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Need help deciphering MRI


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Old 06-16-2017, 01:47 PM   #1
lolgambler
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Question Need help deciphering MRI

This is my first post. I am new to this level of back pain and probable continuing deterioration. Any comments, etc., would be very much appreciated.

I have been having severe back pain particularly when getting out of bed in the morning. After an x-ray last month indicated DDD and other issues, I requested an MRI be done to provide specifics. The MRI was done on 6/14/17 and my family doctor’s note in my medical portal is “Foramen Stenosis L1-2, and 3mm Posterolisthesis of L1-2 and L2-3 – Levorotoscoliosis. Would not pursue this unless causing problem. If problem with increase in pain and decreating quality of life would see neurosurgeon.”

My doctor knows I will not consider surgery, steroid injections, or Rx painkillers.

The following is from the radiologist. I really need each item broken down into something I can understand. My intention is to continue pain management on my terms which currently is working fairly well: Tylenol Arthritis as needed, body pillow when sleeping, back brace, heating pad. BTW, I am a “woman of age” who has had back problems over the years but nothing that chiropractors couldn’t “fix.”

Impression:

1. Lumbar levorotoscoliosis.

2. Hemangioma is incidentally noted in the L1 vertebral body.

3. L1-2 level: Posterolisthesis of L1 on L2 measures 3 mm. Diffuse disc bulge effaces the ventral epidural fat. Anterior disc bulge with spondylosis displaces the prevertebral soft tissues. Neural foramina are narrowed bilaterally.

4. L2-3 level: Posterolisthesis of L2 on L3 with loss of disc height and hydration. Diffuse disc bulge with hypertrophy of facets and ligamentum flava produces mild central stenosis with mild bilateral neural foramen stenosis. Anterior disc bulge and spondylosis displace the prevertebral soft tissues.

5. L3-4 level: Loss of disc hydration. Disc bulge effaces the ventral epidural fat. Neural foramina are mildly narrowed on the left and patent on the right.

6. L4-5 level: Loss of disc height and hydration. Diffuse disc bulge with hypertrophy of facets and ligamentum flava produces mild central and bilateral lateral recess stenosis with mild bilateral neural foramen stenosis.

7. L5-S1 level: Disc bulge effaces the ventral epidural fat. Posterolateral disc bulge and facet arthropathy narrows the bilateral neural foramina.

Last edited by lolgambler; 06-16-2017 at 01:53 PM.

 
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Old 06-18-2017, 10:00 AM   #2
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Re: Need help deciphering MRI

Welcome to the board. I will attempt to give you some basic understanding of your issues, including some basic anatomy that it helps to understand.

In a report such as this, the spine is looked at in segments. At the most basic level, there are the two vertebra, separated by the intervertebral disc..as in L1-2 for example. This refers to the first and second lumbar vertebrae separated by the disc, which provides a cushion between the bones.

The disc is composed of something like 90% "moisture" but there is no direct supply of "moisture" to the disc. It has to absorb nutrients from adjacent tissue. As we age the discs tend to lose moisture and dry out. This results in the disc flattening, which brings the bones closer together. This is referred to as "disc space narrowing." Sometimes the disc develops a bulge or a tear in its outer wall. This degeneration tends to set in motion a series of changes that affect the disc and adjoining facet joints.

The body always fights to maintain stability. As the disc deteriorates, the body tries to compensate. It does so by laying down little bone spurs and enlarging the facet joints, among other little changes. Remember that each spinal segment exists within a specific special area, so any enlargement kind of automatically causes issues--the space becomes over-crowded, which tends to result in spinal nerve compression and displacement of tissue.

The two areas that are most commonly affected are in the neuro foraminal openings, also called foramina, and the central canal where the cerebral spinal fluid and nerves of the "cauda equina" are located. When a disc bulges, a joint enlarges or other tissue loses its elasticity or enlarges, it can push into, efface or block the foramina and/or central canal. This puts pressure on the nerve which causes what we lay people call a "pinched nerve." It can cause pain and other symptoms at the site of the pinch or anywhere along the path of the nerve. (You can search for a "dermatome map" to see what areas of the body are innervated by a particular nerve. For example, if your big toe is numb, the doctor would know to look at L4.)

OK...so the report indicates some curving of the lumbar spine toward the left...(scoliosis). It doesn't indicate to what extent this is curving. At levels L1-2 and L2-3 there is a spondylolisthesis, which is where one vertebra slips over the top of the adjacent vertebra. This is not of much significance.

From L2-L5, there are various types of bulges going on that are causing a small amount of narrowing in the foramina. There is some arthritis in some of the facet joints...

As you were told, there are signs of degenerative disc disease, but it is, overall, mild...this on a scale of: minimal, mild, moderate and severe. Doctors rarely prescribe treatment for issues thought to be mild.

You should be able to continue with the types of conservative treatments you are currently using. Nothing would require surgery even if you agreed to it!

 
Old 06-18-2017, 11:06 AM   #3
lolgambler
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Thumbs up Re: Need help deciphering MRI

Thank You! I'm having difficulty getting appointments with my family doc as he is currently in the process of merging with another practice and everything is working slowly or not at all. So it helps to understand the MRI prior to being able to sit down with him -- whenever that can be arranged.

My DIY pain management plan consists of Tylenol Arthritis as needed, a heating pad when needed, sleeping with a body pillow, and wearing a back brace most of the time except sleeping. I do have almost constant pain of some type, mostly lower back, but it's 1-3 on a scale of 10. It's doable.

A question I have is what can I expect in the future?

Again, thank you. These boards are an amazing wealth of information.

Pat

 
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degenerative disc disease, lumbar disk herniation



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