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Old 02-22-2012, 11:46 AM   #2
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Unhappy Re: understanding my mri

Welcome to the board. You might want to repost this over on the Back board. Most of the lumbar spine "patients" are hanging out over there.

Remember we are all fellow laymen with no formal medical training so keep that in mind when reading. I can give you a general idea of your report so you can do a little research before you go back to the doctor for the "official" interpretation of the findings.

Basically you have a bit of degenerative change going on in several segments of the lumbar spine.

I'm going to assume this is your first trip to the back rodeo and you don't have much experience with anything pertaining to the back. We will start with the basics.

The spine is made up of 33 vertebrae separated by a spongy cushion that is the "intervertebral disc." Its purpose is to provide cushioning between the bones, to act as a ligament that holds the spinal column together and as a joint that allows some movement in the spine (so we can bend and twist). There are 23 discs divided into 4 sections: cervical, thoracic, lumbar and sacral, and any one of them can develop a problem.

There are nerves running up and down the spine that branch out from the spine and carry signals to the rest of the body.

Now for your specifics:

At L4/L5 level, there is a mild diffuse disc bulge with posterocentral, left paracentral disc protrusion impinging onto the anterior sac, abutting the L5 traversing nerve root. No obvious compression or displacement of the exiting nerve root seen. Bilateral facet joint degenerative changes with ligamentum flavum hypertrophic changes seen.

There are various ways that a disc can become damaged. Often it comes from just the wear and tear of daily living. Unfortunately the human spine begins to degenerate in our twenties. It's just that most of aren't aware of this for several more decades, but sometimes it happens sooner.

The most common disc problem is a disc bulge...sometimes called a protruding disc or a herniated disc. At the disc located between the Lumbar 4 and Lumbar a5 vertebraes, there is a MILD disc bulge. (In MRI language, issues are described and catagorized as minimal, mild, moderate and you can see where you fall in that continuum.)

Think of a bulging disc like a water balloon. If you press on one part of it, it will bulge out on another part of the surface. This is the way with the disc. In your case the bulge is big enough that it is moving out of its allotted space between the two vertebrae and is pressing up against the L5 nerve. This nerve carries feeling and sensation from the lower back down the when anything irritates the nerve, it can cause pain.

The report indicates that the bulge is abutting the nerve but it is not compressing it. This is a good thing and would result in less pain than if the nerve was actually being pinched or compressed.

There are also some issues with the facet joints at this level. There are three things that allow movement between every two vertebrae: the disc separating the two vertebrae and then, two facet joints that connect the two vertebrae. They are a synovial joint just like other synovial joints in the body, like the ankle or knee, and they are subject to arthritic changes. They can become inflamed; fluid can build up, etc.

Your report mentions that at this level the facet joints are showing some signs of degenerative change. This could mean they aren't as smooth on the surface as they once wear, or they might be swollen, etc. The report doesn't specify....

The ligament flavum is a thick covering that surrounds the central canal. It connects under the facet joints to create a "small curtain" over the posterior openings between the vertebrae.

As we age, this ligament tends to dry out and thicken up...and at the L4-L5 segment, it is showing some signs of change.

The report indicates that your primary problem comes one level down, at the Lumbar 5-Sacral 1 segment.

At L5/S1 level, diffuse disc bulge seen along with posterocentral, left paracentral and left foraminal disc protrusion impinging and compressing upon the left S1 traversing nerve root, abutting the extra-foraminal course of the left L5 exiting nerve root seen. Bilateral ligamentum flavum hypertrophic changes are seen at this level.

This is similar to what I described going on at L4-L5, but in this case, the disc bulge is pressing onto the spinal nerve that exits at this level. it indicates it is "impinging and compressing" the S1 traversing nerve root. This compression can cause a great deal of pain that radiates down the back of the leg...what is commonly thought of as "sciatic" pain. In addition, there is another nerve that is located in the same area and the disc bulge is pressing up against it. These happenings are occurring on the left side.

And again, at this level too there are some changes showing up on that ligamentum flavum....all these findings indicate signs of degenerative change...nothing in and of itself is really bad...but when put together, they probably account for the pain you are feeling.

Usually what happens in this type of situation is that conservative treatments will be prescribed...a course of physical therapy to strengthen the core and back muscles and to teach you how to move in a way that protects your spine. Oral medications are often given to help with pain
and sometimes steroid injections are given to help kind of shrink the disc bulge and get it to move off the nerve.

Hope this helps.