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    Old 11-02-2012, 06:25 PM   #1
    tdouglas
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    Please help me understand my MRI report

    I'm scheduled to see a doctor about this report next week, but I'd like to know what it means beforehand. Here is the info:

    FINDINGS:

    There is mild retrolisthesis of L4 on L5. There is disc desiccation, height loss, and an annular fissure at L4-L5.

    L1-L4: Everything is normal except that there is mild bilateral facet arthropathy in all of these discs.

    L4-L5: There is a disc bulge with superimposed central disc extrusion. There is mild bilateral facet arthropathy. There is no neural foraminal narrowing. There is severe central canal stenosis.

    IMPRESSION:
    Severe degenerative disc disease at L4-L5 with milder degenerative changes in the remainder of the lumbar spine as described in detail above.

    Degenerative disc disease is a pretty broad term, so I'm not exactly sure what's wrong or what I'm looking at in regards to treatment options. Any sort of help on any of these terms would be highly appreciated.

     
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    Old 11-02-2012, 10:32 PM   #2
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    Re: Please help me understand my MRI report

    Tdouglas:

    Welcome to the board.

    First, the report says degenerative changes. This is not uncommon. You didn't state your age in your post, but normally if you take any adult past the age of lets say 18 years of age, & do an MRI most likely they will find some "degenerative" changes with in the spine. It is a normal part of the aging process. You can have changes and most people wont be even symptomatic of this changes. So that isn't a major concern the way I would read your report.

    The changes are usually to the discs. The discs are at various levels in the neck; mid-back; low back in between each vertebrae, the bony substance. The disc is like a grape it is soft; acts a cushion; watery and over time it will lose its height and the fluid/water within each disc. And eventually they tend to protrude out from the area that they are located. The issue is whether it protrudes and causes any symptoms.

    I don't know if you are having any symptoms in your low back such as pain, or radiating pain down your leg while sitting; standing or walking.

    But what concerns me is that in your post is that there is "severe central canal stenosis."

    Stenosis of the spine can occur in 2 areas of the spine that I am aware of. First as in your case per the MRI it is central stenosis. Which means the following: Think of your spine like a straw. Down the center part of the straw are all the nerves stemming from the brain.

    There is then the "foramina" stenosis which means that each level in the spine there are exit spots from the spine. Like the exits in your neck, those nerves will deal with the nerves in your upper body, like your arms and hands and fingers. The lower exits in the lumbar/low back deal with nerves in the legs; feet; & toes. You stated NO foramina stenosis. So the stenosis is in the center of the spine. So the opening in the central canal is getting smaller or narrower. And this can put pressure on the nerves thus causing symptoms.

    The question is if the stenosis is enough to cause problems for you snd cause symptoms such as radiating pain; numbness; tingling in your legs.

    I dont know what yoru symptoms are as per the MRI report or your post.

    Hope this clarifies some information for you. Good luck with follow up appoitment.

    Maybe for you it may be a matter of some physical therapy or medication to help deal with your problem.

    If you need more information feel free to post again. Good luck.

     
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    Old 11-02-2012, 10:44 PM   #3
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    Re: Please help me understand my MRI report

    [QUOTE=pebblebeach3;5082825]Tdouglas:

    Welcome to the board.

    First, the report says degenerative changes. This is not uncommon. You didn't state your age in your post, but normally if you take any adult past the age of lets say 18 years of age, & do an MRI most likely they will find some "degenerative" changes with in the spine. It is a normal part of the aging process. You can have changes and most people wont be even symptomatic of this changes. So that isn't a major concern the way I would read your report.

    The changes are usually to the discs. The discs are at various levels in the neck; mid-back; low back in between each vertebrae, the bony substance. The disc is like a grape it is soft; acts a cushion; watery and over time it will lose its height and the fluid/water within each disc. And eventually they tend to protrude out from the area that they are located. The issue is whether it protrudes and causes any symptoms.

    I don't know if you are having any symptoms in your low back such as pain, or radiating pain down your leg while sitting; standing or walking.

    But what concerns me is that in your post is that there is "severe central canal stenosis."

    Stenosis of the spine can occur in 2 areas of the spine that I am aware of. First as in your case per the MRI it is central stenosis. Which means the following: Think of your spine like a straw. Down the center part of the straw are all the nerves stemming from the brain.

