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    Old 11-14-2003, 12:25 PM   #1
    dayton's Avatar
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    finally mri results -- please help interpret

    Hi everyone, FINALLY got mri results. ok here's hip:

    FINDINGS: ap pelvis encompassing both hips and frog leg lateral views both were performed.

    hip joints bilaterally appear symmetrical and normal. No evidence of fracture, osseous lesion or seconday signs of avascular necrosis is visualized. Internal trabecular pattern of the proximal; femurs is symmetrical and normal. Soft tissues around the hips appear normal. The bony pelvis including the sacrum, sacroiliac joints and symphysis pubis also appears normal. No calcifications in the pelvis or surrounding the hips is seen.

    Ok, here's mri of right hip w/o contrast.

    bilateral hip joints appear normal and symmetrical. bone marrow signal is anatomic particularly in the proximal femurs. no significant hip joint effusion is visualized. the visualized portions of the bone pelvis also demonstrates normal bone marrow signal. the musculature surrounding the pelvis and both hips appear symmetrical and normal. the uterus and ovaries are not visualized. no fluid collections in the pelvis. the bladder is shrunken but otherwise normal in appearance. perirectal fat is clean. no inguinal hernias or inguinal masses are seen.

    normal right hip. no evidence of bony or soft tissue abnormality is seen. nonvisualization of the uterus and ovaries. they could have been resected versus atrophic. clinical correlation regarding this is recommended. (I had a hysterectomy)


    alignment appears grossly normal. vertebral body stature and bone marrow signal are normal. L1-2, l2-3, l4-5 and l5S1 discs are desiccated but normal in height. l3-4 disc is normal in height and hydration. the conus ends at l1 and appears relatively normal. ectasia of the distal thecal sac at the level of s2 and s3 is visualized with the csf appearing homogenous representing a normal variant. mild subcutaneous edema in the adipose tissue in the posterior midline back is seen. the paraspinal musculature is normal, however, distal aotic flow void is appropriate.

    l1-2 very minimal early annual bulge is present without central canal or exit foraminal compromise.

    l2-3 superimposed upon diffuse bulge is fissuring and edema of the lateral aspect of the left annulus visualized on the t2 weighted sequences. no evidence of focal herination is seen. the bulge is slightly greater along the posterolateral aspects. no central canal stenosis is visualized. mild encroachment upon the exit foramia is present without impingement.

    l3-4 normal

    l4-5 disc bulge is present slightly greater along the left posterolateral aspects. no evidence of focal herniation or central canal stenosis. exit foramina is mildly encroached upon.

    l5-s1 mild disc bulge is present without focal herniation or central canal stenosis. in conjunction with mild facet arthropathy, there is mild encroachment upon the exit foramina although distortion of the existing l5 nerve roots is not present. rim of perineural fat is preserved around the exiting nerve roots.

    remaining posterior elements in the lumbar spine appears normal.


    mild degenerative disc disease l2-3, l4-5 and l5-s.

    fissuring and edema of the left lateral margin of the l2-3 disc is visualized.

    no evidence of focal herniation, central canal stenosis or exit foraminal stenosis is visualized through the lumbar spine.

    mild encroachment upon the exit foramina at l5-s1 in conjunction with facet arthropathy is visualized. milder encroachment at l2-3 and l4-5 is also visualized.

    ectasia of the distal thecal sac as normal variation. no tethering of the cord of distal limpoma is visualized.

    mild subcutaneous edema in the posterior midline adipose tissue which does not extend into the paraspinal musculature. significance of this is unknown.

    SO WHAT IN THE SAM HILL DOES THIS MEAN? did the pain doc damage my back or what?

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    Old 11-14-2003, 03:23 PM   #2
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    [COLOR=Navy][B][CENTER]Hello Dayton,[/CENTER][/B]
    [INDENT]Wow, it looks as if you have had a lot of testing. I will try and help you out with some of your report.

    Well, the good news is that you don't have stenosis. It looks as if you have 4 disc bulges. Their is no sign on this report that they have herniated. As for the edema, they had also found that on my most recent CT Scan. Subcutaneous edema designates generalized accumulation of fluid in subcutaneous space, usually from increased hydrostatic pressure. I also suffer with DDD but it only has affected one of my lumbar disc, however that disc has not been the cause of my back pain. I did find that out when I had a discogram. However, you do have three disc that have DDD. You have also been diagnosed with Facet Arthropathy. It is not uncommon to see both Facet Arthropathy and DDD together. I think most of your pain could be cause from the facet arthropathy. Here is some information on FT:

    Facet Arthropathy- a degenerative disease affecting the facet joint.

