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AndreaS84 09-27-2012 06:37 AM

MRI advice
 
[I]Lumbar MRI Help

--------------------------------------------------------------------------------

I] I am a 27 year old female, my mother also has a history of back issues and several surgeries that did not turn out for the best.
History: My first time dealing with Sciatica was 8 years ago during a pilates class. I overextended myself and had it happen. I tried chiropractic for a year or so, the pain went away and I stopped going.
I recently started back with the pain after I lost some more weight (I had a very intense workout routinue) I originally thought I had a hamstring tear as the pain was intense and radiating from left buttock all the way down to the top of my foot. These days the top of that foot is losing more sensation.
The orthopediac surgeon told me to see a nuerosurgeon, who I was SUPPOSED to see today but a referall issue stopped that in it's tracks. I cried in the office. I've been pretty strong but this chronic, constant pain is taking it's toll on me. I've regurally had to take liek 12 naproxen just to make it though the day. I'm currently on my boyfriends anti-inflammatories,. thank god for that.


MRI TAKEN ON 9/5/2012

History: pain, radiculopathy, left lower extremity.
TEchnical FActors: T1 sag, ax; T2 sag, ax; 3D myelogram images with sagital reformats.
Findings: The cord and conus are normal distally and terminate in a normal postion at the L1 level. assuming 5 lumbar vertebrae. The preverterbral space, including the descending aortic caliber and inferior vena cava, is unremarkable with the cava patent. No retroperiotoneal adenopathy of significance is identified.

Lower Thoraci discs unremarkable.

L1-L2 and L2-L3 discs are unremarkable. NO focal lumbar disc protrusion/herniation. NO central spinal canal stenosis. No substantive neural foraminal encroachment. NO posterior facet joint degenerative arthropathy is evident.

L3-L4: Extrusion-type disc herniation extending inferior to the disc margin approximately 8mm. There is moderate compression of the central canal measuring 8.5mm in AP diameter. Moderate bioframinal narrowing noted as well, right greater than left. Mild facet arthropahty evident.
L4-L5: Central disc displacement. NO signifcant central canal stenosos evident. Mild central canal stenosis evident. The neural foramina are patent without neural impringement.

L5-S1: Left paracentral extrusion-type disc herniation extending into the left lateral recess with moderate central canal stenos and left foraminal narrowing. This effaces the exiting L5 AND DESCENDING s1 NEVER REOOT. rIGHT NEURAL FORAMENT PATENT.


conclusion:
1. Left paracentral extrusion type disc herniation L5-S1 level compressing the desciending S1 and exiting L5 nevrve root.
2. Extursion-type disc herniation L3-L4 level extending inferior to the disc margin and resulting in moderate central canal and biforaminal narrowing, left greater than right.
3. Shallow central disc protursuion L4-L5 level with mild central canal stenosis
\4. Please refer to the body of the report for additional findings at the respective disc space levels.

teteri66 09-27-2012 11:09 AM

Re: MRI advice
 
You are correct. You do need some help. I am curious why your orthopedic doctor referred you to a neurosurgeon. Was he not an orthopedic spine surgeon? Orthopedic spine surgeons receive almost identical training as neurosurgeons when it comes to the spine. Sometimes they take a slightly different approach to the same problem and it is always helpful to get an opinion for each when one is contemplating surgery.

Regardless you do need to see a spine specialist/spine surgeon because you have some issues that need to be addressed.

The feeling of a strained hamstring is often the only sign a person gets when a lower lumbar disc is herniating. That was the case with my husband.

I will try to go through your MRI and point out the "highlights," trying to explain the terminology so when you see the spine specialist, you will be able to converse with him or her. ;)

First, the good news: the lower thoracic area looks good and there do not appear to be problems and the first two lumbar areas, L1-L2 and L2-L3.

At the next level, L3-L4 and again at L5-S1, the discs are extruding. When a disc bulges and goes beyond its disc space, and when some of the disc material breaks through the disc wall, it is considered extruding. The disc material has broken through the annular wall, which is the outer layer of the disc, but it is still attached. If it were to break free, it would be a disc sequestration.