    There is then the "foramina" stenosis which means that each level in the spine there are exit spots from the spine. Like the exits in your neck, those nerves will deal with the nerves in your upper body, like your arms and hands and fingers. The lower exits in the lumbar/low back deal with nerves in the legs; feet; & toes. You stated NO foramina stenosis. So the stenosis is in the center of the spine. So the opening in the central canal is getting smaller or narrower. And this can put pressure on the nerves thus causing symptoms.

    The question is if the stenosis is enough to cause problems for you snd cause symptoms such as radiating pain; numbness; tingling in your legs.

    I dont know what yoru symptoms are as per the MRI report or your post.

    Hope this clarifies some information for you. Good luck with follow up appoitment.

    Maybe for you it may be a matter of some physical therapy or medication to help deal with your problem.

    If you need more information feel free to post again. Good luck.[/QUOTE]

    First of all, thanks for the response. I appreciate it.

    I first injured my back over a year ago when I was 21 by attempting to lift something I shouldn't have, so the degeneration isn't age-related. I have some pretty bad lower back pain and stiffness. It's a constant pain that only gets relieved when I lay down, and even that relief is starting to go away. Whenever I lift my right leg or move it around at all (as in walking, etc), there is pain in my back, but I'm not sure if it's sciatica or not. It's hard for me to tell.

    I've been told to do stretches and exercises for months, but I haven't felt any relief from those things.

    So in regards to the severe central canal stenosis and the severe degeneration disc disease, what should I be worried about? What kind of route would you expect a spine doctor to take with this? I'm not confident that physical therapy will do much, since I've been stretching and doing extensive back exercises for months with no positive effects.

    Again, I really appreciate any help you can give. The word "severe" is not sitting well with me...

    P.S.: I forgot to ask about the retrolisthesis. I've tried researching the term, but I can't find much about it. Do you know what that means?

    Last edited by tdouglas; 11-02-2012 at 10:47 PM.

     
    Old 11-03-2012, 03:21 AM   #4
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    Re: Please help me understand my MRI report

    Hi. You stated that you seemed to get relief from your pain when you are lying down - bed rest. That I can understand & makes sense to me. I find that bed rest gives me relief as well.

    Just to step back for a moment, a little about my spine issues:

    - I am 59 and have had spine issues since I was 35;
    - 1994 lumbar spine surgery; herniated disc;
    - 1995 cervical spine surgery; stenosis;
    - 1997 lumbar surgery; Harrington Rods implanted;
    - 2000 cervical surgery for kyphosis, couldnt keep neck in proper alignment; harrington rods implanted

    - There were two other surgeries. To help me with pain management I had an implant done called Spinal Cord Stimulator to control pain. It was eventually removed since it was not helping.

    - I still have ongoing problems with my neck & low back. There is concern if more neck surgery should be done or not, but it is risky for a number of reasons.
    - I am in constant pain and have been on different pain medications. Hydrocodone for 1 is the most recent.
    - But I need something that is more effective. I am having a different type of implant done in my back.Different from the Spinal cord stimulator. I am going thru a Trial test to have a Intrathecal Pump implanted which is basically a Morphine pain medication that will be delivered directly into the spine as compared to oral medications.

    Now back to your issues.
    It could be sciatica but not 100% sure that it is. I have sciatica in my low back but the feeling while it is pain I get a "radiating feeling" down the back part of my leg.

    Here are the symptoms of sciata that I looked up:

    Common symptoms of sciatica include:

    Pain in the rear or leg that is worse when sitting
    Burning or tingling down the leg
    Weakness, numbness, or difficulty moving the leg or foot
    A constant pain on one side of the rear
    A shooting pain that makes it difficult to stand up

    I am not sure if sciatica would occur as part of the aging process and be considered degenerative in nature. It could be related to the incident when you lifted something. But not 100% sure either.

