If anyone could help explain this, it would be awesome.
Long story short, I hurt my back 3 1/2 months ago and have seen no improvement since day 1. I'm 30 years old, and cannot stand for over 1/2 hour without it getting worse and worse, to the point I need to lean heavily and support most of my weight with my arms. I did not have back problems before this injury.
The M.R.I shows:
Mild loss of disc signal at L5-S1. The conus is appropriately located.
L3-L4 through L5-S1, mild annular disc bulge. No central stenosis.
Moderate bilateral neural foraminal narrowing at L5-S1.
As this was a work related injury, I'm dealing with an insurance company that I suspect will tell me these results are entirely due to aging. ( Which is laughable, since I have no history of back problems, and the symptoms began the moment I tossed a 100+ pound skid at work and felt a 'pop'. An uncannily coincidental time for age-related pain to manifest.)
Can anything listed in these results explain why I can't even stand for a half hour? Or has the actual problem potentially been missed entirely? I thought I read somewhere that 'Loss of disc signal' could mean that movement messed up the MRI, resulting in skewed results. Is that true?
Apologies for the long post.
Any help would be greatly appreciated.
Apologies for the vagueness in the original post.
The main bad spot is about 2 inches above my tailbone, centered on the spine, though the pain radiates horizontally in both directions from there. At its worst, I had pain shooting down my left leg all the way to my toes ( though that symptom disappeared weeks ago...the only progress I've seen).
At present, I'll wake up feeling only dull pain just above the tailbone, but as long as I'm on my feet it slowly gets sharper and spreads, until I need to lean on something or sit down due to pain and weakness. Prescribed anti-inflammatories and muscle relaxers don't seem to touch the pain.
I was first told it was a lumbar strain, but since it's been almost 4 months now, well beyond the usual recovery period of 8 weeks max, I was under the impression that 'muscle' issues have pretty much been ruled out, or if it was muscular, I should have at least seen substantial progress by now. Though I'm no expert, my physio seemed to agree.
Is it possible that standing for extended periods could causes a disc bulge to become irritated/inflamed, which in turn aggravates the foraminal narrowing...pinching nerves and causing acute pain?
Again however, very possible you're right and my body just heals 'muscle badness' freakishly slow. Kind of hoping for that actually.
Anyway, thanks for taking the time to respond. That was quick.
<< Is it possible that standing for extended periods could causes a disc bulge to become irritated/inflamed, which in turn aggravates the foraminal narrowing...pinching nerves and causing acute pain? >>
That's what I'm thinking. It may or may not be the disk bulging, but when you're in a standing position, you have a lot of force pushing down, and you also have your abdomen pulling everything forward (unless you're built like Bruce Lee).
I would note that the radiologist says you have "moderate" foraminal narrowing. Since that's only one step below "severe" in the minimal/mild/moderate/severe scale that radiologists use, it's worse than it sounds, especially since the MRI is taken lying down, and your problem comes from standing.
So my amateur's GUESS is that your left L5 nerve is getting squoze some. You would suffer from direct pain where that's happening, and also from referred pain going down your leg (the outside, I believe). You can look up the dermatome and see what you think.
In someone your age, these things usually get better, and become episodic, but you never know. I suspect you're in this for the long haul, so you may as well learn all you can about it and what you can do to fight it.
The Following User Says Thank You to WebDozer For This Useful Post: Skot (06-18-2012)
Thanks again for the help. Though I realize it's an educated guess, it's a lot more in depth than 5 or so doctors have been with me so far. I've gotta say, I hope you're wrong about the 'long haul' bit. After 4 months of this I'm pretty close to 'crazy'. And I realize that probably sounds whiny, on a forum full of people with much worse spine problems than me, but it's true.
I guess I have some reading to do now. Thanks for the help again, and the speedy reply. You're good stuff.
skot water loss in the disc is an aging process.everyone has some mild to severe. the anular bulges just mean there is some bulging into thr spinal canal that causes pain usually centralized to back. the bilateral foramen encroachment means it is pressing on nerves going out the foramen and is causing leg pain and weakness.
I just had L4,5 and S1 operated on so I can tell you, that bi-lateral neural foraminal moderate encroachment is probably the cause of your problems. The exiting L5 nerves go from the back down to the outside of the lower leg and to the foot, including the big toe and the 2nd and 3rd toes. When I blew the disk for the umpteenth time last July, my toes "disappeared". Got them back in late March with surgery.
Here would be my recommendation since you are on WC.....demand they do an EMG/NCS...stands for Electromyelography and Nerve Conduction Studies. My MRI showed the problem was moderate but the EMG/NCS showed it to be worse....it measures the speed with which electrical pulses travel the nerve...slower means a problem.With my EMG showing different from my MRI, the surgeon did operate and after, said the MRI did not show at all how bad things were. I didn't have any pain...my legs were NUMB.
You might also ask about a standing MRI. Some say they aren't worth it and don't show any more than a regular but in your case, with WC, you need to explore every possible avenue of knowing what is and isn't wrong. WC can be a b@#$%. X-rays done lying down, standing and bending backwards(very important) should also be done.
This will become a baseline. If the docs don't think it needs surgery now, they will have a really good idea of when you do need intervention. But you need a full baseline and that means the nerve tests and additional x-rays and MRI if you can find a standing MRI near you. A single MRI is never enough to warrant anything. It may be for the neck but not the lower back.
The Following User Says Thank You to jennybyc For This Useful Post: Skot (06-19-2012)
Thanks so much for taking the time to write this out.
I had asked my physio if there were other tests worth looking into and was told 'no'...so it's good to hear there are still some diagnostic options. I didn't know 'standing' MRI's existed, so that helps too. I'll be asking my doctor about everything you mentioned here next time I see him. And silently wondering why the hell he didn't order this stuff a month ago.