This disc material is pushing out into the central canal and causing moderate compression. Also, in the associated foramen, there is also what should be open space that is being blocked by this extruding disc material. The foramen are openings through which the spinal nerves pass from the spine out into the body. These are the two main areas where nerves can become compressed. it is this compression that results in the radiating pain we feel that goes into our legs and feet or upper limbs if it is a cervical problem.

At L5-S1 the same thing is going on but the extrusion seems to be affecting the left foraminal opening more than the central canal...but it is causing stenosis in both areas. This material is noticeably pushing into both the S1 and L5 nerve roots. This is probably where the worst of your pain is coming from.

If you enjoy doing a little research, look online for a "dermatome map." This will give you an idea of which spinal nerves innervate which area of the body.

When a nerve is compressed, pain can be felt at the point of compression in the spine, or it can cause pain at any point along the pathway of the nerve. My stenosis caused horrid leg pain and numb feet, but I hardly had any back pain.

So basically the discs from L3 to S1 are showing signs of degenerative change, which is causing stenosis in the central canal and some of the foramen. At L5-S1 we know for sure that the spinal nerves are being "squished" as it is apparent on the imaging. Chances are, that the disc extrusion at L3-L4 is also causing issues that are contributing to your pain.

I would imagine the spine doctor will want to try conservative treatments first, such as a course of physical therapy, oral medications and a series of epidural steroid injections (ESI) to try to shrink up the disc extrusion and inflammation.

Your mother's experiences with surgery point to the necessity of finding the very best spine surgeon that is available to you...and if surgery is ever recommended, take the time to get several opinions.

One side note: anyone that has lower lumbar problems needs to be aware of the symptoms of "cauda equina syndrome." These include sudden loss of muscle, such as a drop foot that comes on suddenly, and the loss of bladder and/or bowel control. If any of this happens to you, call your doctor ASAP or go to the emergency room. Cauda equina issues are just about the only true medical emergency when it comes to the lumbar spine. The compressed nerve must be decompressed quickly or the risk of permanent damage is high. This does not happen often, but all of us with lower lumbar problems need to be aware of the symptoms just in case....

Good luck. Please let us know how you progress and what you learn when you do get in to see the specialist.

AndreaS84 10-01-2012 09:31 AM

Re: MRI advice
 
Well, I changed my PCP and saw a regular family practice physician Friday. I was so glad when she came in, listened to me, took one quick look at my MRI and agreed I needed HELP!

Just hearing that was such a relief, I've been haggling with my old PCP's office for two days, having to call them to remind them to d/l my MRI report so they could get my referrall started to the neurosurgeon for my "possible" herniated dics. When she said that I raged, it's not possible IT'S VERY REAL and if you had an inkling of how much pain this is then perhaps there would be some light lit under your butt.

So I called my insurance company this morning to get the referall straightened at the neurosurgeons office. It was so dissapointing to be turned away last week after their website said "no physician referral" necessary. On top of that one very rude front assistant came out and explained to me like some ignorant child "look if we don't get that we don't get paid", meanwhile I call my insurance company and they tell me that's not true. I have 60 days to get a proper referall anyway from my PCP. With the MRI I had and an old order for an orthopedic surgeon you'd think they would see me. I mean they verified my insurance. That assistant lied to me multiple times

I can't wait to go in Wednesday go in and proceed to make her time there a living hell. I even got so much rudeness from her on the phone just calling to see if they had put the referall in or gotten my e-mail of my MRI, her first reaction was "we don't normally give out our e-mail how did you get it" instead of just CHECKING the e-mail for my MRI.

update Wednesday.

AndreaS84 10-01-2012 09:33 AM

Re: MRI advice
 
[QUOTE=teteri66;5062976]You are correct. You do need some help. I am curious why your orthopedic doctor referred you to a neurosurgeon. Was he not an orthopedic spine surgeon? Orthopedic spine surgeons receive almost identical training as neurosurgeons when it comes to the spine. Sometimes they take a slightly different approach to the same problem and it is always helpful to get an opinion for each when one is contemplating surgery.

Regardless you do need to see a spine specialist/spine surgeon because you have some issues that need to be addressed.

