Explain my lower back mri

MSNik

You really need to talk to the doctor who ordered this to get a full understanding of this; however, some of the terminology is relatively easy to explain.

L4- L5- you have disc bulging. This means that the disc is out of alignment. If you are having pain, this could be why....this is not serious enough for surgery and sometimes can be corrected with physical therapy and strengthening exercises.

At L5 you may have the bulge pushing against a nerve; this would definitely cause you pain.

The word stenosis means narrowing of the spine. It mentions in several places that you do not have this.
Stenosis, or narrowing of the spine happens naturally as we age; since you are not showing it, I would assume you are on the young side. When it happens, it can cause the discs to move about; so this is not the reason why your discs are bulging. I would assume you were in some sort of accident or trauma to cause this to happen?

Once a disc bulges, it can herniate. I am pretty sure you might have heard of herniated discs? You do not have any...but you want to find out what you can do to remove the pressure of the bulge and push it away from your nerves to stop the pain....

Beyond this, you will need to speak to your doctor. I am not in any way a doctor or medical person, I am simply explaining the meaning of the words to you. I hope it helps!

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RRMS- dx 05

Bbn129

I’m 27 and been dealing with lower back pain since 2011. I’m not exactly sure what caused it. The doctor told me the only way to go was a full lower spinal fusion. I’m going to see a second doctor for another opinion. I’ve done physical therapy and seen a chiropractor several times. It shoots pain down my left leg all the way to my toes but sometimes it goes down my right side. My back spasms when I’m sitting down. I can’t hardly bend over to pick things up off the ground. It’s jest getting worse as I go.

teteri66

Welcome to the board. You must definitely get at least one more opinion. Be sure you are seeing someone whose practice is limited to the neck and back...either an orthopedic spine surgeon or a neurosurgeon. I am surprised you were told you need such a big surgery, especially considering your age and that there doesn't appear to be any major nerve compression.

Keep in mind that members are not medical professionals, just fellow travelers with neck and back issues who share information and suggestions...so keep that in mind as you read! I have had four lumbar surgeries, including two fusions and am now fused from L3 to S1 with additional decompression done at L2-3.

Most surgeons do not like to perform fusions on their younger patients unless there are absolutely no options. This is because a fusion causes those sections of the spine to be immobile, which puts additional stress on the first segment after the fusion. This is sometimes called the "domino effect" or adjacent disc disease. Obviously the younger the person is, the more time for the degeneration to occur.

Now, regarding the MRI, first it is important to know that radiologists use specific words when writing a report that indicate "how bad" or "how much" a finding is. These are: minimal, mild, moderate and severe. Speaking very generally, doctors tend to ignore issues that are judged to be minimal or mild. Moderate issues may require some sort of treatment, but it may be conservative modalities. An issue is usually somewhere between moderate and severe before requiring surgery...in the lumbar spine, anyway.

The discs are the soft cushions that separate the bones (vertebrae) of the spine. They are composed of 90+% moisture and, as we age, they tend to lose moisture and dry out. They are subject to abuse from the wear and tear of daily living. Playing sports, lifting heavy objects, etc. can speed up this degenerative process.

As the disc flattens or bulges out or herniates, it sets up a cascade of events involving other parts of the segment at L5-S1 with the issues at L4-5 being slightly worse. The diameter of the central canal is 15mm which is wide enough to accommodate the nerves. The disc at this level is bulging and in addition, the outer layer of the disc has a tear noted as an "annular tear." This combination of changes is putting pressure on the L5 nerve...which most likely is causing pain, perhaps tingling, to run down the back of the leg...perhaps into the foot.

What specifically are your symptoms? Did you play or participate in sports in high school? Are you currently seeing a spine surgeon?

Bbn129

My symptoms include constant lower back pain pain going down my leg into my hip knee and ankle tingling in my toes. Inability to bend over fully. Some days my pain is worse than others. Also the pain is moving up in my back. They think it’s because my upper back is trying to compensate for the lower. I see another doctor next month for a second opinion. I didn't do sports in high school because by high school I had already had 2 knee surgery’s.

teteri66

You might want to ask the next surgeon about the possibility of having a spondylolisthesis. This is a situation where one vertebra slips over the top of the adjacent vertebra. It is most common at L5-S1 followed by L4-5. It is one of the main "problems" that leads to someone having a fusion because it tends to cause instability. It often develops in older people as a result of degenerative changes, but there is another type that can form during the teen years...that's one reason I asked about sports.

Sometimes spondylolisthesis can be subtle and can be missed in the initial diagnosis. A flexion/extension X-ray is a good diagnostic tool to see this slippage.