    You said you were told to do stretching exercises. Are you doing this on your own? Or are you going thru physical therapy? If you are doing it on your own what concerns me is if you are 1. doing the right exercises for the problem & 2. if you are doing it correctly. If you are not in physical therapy I think you should consider it so that you are given the right exercises to do and what not to do also. One note I never went to a chiropractor and question what they do in practice so that is why I am hesitant about whether you should consider it or not. Its your decision on that method.

    the way I am reading the report I am not sure that the degenerative issues are the problem or not. A doctor could tell you more as to the impact that it is having on you and if is causing your symptoms.
    The stenosis concerns me, BUT it depends on the degree of stenosis.That I don't know. Again the doctor could read the MRI films as to whether it is significant enough to be causing your symptoms. But it should be discussed with your doctor.

    Retrololithesis is as follows: as per *********
    There is more to article in wikidpedia but posted the first section.

    A retrolisthesis is a posterior displacement of one vertebral body with respect to the adjacent vertebrae to a degree less than a luxation (dislocation). Clinically speaking, retrolisthesis is the opposite of spondylolisthesis (anterior displacement of one vertebral body on the subjacent vertebral body). In the past this clinical pathology was also called a "retrospondylolisthesis". (2) Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality.

    Retrolistheses are found most prominently in the cervical spine and lumbar region but can also be seen in the thoracic area.

    ******So there is a displacement of the vertebrae that does or is moving towards the back as compared to something that is moving forward or to the front. You can google the term retrolilthesis for more information from *********. There should be other sources as well for more information.

    I am thinking and its just a thought that part of your isses are related to your lifting something incorrectly. That may have had some impact on you. Could degeneration be the issue? Maybe but Im not sure that that is the answer.

    I do think you need professional physical therapy and possible anti inflammatory medications and meds to deal with the pain issue.

    One thing to keep in mind for future reference. As I told you I have been thru tons of surgeries. Surgeries in my opinion should only be done when all other viable options have been exhausted.

    Spine surgery is risky. Dont let any one tell you ever that a surgery whether it is spine or something else that a surgery is routine. There are risks with all surgeries. Any surgery whether routine or not can be damaging.

    On treatment for the spine one thing to note, whoever you see he/she should be trained in spine issues and that treatment of spine issues should be part of their daily practice.
    They should be board certified in Orthopedics or Neurosurgery. Don't rely in your primary care doctor treat you for your spine. There is a reason that we have specialists.
    I tend to prefer a doctor at a major teaching hospital if possilbe. But part of that is because my case is on the complex side and I get better expertise and knowledge from doctors that are used to complex cases.

    Not sure that I addressed everything for you.
    If you think of anything that needs to be clarified or think of additional questions, please ask.

    If I dont respond it is because I am in the process of getting set up for the morphine pump implant and have appointments before they do it and I am expected to be admitted for 5 days to the hospital for whne it is done. I am waiting for the final paperwork, precert from the insurance company and the date that I am going in.

    good luck to you.

     
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    Old 11-03-2012, 07:47 PM   #5
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    Re: Please help me understand my MRI report

    Thank you for your very long, detailed response. I'm very appreciative of you taking some time to type all of this up. Also, I'm sad to hear you had to go through all of those surgeries and are still in pain.

    First, about the stretching/exercises: They were prescribed to me by my primary care physician because she was convinced I was simply dealing with tight muscles. She gave me a list of things to do and I did them for months. I knew it wasn't simply a tight muscle, but I did the stretching/exercises to see if they would help. Of course, they didn't, and in the case of some hip pain I was having, they made the hip problems worse.

    I'm expecting my next doctor to recommend physical therapy, which I'll do, but I'm not confident it will help my pain. I visited two different chiropractors in the past, but I wasn't happy with what they wanted to do to my back.

    I'm also quite worried about the stenosis. The report says that the stenosis is severe, which is never a good sign. The MRI images show that the herniated disc is almost completely pinching the spinal fluid off. I'm not sure what happens if the disc does completely pinch it off, but I'm guessing it's not good.

    I've tried ibuprofen and a host of neurological pain medicine prescribed by my primary care physician, but nothing has helped. I've been able to "handle" the pain for the most part, but over the past week or so, I've been in astronomical pain. I was recently referred to a pain manager at a pretty good hospital, so hopefully I can get some relief from them.

    I will take your advice on surgery and on doctor choice to heart. Again, I really appreciate your time and advice. You don't have to respond again if you don't want to, as you've given me a ton of information already. But I'm willing to listen to any other advice you can give.

    I wish you luck in finding some pain relief.

