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Help with an MRI

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Old 03-23-2012, 04:41 AM   #1
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Stang99 HB User
Help with an MRI

Had recently experienced severe, and I mean SEVERE, back pain recently. Thank goodness for narcotic pain relievers! Once I returned to the land of the living, my doctor recommended a lower lumbar MRI. I knew I had a problem, but the results of the MRI as provided by the radiologist seems to indicate the problem may be worse than I expected. I would like to share the results and solicit input from others with training and/or experience.

- A transitional vertebra is seen at the lumbosacral junction with lumbarization of S1 vertebra.
L2-L3 (numerical): There is disc desiccation, marked loss of disc height and anterior endplate osteophytes. There is mild concentric annular disc bulge inclining more toward right side with mild inferior narrowing of the corresponding exit neural foramen, however, no demonstrated radicular impingement.

- L3-L4 (numerical): There is disc desiccation, moderate losss of disc height and anteriorendplate osteophytes. There is posterior left paracentral disc herniation of protrusion type, migrating cranially. It produces leftward flattening of ventral thecal sac and radicular impingement of the traversing left L4 nerve root within its lateral recess. The corresponding exit neural foramina are otherwise preserved.

- L4-L5 (numerical): There is disc desiccation, moderate loss of disc height and endplate spondylosis. There is concentric annular disc bulge, inclining more toward left side. There is superimposed facet degenerative hypertrophic arthropathy and ligamentum flavum hypertrophy. The combined processes have produced secondary central spinal canal stenosis and bilateral exit neuroforaminal narrowing, left more than right with radicular impingement of the exiting left L4 nerve root.

- L5-S1 (numerical): There is disc desiccation, marked loss of disc height and endplate osteophytes. There is posterior right subarticular disc/ostelphyte complex producing right exit neuroforaminal narrowing and compromising the exiting right L5 nerve root. There is bilateral facet degenerative hypertrophic arthropathy.

- The sagittal diameter of the bony lumbar spinal canal is developmentally reduced opposite L3 through L5 levels.

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Old 03-23-2012, 07:16 AM   #2
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Re: Help with an MRI

Welcome to the board. As members, we do not have formal medical training, so any comments will be based on experience as fellow spineys, not from any training!

Bear in mind that any imaging such as MRI is one piece of the diagnostic puzzle. The doctor will correlate the findings with what is found upon physical examination, basic neurologic exam, medical history and probably most important, listening to the patient's description of symptoms.

Also keep in mind that the spine is not the human being's best designed "system." In fact, the aging process in the spine begins in our twenties. Sometimes a report that looks bad will be met with a comment such as this: "for someone your age, things look fine." What this translates to is if your MRI were lined up next to those of your peers, it would look very similar.

So, what this means for everyone is some terms that we hear of like "herniated disc or bulging disc" are not necessarily all that awful or "bad." Many people have disc degeneration or disc herniation and are blissfully unaware of it because it is not causing any symptoms. They only discover it when imaging is done for some other purpose.

Your report looks like it is indicating that there are many problems in your lumbar spine....but you will not know if they are actually problematic for you until the doctor examines you and moves your body to check for limitations.

You will note the word "dessication" appears at every level. This means that the lumbar spine is showing signs of wear-and-tear. Dessication means that the discs are beginning to lose moisture, which in turn causes them to lose their cushioning effect. When all disc height is lost, you end up with a "bone on bone" situation which can be painful, particularly if a nerve ends up caught in between the bones. (but yours aren't at that point).

In general, your discs all show signs of degenerative changes. It mentions osteophytes, which are bony overgrowths like a bone spur that rough up the edge of the vertebra. In and of itself, it is not a problem per se, but another indication of disc degeneration.

Next you will see that you have some discs that are bulging. This too is not necessarily a problem....what you need to know is whether it is causing any involvement with the spinal nerve root. And yes -- the report indicates that the L4 nerve is being impinged, and is the L5 nerve. This is often a source of pain that can radiate out into the lower limb.

Another finding that can cause you pain is that your central canal is more narrow than "normal" beginning at the L3 level and continuing down through the rest of the lumbar area. It states: [B]The sagittal diameter of the bony lumbar spinal canal is developmentally reduced opposite L3 through L5 levels.[/B]

The spinal nerves exit at each vertebral level and move into the central canal. Above the L1 level they form the "spinal cord." Below this level, the nerves twist together to form what is called the "cauda equina" which travels down through the canal and branches into the sciatic nerve in each leg. At any point, if something (like a bulging disc, enlarged joint, inflamed tissue, etc.) is pushing into the spinal canal, it can irritate this bundle of nerves or it can compress a nerve...which can cause those "nerve pain feelings" such as tingling, numbness, electrical sensations, etc.

There are two main places where the nerves are commonly compressed in the spine. One is in the central canal itself, and the other is in the foramina, which is an opening at each vertebral level through which the nerve exits. If the foramina becomes blocked or is narrowed by things such as osteophytes, enlarged facets, etc. the result is nerve compression. This narrowing process is referred to as "stenosis" and it can also happen in the central canal.

You will notice that at L3-L4, L4-L5 and L5-S1 levels there is "neuroforaminal narrowing" and stenosis is mentioned as well. Both the L4 and L5 nerves are being affected.

You don't mention having pain going down your it only in your back? The MRI would indicate that you might have pain that would run along the areas innervated by the L4 and L5 nerve.

You didn't copy the "Impression" section of the MRI...which is a summary of the report...but I would imagine it talks about general disc degeneratives changes and the compression of the L4 and L5 spinal nerves.

As I mentioned, the doctor will put you through some physical "tests" to look for possible compromise of those nerves, and to correlate his findings to those noticed on MRI.

Hope this helps and that I haven't confused things further!

Last edited by teteri66; 03-23-2012 at 07:21 AM.

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Stang99 (03-28-2012)
Old 03-23-2012, 07:18 AM   #3
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Re: Help with an MRI

I can believe you had some severe pain just reading the MRI notes. What has your doctor told you regarding the MRI? Has your doc started planning anything do help you with this? An orthopedic surgeon or neurosurgeon that specializes in the lower spine will be the best thing as far as future treatment.

There are definitely factors at work in there that could be causing your pain. My MRI looks tame in comparison to yours, and I know what kind of pain I have been in.

The stuff I am familiar with is the transitional vertebra, the facet hypertrophy (arthritis), and the disc desiccation (degeneration). At least it sounds like your transitional vertebra is bilateral lumbar. Correct me if I am wrong on that.

While many doctors don't think a transitional vertebra is an issue, my personal belief and experience is that they are, especially if you have an extra lumbar vertebra. Having an extra lumbar vertebra results in more curve to the lower spine, and increased movement because a segment that was suppose to be stationary is not. This was actually explained how it was explained to me by a chiropractor. The mechanics of your spine are different because of that extra lumbar vertebra.

The osteophytes are also an arthritic issue, if memory serves me correctly. If my memory isn't correct, I hope someone will correct me. You also have some nerve impingement, which means the nerve is being pinched to some degree. The facet hypertrophy could indicate some nerve interference at the facet joints (personal experience).

Many doctors, if doing diagnostic injections use cortisone along with a numbing agent for their injections. My personal preference is for just the numbing agent, as there are potential problems with too much use of steroids, which cortisone is.

This is all personal knowledge or experience, and a spine specialist is going to be your best resource for explaining, diagnosing and treating your problems. Hope this helps you understand some of this, and hopefully someone else can help you understand some of the other issues showing up. There are some things that I don't have personal experience or knowledge of.

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Stang99 (03-28-2012)
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