    The facet joints connect the posterior elements of the vertebral bodies to one another. Like the bones that form other joints in the human body, such as the hip, knee, or elbow, the articular surfaces of the facet joints are covered by a layer of smooth cartilage, surrounded by a strong capsule of ligaments, and lubricated by synovial fluid. Just like the hip and the knee, the facet joints can also become arthritic and painful, and they can be a source of back pain. The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthropathy, which simply means a disease or abnormality of the facet joints.

    Most people who have facet arthropathy will complain of low back pain that is worse with twisting or extension (bending backwards) of the lumbar spine. The pain is often quite well localized, and unlike the pain and numbness caused by a herniated disc or sciatica, it does not usually radiate into the buttocks or down the legs. However, as the facet joints become arthritic, they often develop bone spurs that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This can be a contributing factor in the development of spinal stenosis, which does cause pain, numbness, and weakness in the buttocks and legs.

    Facet arthropathy is rarely the only cause of significant back low back pain, and patients who have this condition often have other disorders that may be contributing to their symptoms, including degenerative disc disease, arthritis of other parts of the spine, and often spinal stenosis as well. Most people with even mild to moderate amounts of arthritis of the lumbar spine will have evidence of facet joint degeneration on a CT scan (CAT scan) or MRI. A bone scan, which shows areas of active inflammation in the spine, is a test that can be used to determine whether or not facet arthropathy may be contributing to a patient's back pain. The facet joints themselves can be selectively injected with a mixture of a local anesthetic and an anti-inflammatory steroid. If this injection relieves a significant amount of the patient's back pain, and there is evidence to suggest that the facet joints are arthritic (such as a positive bone scan, CT, or MRI), then the diagnosis of facet arthropathy can be made with some confidence.

    There are several options for treating the pain and symptoms caused by facet arthropathy. The initial treatment of facet joint disease involves avoiding the motions that cause the joints to be painful (such as repetitive twisting, lifting, or extension of the lumbar spine), a course of anti-inflammatory medications, and stretching and strengthening exercises to improve the strength and endurance of the muscles in the lumbar spine. Injections can be used to relieve some of the pain and discomfort of facet arthropathy by quieting down the inflammation and synovitis that is caused by this type of arthritis. Unfortunately, this is often not a permanent solution, and the pain may recur after several months. There are a few techniques that have recently been developed that attempt to alleviate the pain of facet arthropathy by permanently destroying the nerves that innervate the facet joints and "feel" the pain of the arthritis. These procedures use small electrical probes that are inserted through the skin into the area of the nerves to the facet joints, and an electrical current that destroys the nerve is sent to the tip of the probe. This procedure is called a sinu-vertebral nerve ablation.

    In other situations, surgery may be indicated to relieve the pain of facet arthropathy. This usually occurs when there is evidence of nerve root compression from enlargement of the facet joints, or other disorders in the lumbar spine (such as degenerative disc disease, spinal instability, or spinal stenosis) that need to be treated with surgery. In the course of most forms of a spinal fusion, the surgeon removes the facet joints between the levels of the spine that are to be fused together, which effectively eliminates the facet joints as a source of future symptoms of back

    I don't know much about your previous condition or reports. I do hope that some of this info help you. Please keep us posted on what you doctor does recommend for you. I wish you the best.[/INDENT]
    [B][CENTER] Have a good night. [/CENTER][/B][/COLOR]

    Old 11-14-2003, 06:26 PM   #3
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    do you think t his is something that is fixable? i have 14 months left for retirement and am very anxious to make it. my doc left early on friday and didn't get back to me.

    is this something that i've had for a long time or could it be something that the pain doc did in september?

    Old 11-14-2003, 06:46 PM   #4
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    Go see Dr. Guyer at TBI. He is not quick to cut. TBI Hurst has top notch PT and a chiroprator, Dr. Jasinski, that is like no other. She bridges the gap between MD and Chiroprator. She is very, very good. Not a bone cracker.

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