     
    Old 11-04-2012, 02:49 AM   #6
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    Re: Please help me understand my MRI report

    Tdouglas:

    One thing concerns me "somewhat." You said your doctor prescribed stretching exercises by your primary care doctor when it was thought you had tight muscles.
    This sort of bothers me on the one hand & I will try to clarify what and why.
    There are specialties for a reason & if there was a concern about "back issues" then you should have been referred to a "specialist" to decide what exercises to do or not to do. It is not for the primary care doctor to treat spine related issues which includes musles etc. Nothing against your primary doctor I'm sure you see her because you are happy with her.

    BUT I also understand that it may have been felt that and I understand that you don't always need to be seen by a specialist automatically just because a symptom appears.

    It sometimes is a grey area and a judgement call as to when a specialist needs to be involved in treatment

    I've seen posts where primary care doctors will go to extremes to treat someone for spine issues for LONG period of times when it is out of their leagues and knowledge.

    So please understand where I was coming from when I expressed my concern as to a primary care doctor recommending treatment.

    Please keep us posted on how you are doing. thanks for listening to me and I know I gave a lot of information but I bothers me seeing someone in pain and someone that needs help. Thats why I joined the board. Good luck

     
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    Old 11-05-2012, 02:35 PM   #7
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    Re: Please help me understand my MRI report

    I agree with you that my primary care doctor probably shouldn't have given me those exercises to do, and I WAS suspicious of them, but I didn't have any other choice. I was desperate for some relief. But here's the kicker: she actually DID send me to a orthopedist. But he said to do the same stretches and didn't even recommend an MRI, even when I asked for one! I'm certainly not happy with the doctors I've seen, but because I'm a very low-income person, I have had to go to a low-income clinic. There wasn't much I could do in "choosing" my doctor.

    Since you've had a lot of back and spine issues in the past, I'd like for you to look at some MRI pics and give me your take, if you don't mind:

    http://**********.us/a/img820/8459/mri3.jpg
    http://**********.us/a/img641/4807/mri2f.jpg
    http://**********.us/a/img202/1289/mri1p.jpg

     
    Old 11-06-2012, 07:19 AM   #8
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    Re: Please help me understand my MRI report

    Tdouglas:

    I had trouble accessing the photos of the MRI. I am not sure if I would have been able to comment on the actual films. I can usually interpret and understand the report as read by the radiologist.

    You said you did see an orthopedist but all he said was do the exercises your primary doctor told you.
    Who ordered the MRI then?

    I understand your situation in getting the best of care from your doctors. Are there any other doctors that you can turn to? Or are you restricted and stuck with the ones you are seeing now?

    From the way you describe it at least I agree you arent getting the attention that you need.

    If you cant change then you may have take a strong position on getting things done or an explanation as to why more isnt being done for you based on the MRI findings..........

     
    Old 11-06-2012, 08:22 AM   #9
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    Re: Please help me understand my MRI report

    One thing I didn't learn until well after my first lumbar surgery was there is a big difference in physical therapists. I think we have all been given a standard sheet of exercises to do for back pain. Usually they are stick figures with minimal instruction, but they look simple to do.

    I started out like most people: I went to my family doctor/PCP with my complaint of sciatic pain. I went back several times before he took my complaints even slightly seriously. He sent me for a course of physical therapy where I was given the sheets of exercises....at some point I convinced him to do more so he ordered a MRI. He looked at it and told me that my MRI was perfectly normal for someone my age. My sciatic pain was unchanged and he finally got tired of hearing me complain, so he sent me to a spine specialist who he termed "conservative" (meaning he never did surgery unless it was absolutely necessary).

    Imagine my shock when after about two minutes with the orthopedic spine surgeon, he told me I needed a spinal fusion. I went from thinking everything was fine to being told I needed a fusion...which at the time sounded like the most extreme thing imaginable. My issue was the spondylolisthesis that I had at L4-L5....the doctor told me it wasn't anything I needed to have fixed, but if it started causing problems, the only procedure that would fix it was a fusion.