The feeling of a strained hamstring is often the only sign a person gets when a lower lumbar disc is herniating. That was the case with my husband.

I will try to go through your MRI and point out the "highlights," trying to explain the terminology so when you see the spine specialist, you will be able to converse with him or her. ;)

First, the good news: the lower thoracic area looks good and there do not appear to be problems and the first two lumbar areas, L1-L2 and L2-L3.

At the next level, L3-L4 and again at L5-S1, the discs are extruding. When a disc bulges and goes beyond its disc space, and when some of the disc material breaks through the disc wall, it is considered extruding. The disc material has broken through the annular wall, which is the outer layer of the disc, but it is still attached. If it were to break free, it would be a disc sequestration.

This disc material is pushing out into the central canal and causing moderate compression. Also, in the associated foramen, there is also what should be open space that is being blocked by this extruding disc material. The foramen are openings through which the spinal nerves pass from the spine out into the body. These are the two main areas where nerves can become compressed. it is this compression that results in the radiating pain we feel that goes into our legs and feet or upper limbs if it is a cervical problem.

At L5-S1 the same thing is going on but the extrusion seems to be affecting the left foraminal opening more than the central canal...but it is causing stenosis in both areas. This material is noticeably pushing into both the S1 and L5 nerve roots. This is probably where the worst of your pain is coming from.

If you enjoy doing a little research, look online for a "dermatome map." This will give you an idea of which spinal nerves innervate which area of the body.

When a nerve is compressed, pain can be felt at the point of compression in the spine, or it can cause pain at any point along the pathway of the nerve. My stenosis caused horrid leg pain and numb feet, but I hardly had any back pain.

So basically the discs from L3 to S1 are showing signs of degenerative change, which is causing stenosis in the central canal and some of the foramen. At L5-S1 we know for sure that the spinal nerves are being "squished" as it is apparent on the imaging. Chances are, that the disc extrusion at L3-L4 is also causing issues that are contributing to your pain.

I would imagine the spine doctor will want to try conservative treatments first, such as a course of physical therapy, oral medications and a series of epidural steroid injections (ESI) to try to shrink up the disc extrusion and inflammation.

Your mother's experiences with surgery point to the necessity of finding the very best spine surgeon that is available to you...and if surgery is ever recommended, take the time to get several opinions.

One side note: anyone that has lower lumbar problems needs to be aware of the symptoms of "cauda equina syndrome." These include sudden loss of muscle, such as a drop foot that comes on suddenly, and the loss of bladder and/or bowel control. If any of this happens to you, call your doctor ASAP or go to the emergency room. Cauda equina issues are just about the only true medical emergency when it comes to the lumbar spine. The compressed nerve must be decompressed quickly or the risk of permanent damage is high. This does not happen often, but all of us with lower lumbar problems need to be aware of the symptoms just in case....

Good luck. Please let us know how you progress and what you learn when you do get in to see the specialist.[/QUOTE]

The original ortopedic doctor I went to was a sports doc, more just bone surgery, wrist etc, he has no specialization in spine. Although he did refer me to an orthopedic spine surgeon. I'll see this guy after I see the neurosurgeon.

AndreaS84 12-24-2012 01:36 PM

Re: MRI advice
 
Update time!
I found out I was pregers shortly after going to neurosurgeon.
I went through with a single level micro d last thur December 20th
They kept me over night I was up and moving like Frankenstein a few hours later. Although I only got up to pee!
The next afternoon I went home and rested. The next day and so far since I've had great daily improvement. I walked the block twice two days ago... And was soooo exhausted. I am now today not taking ANY hydrocodone or muscle relaxers!
Just a few muscle twitches here and there and sharp one second pain in left leg if I move a certain way. I've got a walk scheduled with my BF in thirt minutes and my baby is alive and kicking!
I'll update again at the end of four weeks. Hardest part is taking it easy

noevr 12-24-2012 02:19 PM

Re: MRI advice
 
hi congrats on the baby! I just wanted to add that the most important thing now is to take it easy. Even though you will feel better you must not do any lifting, twisting, bending, etc. until the dr says so. This is how people end up with failed back surgery syndrome and scar tissue. So PLEASE take it easy no matter what. Cathy


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