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    Old 07-02-2013, 08:22 AM   #1
    Paininohio
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    Finally had an MRI, here are results

    Well I finally got an MRI, I am also including the X-ray report from last year.

    X-RAY
    FINDINGS:

    Lumbar spine AP, lateral, and cone-down lateral lumbosacral spot films. There appears to be a transitional lumbosacral segment. There is articulation of the left transitional sacral segment, which occasionally can cause symptoms referred to as bertolotti syndrome. Clinical correlation would be useful. There is fairly advanced degenerative disc disease at the level taken as L3-L4 and L4-L5 with endplate sclerosis and osteophyte formation and moderate facet osteoarthropathy.


    IMPRESSION:

    Transitional lumbosacral segment is suggested with moderate to severe degenerative disc disease at the level taken as L3-L4 and L4-L5. There is a transitional left lumbosacral segment with articulation of the transitional segment and the sacrum which occasionally can be an etiology or source of pain, referred to as bertolotti syndrome.

    MRI
    FINDINGS:

    Lumbar vertebral body heights and alignment are normal. In the L1, L2, L3 vertebral bodies, there are rounded lesions that are high signal on T1 and T2-weighted sequences, likely hemangiomas. Conus medullaris at the L1 level is unremarkable.

    At the L2-L3 level there is mild degenerative changes and minimal disk bulge without spinal stenosis.

    At the L3-L5 and L5-L5, there is degenerative disk disease. There is a moderate degree of spinal stenosis secondary to disk bulge and facet and ligamentous hypertrophy. There is bilateral inferior foraminal narrowing.

    L5-S1, there is disk space narrowing without disk herniation or spinal stenosis or foraminal narrowing.

    IMPRESSION:

    Spinal stenosis at L3-L4 and L5-L5.

    The pain I experience, is mostly in my back, groin area, hips and thighs, and feet. But its not the electrical burning kind of pain, its more of a throbbing, heavy, tightness. In my back itself its stabbing pain that starts mid-back and goes all the way down to my tail bone.

     
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    Old 07-02-2013, 11:26 AM   #2
    teteri66
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    Re: Finally had an MRI, here are results

    Interesting. You have what I would consider a significant finding mentioned in the X-ray but not mentioned in the MRI. However, the reporter is not entirely sure and suggests that "clinical correlation would be useful." The finding is the following:

    [B]There appears to be a transitional lumbosacral segment. There is articulation of the left transitional sacral segment, which occasionally can cause symptoms referred to as bertolotti syndrome[/B]

    The transitional lumbosacral vertebra, referred to as LSTVs, are congenital spinal anomalies defined as either sacralization of the lowest lumbar segment or lumbarization of the most superior sacral segment of the spine. In layman's language this means you have an additional vertebra...it may be slightly attached to the L5 or S1 vertebra. In most cases it is not thought to cause pain, but when it does it is called "Bertolotti Syndrome" (named for the doctor who recognized what it was).

    The reason it is important to note is when the patient is having some sort of intrusive procedure on this part of the spine. If the doctor assumes there are 5 lumbar vertebrae, he could inject or operate on the wrong level if he wasn't aware of this finding.

    Now, it may be the the MRI showed enough more information that this was ruled out and you don't actually have it...or, conversely, it showed up better on x-ray and wasn't seen on MRI. In any case, this will be something to discuss with the spine specialist.

    Now for what is more likely causing your problems: an umbrella term--degenerative disc disease that is causing stenosis. DDD means that the discs are beginning to show some degenerative and arthritic-type changes...the type of thing that can come from living -- wear and tear. There's a little of this at L2-L3 but nothing to be concerned about.