    Pebble gave you a definition...but in simple terms, retrolisthesis just describes the description that the vertebra is slipping (anterior or posterior)--the overall disease condition is called spondylolisthesis and it is a situation where one vertebra slips over the top of the adjacent vertebra. It occurs most frequently at L4-L5, followed by L5-S1. There are several causes for it which I won't go into here, but I will mention that it can arise in young people who spent a lot of their teens doing activities that require the spine to be in extension -- things like diving, gymnastics, dance, or in a contact sport like football and sometimes soccer.

    Your retrolisthesis is described as mild, which would translate to a Grade 1
    (graded from 1-4). In radiology language there are specific adjectives that are used to describe the severity of an issue: minimal, mild, moderate and severe. So, in your case, this is probably not causing you much of a problem and probably is not contributing to your pain.

    The thing is...depending on what exercises you were given, it could be making your pain worse. If anything is done with your back bending backward (in extension) it is BAD for your retrolisthesis. You should avoid doing anything that requires you to arch your spine -- this includes swimming on your stomach, lying or sleeping on your stomach, etc.

    The stenosis is not affecting the spinal fluid. It may be pressing into the central canal, but it doesn't affect any fluid. The danger comes from the nerve becoming so compressed that it cannot function normally. If you develop weakness in a muscle, like foot drop, or numbness, it is a sign that the nerve is badly compressed.

    This pressing into the central canal is what is causing you to feel pain when standing or sitting, and relief when you lie down. Once it is decompressed, most people get almost instant relief. Of course the nerve may be somewhat damaged, so it can take awhile for all the pain to go away.

     
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    Old 11-06-2012, 03:52 PM   #10
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    Re: Please help me understand my MRI report

    [QUOTE=pebblebeach3;5084436]Tdouglas:

    I had trouble accessing the photos of the MRI. I am not sure if I would have been able to comment on the actual films. I can usually interpret and understand the report as read by the radiologist.

    You said you did see an orthopedist but all he said was do the exercises your primary doctor told you.
    Who ordered the MRI then?

    I understand your situation in getting the best of care from your doctors. Are there any other doctors that you can turn to? Or are you restricted and stuck with the ones you are seeing now?

    From the way you describe it at least I agree you arent getting the attention that you need.

    If you cant change then you may have take a strong position on getting things done or an explanation as to why more isnt being done for you based on the MRI findings..........[/QUOTE]

    My primary care doctor finally ordered the MRI after almost a year of me begging/asking for it. Once she saw the MRI report, she immediately referred me to a pain manager at a local hospital. I recently got approved for 100% coverage at this hospital, so I'm hoping to see some more qualified doctors.

    At this point, I'm calling every day and talking for hours with various people at the hospital, trying to make appointments and trying to talk to doctors about my back issues. I'm going to see a different primary care physician on Thursday, so maybe he can help direct me to the fastest path to recovery.

    The biggest problem I have now is not knowing what my MRI report means. I mean, I've done all the research I can do, and you certainly have been a great help, but I don't know what kind of bad news the doctor will give me. Will I need immediate surgery? How close am I to having permanent damage, if I don't already have some? I'm just scared, I guess.

     
    Old 11-06-2012, 04:11 PM   #11
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    Re: Please help me understand my MRI report

    [QUOTE=teteri66;5084464]One thing I didn't learn until well after my first lumbar surgery was there is a big difference in physical therapists. I think we have all been given a standard sheet of exercises to do for back pain. Usually they are stick figures with minimal instruction, but they look simple to do.

    I started out like most people: I went to my family doctor/PCP with my complaint of sciatic pain. I went back several times before he took my complaints even slightly seriously. He sent me for a course of physical therapy where I was given the sheets of exercises....at some point I convinced him to do more so he ordered a MRI. He looked at it and told me that my MRI was perfectly normal for someone my age. My sciatic pain was unchanged and he finally got tired of hearing me complain, so he sent me to a spine specialist who he termed "conservative" (meaning he never did surgery unless it was absolutely necessary).

    Imagine my shock when after about two minutes with the orthopedic spine surgeon, he told me I needed a spinal fusion. I went from thinking everything was fine to being told I needed a fusion...which at the time sounded like the most extreme thing imaginable. My issue was the spondylolisthesis that I had at L4-L5....the doctor told me it wasn't anything I needed to have fixed, but if it started causing problems, the only procedure that would fix it was a fusion.

