I could use some help understanding what this is telling me, and how serious it is. I have persistent lower back pain, and after trying numerous adjustments etc. I got an MRI. It came back with this report:
Quote:
Scattered intraosseous hemangiomas noted, the largest within the L1 vertebral body. No suspicious disc, marrow or paraspinal edema noted. Distal cord signal is normal. The conus terms normally at L1-2.
At L4-5, mild annulus bulge and facet degeneration is noted. The central canal and neural foramina are patent.
I was told that this was essentially a "negative MRI with nothing to explain my lower extremity radiculopathy".
Anyone who knows about this stuff have any advice given what they read above?
You said persistent lower back pain, but then you say "I was told that this was essentially a "negative MRI with nothing to explain my lower extremity radiculopathy"." Can you be more specific on the pain you feel - where it is and nature of it (ache, stab, shock, burn, etc).
Your MRI means
1. Scattered intraosseous hemangiomas noted.
(Intraosseous hemangioma is a slow-growing benign collection of cells of capillary, cavernous, or venous origin. Spine Vertebral body hemangiomas usually do not cause any symptoms and are usually left untreated. Sometimes they are incidentally found in a patient with low back pain.
2. At L4-5, mild annulus bulge (disc bulge) and facet degeneration is noted .
( Although minor it is possible based on your anatomy that this is causing you pain. Many doctors don't dismiss symtpoms just because MRI looks minor. You don't have bad things going on but it doesn't mean you don't hurt. It looks like the bulge isn't pressing on anything - so it could be possible the facet is causing the pain. The facet joints lie on the side of the spine closest to the skin of your back. A pair of these joints can be
found at each of the 32 motion segments in the human spine. These joints move with each bend or twist of the body, working in conjunction with the
intervertebral disc to allow motion in the neck, trunk, and lower back. The facet joints allow movement between two surfaces covered with a
thin layer of cartilage, and a fluid-like sac helps to lubricate any motion, just like in the knee. Microscpic injuries (tears and abrasions on the cartilage) can lead to an inflammatory process that produces pain. This is a form of osteoarthritis just like in the other joints of the body. Severe back pain is the most common complaint. This can be associated with leg pain that is almost undistinguishable from sciatica caused by a herniated disc. In addition, the symptoms are typically worse in the morning upon awakening and can be aggravated by bending backwards (in extension). Facet arthritis can occur in any part of the spine but is most common in the lower back. Facet disease is one of the most under diagnosed back problems. There is a special test called a SPECT scan that can reveal the facet disease. Facet arthritis is primarily treated with medications used to reduce inflammation, including non-steroidal anti-inflammatory medications as well as oral steroids. Physical therapy to mobilize and stretch the joints. For
severe cases a direct injection of anti-inflammatory medications into the joint can be effective. )
3. The central canal and neural foramina are patent.
(this means your spinal cord isn't being pressed on and your nerve roots are not being compressed either). Patent means wide enough - normal.
If you are having leg pain like sciatica there is another way to get it besides from your spine. The nerve runs through front, side, back of leg, and can be pressed at the hip abductors/leg called piriformis syndrome. It probably causes pain in more in the butt and down the leg - so if you are having pain higher up not sure if you would have this.
So if your pain continues I would go back to the doctor and if you haven't seen an orthopic doctor get referred.
Thank you so very much for your excellent explanation. I find this very helpful.
You asked for more details on my lower back pain:
I have constant pain in my lower back, even when at a resting state, such as lying down. The pain is centered on the lower spine in the L1 to L2 (?) region. The pain is always at about 1 to 2 out of 10, and can get severe if I do something to aggravate my back.
There is no tingling, numbness, or shooting pains associated with it. Having been doing a series of specific stretches for the lower back, i will sometimes feel the pain radiate (very mildly) on a diagonal from my lower back to the top of my right hip, about 2 inches away from my spine.
The pain has been with me for years now - about 5 or more years ago it only acted up when I aggravated it, but no general resting state pain. For the last couple of years I have had constant pain, and it continues to get worse to the point that I am losing sleep and hurt considerably when first standing from a seated position.
The thing that seems to aggravate my back most of all is spending time bent over. If I do gardening, or say, painting a baseboard, I will be in intense pain after a while (10 or more minutes). I still have decent flexibility in general, and can lift things without aggravation (of course I do so carefully). I exercise regularly - swimming, biking, hiking - and am fit and in trim shape.
I only used the term "radiculopathy" because that is the term they used in the MRI report. I may have used it incorrectly.
So far, I have:
- gone to a Physical Therapist who diagnosed a slipped disc. He gave me some stretches to do that helped a little.
- gone to an Osteopath who said it was not a slipped disc, but he didn't know what it was. He gave me some stretches that helped a little.
- gone to an Acupuncture Clinic, which had no effect.
- gone to a Yoga class for Lower Back Pain which helps a little but has not changed anything about my condition.
- finally got the MRI as discussed above, and am discussing it with my general practitioner doctor.
Thanks for your help.
I appreciate any questions/observations/advice you may offer up on my condition.
Oh, and the nature of the pain:
Generally it is a constant sharp ache. When I aggravate it by bending for too long it becomes a very sharp pain like a knife. Especially when I straighten back up, but then it lingers for quite some time afterward. It is pretty constant and doesn't throb or shoot. It stays pretty centered on the spine. Sharp ache seems like the best descriptor.
I have a "good" anthropomorphically designed desk chair (I have a desk job). I had a different chair with a good reputation previously, but recently changed it to a new one to see if there was any difference. No noticeable improvement so far.
Thanks for adding more detail - I will think on what you have written here for a day before I offer any more advice. We all know this pain well - ice and heat, and I am wondering if ibuprofen (advil, aleve type medications) help yoiu?
Linear Mode