    At L3-L4 and L4-L5 the DDD is more pronounced. [B]There is a moderate degree of spinal stenosis secondary to disk bulge and facet and ligamentous hypertrophy[/B] At both these levels, there are bulging discs and the facet joints and surrounding ligaments are showing signs of "hypertrophy" which means increasing in size or enlarging. What happens is when a disc begins to degenerate, the body responds by laying down more cells in an effort to stabilize the disc or spinal segment. This results in ligaments calcifying and in the growth of osteophytes, which are like bone spurs. What happens is that things are tightly packed into the area of the spine. When there are growths that don't belong there or a disc or facet enlarges, it takes up space that is needed by the spinal nerves to function normally. This results in a condition called stenosis.

    Stenosis is a Greek word that means "narrowing." There are two places where stenosis occurs in the spine: the central canal and the neural foramen.
    The foramen are openings at the end of each vertebral body that allows the nerve to pass from the spine out to the body. If there is anything occupying space in this opening, it takes room away from the nerve, which can result in nerve irritation or compression. It is this compression that causes the nerve sensations your feel in the leg. Depending on how badly the nerve is compressed you can just have odd sensation, pain, aching, electrical sensations, or tinging and finally, numbness, when the nerve is badly compressed. When the spinal nerve is compressed, you can feel pain at that level or anywhere along the path of the nerve. To see a diagram of which spinal nerves innervate which part of the body, look up a dermatome map on the net. This is how when you tell a doctor your big toe is numb, he knows to check to see what's going on with the L4 nerve. L5 innervates down the back of the thigh, wraps around to the lateral side of the calf and down the center of the foot to the three middle toes. It is often responsible for true sciatic pain. S1 innervates the little toe.

    You have stenosis, indicated as moderate, at both the L3-L4 and L4-L5 levels. This would explain the type of pain you are experiencing. If it were more severe, you would probably have a sharper kind of pain and tingling , perhaps some numbness.

    Hope this helps you understand some of the terms in your report. You can read up on lumbar spinal stenosis. There are many good articles online and if you find some with animations or diagrams it will be easier to understand what is going on, where the foramen are located, etc.

    Your doctor will most likely recommend some conservative methods of treatment like a course of physical therapy, perhaps some oral medications for pain and inflammation and possibly a series of epidural steroid injections.

    Last edited by teteri66; 07-02-2013 at 11:29 AM.

     
    Old 07-02-2013, 12:09 PM   #3
    Paininohio
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    Re: Finally had an MRI, here are results

    teteri66, thank you! I was hoping you would see my post 8-)

    One other thing is bothering me though, "In the L1, L2, L3 vertebral bodies, there are rounded lesions that are high signal on T1 and T2-weighted sequences, likely hemangiomas". I've done some research on this and it is said that they're usually benign and they usually don't cause pain. Also they say it usually only occurs in one vertebrae, but I have it in 3 vertebrae. They are so obvious, even I can see them on the MRI, also they didn't show up on the X-ray a year earlier. Personally I think they do hurt, because there is pain in that area on my back, above the levels with stenosis.

    I do see a pain management doctor, I have been with them for a year and a half. I was having what I though was just another flair-up but it wouldn't go away so my family doctor ordered the MRI. So I don't know what to think. I've been petrified of getting the ESI, but honestly the pain has been so bad lately that I just have to try it.

     
    Old 07-02-2013, 01:08 PM   #4
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    Re: Finally had an MRI, here are results

    A number of people on the board have had hemangiomas, and no one has had an issue with them, or continued problems, as far as I know. It may just be the way the cellular structure develops in the veertebra, that there are little pockets of vessels...I really don't know. I don't have them so haven't learned as much about them as other things that I have had!!

    If you can manage it, you might want to see either an orthopedic spine surgeon or a neurosurgeon to get an accurate diagnosis. Pain management doctors do not have specialized training in the diseases and mechanics of the spine. If there were subtleties on your MRI, it could be missed by a PM doc. And you could find out all the options for treatment, not just what a PM doc can do. I wasted over a year, in pain the whole time, because my doctor didn't notice a spondylolisthesis I had. He kept sending me for injections which did absolutely nothing for me...other that create an intense craving for sweets.

     
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