    Pebble gave you a definition...but in simple terms, retrolisthesis just describes the description that the vertebra is slipping (anterior or posterior)--the overall disease condition is called spondylolisthesis and it is a situation where one vertebra slips over the top of the adjacent vertebra. It occurs most frequently at L4-L5, followed by L5-S1. There are several causes for it which I won't go into here, but I will mention that it can arise in young people who spent a lot of their teens doing activities that require the spine to be in extension -- things like diving, gymnastics, dance, or in a contact sport like football and sometimes soccer.

    Your retrolisthesis is described as mild, which would translate to a Grade 1
    (graded from 1-4). In radiology language there are specific adjectives that are used to describe the severity of an issue: minimal, mild, moderate and severe. So, in your case, this is probably not causing you much of a problem and probably is not contributing to your pain.

    The thing is...depending on what exercises you were given, it could be making your pain worse. If anything is done with your back bending backward (in extension) it is BAD for your retrolisthesis. You should avoid doing anything that requires you to arch your spine -- this includes swimming on your stomach, lying or sleeping on your stomach, etc.

    The stenosis is not affecting the spinal fluid. It may be pressing into the central canal, but it doesn't affect any fluid. The danger comes from the nerve becoming so compressed that it cannot function normally. If you develop weakness in a muscle, like foot drop, or numbness, it is a sign that the nerve is badly compressed.

    This pressing into the central canal is what is causing you to feel pain when standing or sitting, and relief when you lie down. Once it is decompressed, most people get almost instant relief. Of course the nerve may be somewhat damaged, so it can take awhile for all the pain to go away.[/QUOTE]

    Thanks a ton for your response. Your situation sounds exactly like mine: a primary care physician who wouldn't believe my pain was anything more than some muscle tightness. Your situation with your spine doctor is what I fear: being told I need immediate surgery. Like I said before, I can do nothing but hope that I don't have severe, permanent damage because my primary care doctor wouldn't listen to my requests for an MRI.

    So in regards to exercise and stretching, do you think I should just take it easy and not do anything strenuous? I know that seems like a dumb question, but I was wondering what you did in your situation.

    I'm glad to hear that my mild retrolisthesis isn't THAT big of a deal. Now I can focus on the herniated disc, severe spinal stenosis, and mild facet arthropathy (which I still don't know much about). It sucks having a TON of questions that I can't get answered for an indeterminate amount of time.

    Would you have any thoughts on my MRI pics? I know it's a long shot, but I'm just trying to gather as much info as possible.

     
    Old 11-26-2012, 09:45 AM   #12
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    Re: Please help me understand my MRI report

    Here's an update:

    I saw a neurosurgeon today. He recommended a few weeks of physical therapy and a steroid injection. He said that if I wasn't feeling better after those few weeks, he would recommend surgery. It didn't sound like he was optimistic about me finding relief outside of surgery.

    Unfortunately, my insurance doesn't cover physical therapy, so I'm trying to figure out what to do about that.

     
    Old 11-29-2012, 09:37 AM   #13
    Pure Adrenaline
    Newbie
    (male)
     
    Join Date: Jun 2012
    Location: Phenix City, Alabama
    Posts: 6
    Pure Adrenaline HB User
    Re: Please help me understand my MRI report

    TDouglas,
    I don't mean to be pessimistic but from my experience everyone has changes in their bone and discs. An MRI helps to pinpoint any abnormalities which may relate to your pain. If I were you I would definitely study the anatomy of your back bones, discs and nerves as they relate to the pain or discomfort you are having. If you find that the problems noted on the report do not align with your pressure points or pain locations be very careful about having surgery to correct it. Second opinions almost always result in the second doctor agreeing with the first but if the pain isn't there be aware. I have had two semi-unsuccesful surgeries now in my lower back. Be very careful if a doctor says 'referred pain' as in this bad disc at "x" level is causing pain at "y" level. You should know better what you are feeling so put a lot of trust in that. Referred pain can and does happen but is more likely when a nerve is involved. If he can't explain which nerve(s) is causing the pain to be somewhere else be careful. I'm sure you know there is a very high percentage of unsuccesful back surgeries. Good luck and take anything I say with a grain of salt because I am not a doctor or do I pretend to be one.

    Last edited by Pure Adrenaline; 11-29-2012 at 09:42 AM.

     
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