there may be some degenerative changes in the facet joint...which is the synovial joint also located at each vertebral segment which actually link the vertebrae together. They contain fluid just like other synovial joints of the body like the ankle, knee, hip, etc. They develop arthritis, which causes the joints to enlarge, to grow bone spurs, etc.

[B] Small focal areas of T2 hyperintensity near the left facet joint at L2-3 and L4-5 - See discussion.[/B]

A further note indicates that there is a small area that is showing up At L1-L2 and another at L4-L5 ("hyperintensive") on the MRI that may be indicative of a small pocket of synovial fluid or perhaps something from a prior injection...the writer states this should be correlated by the doctor.

Are you seeing a spine specialist or is a family doctor treating you?

 
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Old 01-22-2013, 09:02 AM   #3
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Re: Help me interpret my MRI?

I am seeing a pain management specialist for my hip/sciatica ailments. I have had injections in both of my hips 2 times. I had couldn't tolerate the side effects of the steroid even though they were fairly effective for the hip pain, so I couldn't receive any more. My doctor gave the second injection about a month after the first, which is way too soon, and I think that may have contributed to the adverse effects I felt the second time around. I do physical therapy, but it hasn't helped much.

My hip pain is aggravated by standing for extended periods (anything more than maybe five minutes, maybe), sitting for a long while, and laying in bed is awful. No position is comfortable. I can't lay on either side, and even laying on my back, my hip will start to ache terribly and wake me after a few hours. My sciatica is pretty unrelenting, and I am not sure what triggers it. I make sure not to stay on the toilet or bar stools too long though. I don't exercise much. I have some anxiety issues as well, and it is difficult to get out of the house. I try to go on walks when possible. I haven't had any significant injuries.

 
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Old 01-22-2013, 10:51 AM   #4
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Re: Help me interpret my MRI?

Your hip pain may be coming from your issues at L4-L5 and possibly L5-S1. My MIL was treated for several years for bursitis in the hips. She used to get injections. Eventually it turned out it was all a degenerative disc at L4-L5.

If you look at a dermatome map, you will see the areas that are innervated by these particular spinal nerves. Also there are large muscles that have attachments to the spine that run to the hip...if you are compensating for back pain, it can be easy to cause a pelvic rotation which pulls on the hip and causes pain. Unless you have tests that confirm a mechanical hip problem, I wouldn't automatically assume the pain is caused by the hip itself.

Also, one reason why your sciatic pain seems to move from leg to leg is due to the location of the disc bulge. Sometimes they bulge out to the left side or to the right, but sometimes they go across that middle area where it can affect the nerves to both legs. And you may have a bit of instability at these levels, too, that would contribute to this pain seeming to move from one side to the other.

Last edited by teteri66; 01-22-2013 at 10:55 AM.

 
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